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Incisional hernia

Introduction

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Synonyms and keywords: Ventral hernias

Overview

Overview

An incisional hernia occurs when the area of weakness through which the hernia occurs, is the result of an incompletely healed surgical wound. Since median incisions in the linea alba are frequent for laparotomy, ventral incisional hernias are termed ventral hernia. These can be the most frustrating and difficult hernias to treat.

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Incisional hernia overview from Other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Soumya Sachdeva

Historical Perspective

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Overview

Historical Perspective

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Classification

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Overview

Classification

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Pathophysiology

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Overview

Pathophysiology

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Causes

Overview

These hernias present as a bulge or protrusion at or near the area of the prior incision scar. Virtually any prior abdominal operation can subsequently develop an Incisional Hernia at the scar area, including those from large abdominal procedures (intestinal surgery, vascular surgery), to small incisions (Appendectomy, or Laparoscopy). These hernias can occur at any incision, but tend to occur more commonly along a straight line from the breastbone straight down to the pubis, and are more complex in these regions.

Causes

  1. Infection – Cases operated for peritonitis such as perforated duodenal ulcer, gangrene of the intestines.
  2. Anatomical site – The midline of lower abdomen is highly prone, due to absence of posterior rectus sheath below the arcuate line.
  3. Obesity with weak muscular tone.
  4. Faulty sutures
  5. Faulty technique of closure of the abdomen.
  6. Ascites
  7. Wrongly placed incisions tampering the nerves.
  8. Persistent postoperative cough.

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Soumya Sachdeva

Differentiating Incisional hernia from other Diseases

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Overview

Differential Diagnosis

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Epidemiology and Demographics

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Overview

Epidemiology and Demographics

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Risk Factors

Overview

Risk Factors

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-In-Chief: Jinhui Wu, M.D.; Soumya Sachdeva

Screening

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Overview

Screening

  • Reducible hernia: There is a bulge in the abdominal area. It may be tender and can cause discomfort during any type of physical strain, such as lifting or coughing. The bulge may disappear when the patient is lying down, and be more visible when standing up.
  • When a hernia cannot be pushed back into place, symptoms include pain, nausea, vomiting, inability to have a bowel movement, and a bulge that remains even when lying down.

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-In-Chief: Jinhui Wu, M.D., Soumya Sachdeva

Natural History, Complications and Prognosis

Overview

Natural History

Complications

Hernias in this area have a high rate of recurrence if repaired via a simple suture technique under tension and it is especially advised that these be repaired via a TENSION FREE repair method using mesh (a type of synthetic net).

Prognosis

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Soumya Sachdeva

Diagnosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X Ray | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case Studies

Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-In-Chief: Soumya Sachdeva