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Hernias arising from previous surgical incisions are called surgical site hernia or incisional hernia. The incidence after open abdominal surgery is quite high, at 15-20%. These hernias enlarge over time and can be more difficult to repair. They cause cosmetic issues and pain. From time to time, they can get stuck and cause other problems. They may require emergency surgery due to the strangulation of the organs entering the hernia, albeit a little.
Who gets incisional hernia?
Anyone who has undergone abdominal surgery has this risk. However, this risk increases under certain conditions:
How is an incisional hernia determined?
An incisional hernia usually presents as a bulging out of the old surgical incision site. It may be accompanied by mild pain. In some cases, it may occur with pain due to compression of the organ without swelling, especially in small hernias.
How is an incisional hernia diagnosed?
The diagnosis is usually made by the surgeon's physical examination. Ultrasound and computed tomography (CT) may be required for diagnosis.
It is recommended to evaluate with CT before surgery in large hernias. Beyond diagnosis, it can detect other hernias that may exist, determining the size of the damaged area (which is very important in choosing the surgical technique), and learning which organs are in the hernia sac.
How is the treatment of incisional hernia?
Undoubtedly, the repair is done surgically. Open, laparoscopic or robotic methodscan be used. Of course, these different techniques have advantages over each other. However, scientific studies show no difference between the methods in terms of hernia not recurring, which is the primary goal of hernia surgeries. On the other hand, the cost of laparoscopic and especially robotic repairs is quite high.
Repairs of incisional hernias require experience. They are more prone to recurrence than inguinal hernias. These patients should have a good preparation period before surgery. Smoking should be stopped if possible, and if there are signs of infection in the area to be operated, it should be treated without surgery.
Hernia repairs should be done without creating tension in the tissues. To achieve this, a synthetic patch must be used. One of the biggest causes of recurrence is insufficient patch size. Therefore, appropriate patches should be used in the appropriate size.
Open repairs can be made in various layers of the abdominal wall. There are techniques such as anterior muscle repair and patching, posterior muscle repair, open intra-abdominal patching. If the hernia hole is very large, anatomy and physiology may need to be corrected with a technique called layering. In posterior muscle repairs, surgery site problems such as infection and seroma are less common.
It is also possible to perform these operations with laparoscopic and robotic techniques. However, the cost factor must be taken into account.
Since incisional hernias grow over time, their early repair both reduces the risk of recurrence and prevents the need for an operation with complex techniques. In large hernias, the patient's quality of life deteriorates, and movement becomes difficult. Respiratory quality deteriorates. In such cases, the abdominal wall anatomy should be tried to be restored when planning hernia repair. Reconstruction of the abdominal wall should be achieved, as the rectus muscles in the midline are usually sideways. In patients with this type of repair, it has been shown that recurrence is reduced, pain is relieved, respiratory quality is improved, and a significant improvement is achieved in trunk movements.
How long does it take to heal after incisional hernia repair?
Usually, after a simple incisional hernia surgery, you stay in the hospital overnight and are discharged home the next morning. However, in large and complicated cases, this period may take 3-5 days. You will be informed of this before surgery. There may be pain after surgery that can usually be controlled with painkillers. You will be given medicines for this. Patients should not lift heavy objects after surgery and should wait at least 3 months for regular exercise and sports activities.
There will be no dietary restrictions after the surgery.
What are the risks of incisional hernia repair?
In the evaluation before incisional hernia surgery, you will be informed about possible complications. In this evaluation, different information may be available depending on the chosen surgical method, your general condition, whether you have any additional illnesses, and the size of your hernia.
Whether open or laparoscopic, there is a risk of bleeding in the repaired layers of the abdominal wall. Color changes can be seen in the form of small bruises due to skin and subcutaneous leaks. This disappears on average in 2 weeks.
In some patients, especially those with large hernias, fluid deposits, which we call seroma, may be seen in this region after surgery. It usually occurs in the early postoperative period. This liquid is harmless and is absorbed by the body in an average of 6-8 weeks.
Another complication is wound infection, which is an important problem in incisional hernias. By following closely, appropriate antibiotic therapy and surgical drainage should be performed when necessary. Long-term antibiotics may be required.
Intra-abdominal organ injury may rarely occur during laparoscopic repair. The important thing is to realize this during the surgery. Intestinal injury most commonly occurs and is repaired laparoscopically. However, in this case, it is recommended to postpone hernia repair as the risk of infection of the patch will increase.
The most important late complication is undoubtedly the recurrence of hernia. This rate is between 5-30% according to scientific studies. The reasons for the recurrence should be well known and the most appropriate surgical technique should be selected for the patient. The most important principle to reduce recurrences is to perform hernia repair with an appropriate synthetic patch. The patch should be selected according to the size of the hernia hole.
