Incisional Hernia

Question 1

Risk factors

Answer 1

Emergency surgery

Wound type

BMI >25

Midline incision

Wound infection

Pre-op chemo

Intra-op blood transfusion

Advancing age

Pregnancy

Question 2

Clinical features

Answer 2

Non-pulsatile, reducible, soft and non-tender swelling near or at the site of a previous surgical wound.

If incarcerated -> painful, tender and erythematous

Can cause bowel obstruction.

Question 3

Dx

Answer 3

Abdominal lumps like lipoma

Question 4

Investigations

Answer 4

Usually clinical diagnosis

No lab tests or imaging should be required

USS or CT can be used if unclear diagnosis.

Question 5

When is surgery indicated?

Answer 5

Size of hernia

Clinical features

Patient’s age and co-morb

Patient’s preference

Question 6

Surgical repair

Answer 6

Suture repair for small ones

Laparoscopic mesh repair and open mesh repair

Question 7

Complications of incisional hernia repair

Answer 7

Pain

Bowel injury

Seroma formation