Incisional hernia

What is it?

An incisional hernia is a hernia that occurs through a previously made incision in the abdominal wall.

The incision will have been made in order to get to an internal organ – large or small intestine, liver, kidney, aorta (main artery of the body), exploratory op. after an accident – etc.

After operating the surgeon will have had to close the layers of the abdominal wall, with stitches. Sometimes this closure – like a seam in a jacket or dress – comes apart. Either it doesn’t heal properly in the first place or it just comes apart with time. I say sometimes, but it is estimated that at least 12 – 15% of abdominal operations lead to an incisional hernia (and in the USA 2 million abdominal operations are done annually – that leads to a lot of incisional hernias)

You should know at the outset that the success rate for repairing them is depressingly poor with a high incidence of complications and failure. We’ll explore the reasons why.

First of all lets look at some questions I get asked frequently.

Q. Are incisional hernias dangerous?
Q. What will happen if I leave it?
Q Is there anything non-surgical that will help?
Q. Should I have my incisional hernia repaired?
Q. What’s the best way of repairing it?
Q. Is mesh always used?
Q. Is the old cut reopened?
Q. How good is the keyhole repair?
Q. Who should I go to for the repair?
Q. What’s the chance of success?
Q. What can go wrong?

Just a list of SOME of the questions I get asked regularly. Lets try and answer them.

Q. Are incisional hernias dangerous?

If the hernia strangulates – if the hernia contents (the intestine) get trapped and lose their blood supply – yes that’s dangerous. How likely is that to happen? No-one really knows – the figures are not available. And incisional hernias vary so much. If the hole is large and wide it is actually unlikely that the hernia will strangulate. But large ‘wide-necked’ hernias are so unsightly and uncomfortable!

Q. What will happen if I leave it?

it will almost certainly enlarge. It will just get bigger and probably become more and more uncomfortable.

Q. Non- surgical options.

Belts to keep it in may help a little. They are not ideal, and it is difficult to find a good one. But think hard about why you might want a high risk op. before deciding.

Q. Should I have my incisional hernia repaired?

If I had an incisional hernia and decided to have it repaired I would want to find the best man for the job. Very hard to do. But good, interested surgeons are getting good results with the right sort of case, so its worth ‘shopping around’

Q. What’s the best way of repairing it?

That’s a really big question – controversial, and there probably isn’t one ‘best’ way.

a) mesh gives the best results
b) biological meshes are really unproven, and as far as I can see there are no long term results available
c) open or keyhole repairs should be tailored to the patient and the hernia
d) the layer of the abdominal wall in which the mesh is placed is a really important factor

Q. Is mesh always used?

It should be. Sutured repairs have a really high failure rate

Q. Is the old cut reopened?

For open repairs LINK – yes. And if done well it’s an excellent operation. Critics say the risk or incidence of infection is high. I think that Is a reflection of poorly done surgery. In my published series of over 100 open incisional hernia repairs the incidence of wound infection was less than 4 %

Q. How good is the keyhole repair?

It depends who does it. It doesn’t bring the edges of the hole together, so if there is a really wide gap the result may be disappointing.

Q. Who should I go to for the repair?

Difficult – and mentioned briefly above. I’ll deal with this elsewhere on the site.

Q. What’s the chance of success?

The quoted figures are depressingly poor.

Q. What can go wrong?

Lots of things. I’ll deal with this important question on a separate page Incisional hernia problems LINK