Hernias
Incisional hernia
A hernia that develops at a previous abdominal surgical scar. It ranges from small defects to large abdominal wall reconstruction cases.
Symptoms
- Bulge over or near a previous abdominal scar
- Pain or discomfort during exertion
- Sensation of tension or heaviness in the abdomen
- Bulge that increases when standing or straining
Risk factors
- Wound infection after previous surgery
- Obesity
- Diabetes
- Smoking
- COPD or chronic cough
- Early postoperative exertion
- Poor tissue quality or malnutrition
Diagnosis
Clinical examination and ultrasound are usually enough for small defects. For large or complex incisional hernias, a CT scan of the abdomen is essential to assess size, content, loss of domain and muscle anatomy.
Warning signs
Urgent assessment is needed if the bulge becomes hard, painful, non-reducible or associated with nausea, vomiting, fever or abdominal distension.
Surgical options
- Laparoscopic or robotic IPOM for selected cases
- eTEP for retromuscular mesh placement outside the peritoneal cavity
- TAR (transversus abdominis release) for large or complex defects
- Component separation for very large defects with loss of domain
