Incisional Hernia

Question 1

Definition of incisional hernia

Answer 1

Extrusion of peritoneum and abdominal contents through a weak scar or accidental wound on the abdominal wall. Has an orifice and peritoneum sac

Question 2

What are the principles of surgical incision in general

Answer 2

1. Accessible
2. Avoid important structures
3. Cosmetic reasons along langer’s lines
4. Preference
5. Extendability

Question 3

What are the risk factors of incisional hernia

Answer 3

Patient factors

1. Age
2. Malnutrition
3. Chronic disease
4. Steroids
5. DM
6. Obesity
7. Abdominal pressure increased by cough, uropathy or constipation
8. Connective tissue abnormalities

Surgical factors

1. Suture material
2. Technique

Disease factors

1. Infection
2. Wound breakdown
3. Postop complications requiring reoperation

Question 4

What is the clinical presentation of umbilical hernia

Answer 4

Hx:
Previous surgical intervention, postop complications, pain, reducibilty and comorbids

Scars are incision hernias until proven otherwise, so check cough impulse

Physical examination - same as abdo PE and hernia PE

Question 5

What are the types of defects in incisional hernia?

Answer 5

Small <2cm
Large >2cm
Multiple (swiss cheese)
Very large defect

Question 6

What are the complications of incisional hernia?

Answer 6

IO
Incarceration
Strangulation
Excoriation
Persistent pain

Question 7

Dx for umbilical hernia?

Answer 7

Diastasis recti - seperation of rectus abdominis by abnormal distance - no treatment required as no risk of strangulation

Question 8

What is the management of umbilical hernia?

Answer 8

Surgical repair indicated.

Pre op:

1. Weight loss/nutrition optimization
2. Treat chronic conditions which increase intra abdominal pressure

Surgical repair
1. Primary repair with mesh repair is the gold standard via a sublay mesh

Question 9

What are the complications of umbilical hernia surgery?

Answer 9

1. Infection
2. Seroma formation
3. Recurrence
4. Wound sinus/enterocutaneous fistula