Incisional Hernia: Treatment, Surgery, Recovery Period, Risk Factors
Any type of abdominal surgery creates a weak area in the abdominal wall which can be exploited by the muscles to cause incisional hernia. Such cases are very rare. About 2-10% of the cases of abdominal surgeries have the risk of developing incisional hernia. However, incisional hernia may also revert in a very few cases.
In this section of the article you will learn about the treatment for incisional hernia, surgery, surgery complications, recovery period/healing time, risk factors for incisional hernia.
Treatment for Incisional Hernia
The treatment for incisional hernia depends on multiple factors. Normally after the surgery, wound is vulnerable to infection and the tissues are weak as they are in the process of recovery. If there is any complication during this phase, the internal tissues can easily push this weak muscular wall and result in incisional hernia. In worst case, the intestines may get entangled and be deprived of blood flow which results into strangulated hernia. This situation can be fatal for both the tissue as well as the individual. Although most of the cases of incisional hernia results out of the abdominal surgeries but it may also occur in other parts of the body after surgery.
Surgical methods may be used as treatment for all cases of incisional hernia but it is necessary only for the treatment of large incisional hernia. Small cases of incisional hernia can be treated with the help of truss. Truss is a type of garment which is used just like the weight belts to press against the tissue tightly and check the growth of incisional hernia.
When is Incisional Hernia Surgery Necessary?
Surgery is the preferred option for treatment of incisional hernia on in the following cases:
- Surgery for incisional hernia is required if the incisional hernia continues to get worse with the time.
- Surgery is recommended when the incisional hernia grows to a substantial size.
- The incisional hernia becomes painful.
- If the incisional hernia is cosmetically unattractive.
- The incisional hernia bulge stays forever even when the body is in a relaxed position.
When is Incisional Hernia an Emergency?
There comes a situation in incisional hernia where the bulge can get permanent in what is referred as stuck in "out" position. This is called as incarcerated hernia. Still it is not an emergency but needs attention as it can get worse very quickly and can call for emergency. However, the next stage of incarcerated hernia is an emergency situation and must be immediately taken care of. It is called as strangulated hernia and arises when the entangled intestines get deprived of blood supply and can be life threatening.
The emergency situation of strangulated hernia can be recognized by looking for purple or deep red color in the bulging out portion of tissue which is the clear sign. The individual normally experience pain in this situation but it is not necessary. It may also be accompanied by some other symptoms like vomiting, nausea and abdominal swelling.
Surgery for Incisional Hernia
The surgery for the treatment of incisional hernia is adopted only when it is necessary and with the consent of patient. The surgery starts by giving anesthesia to the portion where surgery is to be performed. Then a small incision is created using advanced laparoscopic method that results into a precise and neat incision. A general surgeon as well as a colon-rectal specialist can perform this surgery for incisional hernia.
After the injection of anesthesia, two incisions are drilled opposite to each other on either side of the hernia. One incision is used to insert Alaparascope while the other is for relevant surgical instruments required for operating. The surgeon starts by separating the bulging out muscle or tissue from the abdominal wall and then placing in its appropriate position. This tissue is referred as the "hernia sac". The last part is to correct the muscles and get them normal.
If the issue with the entangled muscles is not serious, it can be simply sutured which can fix the issue and ensure that incisional hernia is permanently fixed. However, for the more complex cases, another approach called "mesh graft" is necessary to resolve seal the hole. This is also a permanent treatment procedure but the defect is left open.
Sutured approach is not suitable for larger and complex defects as there are chances of incisional hernia reappearing in future. Thus use of mesh is a more assured option and adopted as standard treatment procedure for larger incisional hernia. However in cases where the patient's body has rejected surgical implantation in past, the use of mesh is not appropriate for incisional hernia.
After either the tissue is fixed by suturing or using the mesh, the laparoscope is taken off the incision is sealed with sutures. After a few days, the doctor would monitor the wound and remove the sutures with the help of steri-strips. It works like glue to stick the sutures out.
Complications in Incisional Hernia Surgery
There can be complications in incisional hernia surgery. Smaller incisional hernia can are simple and less risky. All the cases of incisional hernia with size of more than 10 cms are considered as large. Such cases are complicated to treat even with surgery and have high risk of re appearing. Large hernia become integrated part of abdominal cavity and can get very tough to separate from the nearby organs. Apart from this, there can be complications for untreated incisional hernia. They are as follows:
- Incarceration: In this case, the intestines projects out of the abdomen and are entangled. This makes them starved from the blood supply and creates a serious situation.
- Strangulation: It is the next stage of incarceration where the intestines start to die because of complete shortage of blood and pose a serious life threat. It calls for serious incisional hernia surgery to save patient's life.
Recovery Period/Healing Time for Incisional Hernia
The recovery period/healing time incisional hernia is decent. Normally it takes only a time of two to four weeks before a patient can get back to routine after surgery of incisional hernia. The first week after incisional hernia surgery is vital as the muscles are highly vulnerable in this stage and must be taken proper care. Avoid such activities that put pressure on abdomen and support the portion with incision with a gentle pressure when required. The patients of incisional hernia have to take extra care, as they are more prone to the repetition of the case of incisional hernia. The following is the list of activities that must be avoided during recovery period of incisional hernia:
- Lifting heavy objects.
- Coughing, sneezing and vomiting should be done very cautiously.
- Rising from sitting position.
- Putting extra pressure during bowel movement.
- Keep your constipation in control by consulting your doctor when required.
Risk Factors for Incisional Hernia
There are multiple risk factors associated with incisional hernia. Obesity or pregnancy can make an individual more prone to incisional hernia. More than one surgery in the abdominal region is also one of the major causes of incisional hernia. If there is a case of hernia in abdomen in absence of prior surgery, it can never be incisional hernia.
Any type of excessive pressure in abdominal muscles due to obesity, pregnancy or weight lifting after the abdominal surgery can also increase the risk of incisional hernia. This is because the tissue around the wound is weak and still under the process of recovering its full strength.
There is no certain time limit about the incisional hernia after the surgery but it is usually seen in the time span of 3 to 6 months in majority of the cases.