What is an incisional hernia?
Incisional hernias can occur after any type of abdominal operation. The hernia or weakness in the abdominal wall covering occurs through an area where the previous operation has occurred, and the surgeon has sutured the muscle layers together. Incisional hernias can occur in up to 20% of patients who have had previous operations in the abdomen.
What causes incisional hernias?
If the hernia occurs within a few days of an operation, then it may well be that the stitches that the surgeon placed have pulled through the tissue and become loose. Alternatively, if an infection develops after an operation it is more likely that an incisional hernia will occur quite soon after surgery. In the longer term a hernia may develop at the site of a previous operation in a patient who has increased intra-abdominal pressure. This would include patients who are centrally obese, have had many pregnancies, are involved in lifting heavy weights, either through the gym or at work, and those that have a chronic cough or chronic constipation.
Do they need to be repaired?
The decision on whether to repair an incisional hernia is based on how big the hernia is, whether it is causing any symptoms such as pain, and whether there is any long term risk of bowel strangulation within the hernia. If a hernia is small and asymptomatic with no long term risk, then a decision can be made to watch and wait to see if it becomes larger or more symptomatic. Clearly if a hernia is causing pain or there is a risk of strangulation of bowel, then it requires surgical repair.
How are incisional hernias repaired?
An incisional can be repaired via a simple open operation, a laparoscopic operation or a combined laparoscopic and open operation.
How long will I be in hospital?
If the hernia is small then hospital stay will probably be only one night. For larger hernia repairs hospital stay may be several nights.
How will I feel after the repair?
There will be some pain and discomfort in the area of the operation but this should be well controlled with painkillers. This bruising sensation will decrease within a few days to a week of surgery. Depending on the size of the hernia, painkillers would need to be taken for one or two weeks.
Are there any risks to surgery?
This procedure has a very low risk. There may be a small chance of bruising or a low grade infection in the wound following an open operation. With a laparoscopic procedure there are very low risks of bleeding, damage to the bowel or adhesion formation. The risk of recurrence of the hernia after operation is low but the chance of recurrence would be increased in patients who have increased intra-abdominal pressures, such as those with central obesity or after further pregnancy.
How long do I need to take off work?
For small incisional hernias you can resume work within a few days of surgery. However large hernias requiring more complex surgery you may need to take two weeks off work.
When can I resume exercise?
I would encourage exercise within days of surgery, increasing activity around the house and walking distance. Aerobic exercise in the form of jogging, cycling or swimming can be started within a week of surgery. Any heavy lifting of weights or suitcases should be avoided for six weeks after surgery until the scar tissue in the hernia repair has become strong enough to prevent the hernia recurring.