Incisional hernia

Incisional Hernia

Diagram of an incisional hernia

An incisional hernia, also known as a laparocele, is a type of hernia that occurs at the site of a previous surgical incision. It is a common complication following abdominal surgery and can occur months or even years after the initial operation.

Pathophysiology

An incisional hernia develops when the fascia and muscle layers of the abdominal wall fail to heal properly after surgery. This failure can lead to a weakness or defect in the abdominal wall, allowing internal tissues or organs to protrude through the weakened area. Factors that contribute to the development of an incisional hernia include poor surgical technique, infection, increased intra-abdominal pressure, and patient-related factors such as obesity and smoking.

Clinical Presentation

Patients with an incisional hernia may present with a visible bulge at the site of a previous surgical scar. The bulge may increase in size when the patient stands, coughs, or strains. Symptoms can include discomfort, pain, or a dragging sensation at the site of the hernia. In some cases, the hernia may become incarcerated or strangulated, leading to severe pain and requiring urgent medical attention.

Diagnosis

The diagnosis of an incisional hernia is primarily clinical, based on the patient's history and physical examination. Imaging studies such as ultrasound or CT scan may be used to confirm the diagnosis and assess the size and contents of the hernia.

Treatment

The primary treatment for an incisional hernia is surgical repair. The choice of surgical technique depends on the size and location of the hernia, as well as the patient's overall health. Options include open repair, where the hernia is closed with sutures or a mesh is placed to reinforce the abdominal wall, and laparoscopic repair, which is minimally invasive and involves smaller incisions.

Prevention

Preventive measures to reduce the risk of incisional hernia include optimizing the patient's nutritional status, controlling diabetes, encouraging smoking cessation, and using proper surgical techniques. Postoperative care, such as avoiding heavy lifting and managing cough or constipation, can also help prevent hernia formation.

Related Pages

• Hernia
• Abdominal surgery
• Laparoscopic surgery