What Is an Incisional Hernia?

Incisional hernias are caused by the rupture or unhealing of the fascial layer deep in the surgical incision, which can be considered as a late incision or a deep incision that heals on the surface. Since the skin and subcutaneous fat layer on the surface of the incision have healed and the fascial layer has cracked, the internal organs or tissues hernia out due to the pressure in the abdominal cavity. The hernia sac may be the already healed peritoneum or it may be gradually gradually form.

Basic Information

English name: incisional hernia
Visiting department: surgical
Common locations: Abdominal wall incision

Common causes: Common incisional hernia, puncture hernia after laparoscopic surgery, and temporary abdomen closure, the incision splits after parenteral fistula
Common symptoms: There is a protruding mass at the incision, abdominal discomfort, and discomfort due to pulling and falling.Some patients may be accompanied by loss of appetite, nausea, anxiety, etc.

Causes of incisional hernia

There are three common types of incision hernias in clinical practice: ordinary incision hernia, puncture hernia after laparoscopic surgery, and incision hernia formed by temporary abdomen closure. The latter mostly occurs in cases of celiac space syndrome, such as intestinal fistula incision. In patients with dehiscence, the skin crawling covered the intestinal incision and healed by itself because the secondary suture could not be timely. According to the size of the hernia ring, abdominal wall incision hernias can be generally divided into 3 types: large: diameter> 10 cm; medium: 5-10 cm in diameter; small: <5 cm in diameter.

Clinical manifestations of incisional hernia

A prominent mass at the abdominal wall incision is the main symptom. It is prominent or obvious when standing and hard, and shrinks or disappears when lying down. When the hernia is larger and there are more organs and tissues protruding, there may be discomforts such as abdominal pain, falling and falling sensation, and some patients may be accompanied by decreased appetite, nausea, and anxiety. Hernia contents can adhere to the outer peritoneal and abdominal wall tissue and become irreversible hernias, sometimes with incomplete intestinal obstruction. A small number of patients with small hernia rings can have incarceration. Incomplete intestinal obstruction is a common complication of incisional hernia. Incisional hernia contents are generally intestinal canal and / or greater omentum and hernia sac and repeated friction with each other is prone to adhesion and cause incomplete intestinal obstruction.

Incisional hernia

Hernia contents can reach the subcutaneous, thin subcutaneous fat layer, bowel type or peristaltic waves can be seen. The patient was instructed to lie supine, and the mass was reset with the fingers into the abdominal wall defect site, and then the patient held his breath to clear the edge of the hernia ring to understand the size of the defect and the strength of the edge tissue.

The diagnosis of abdominal wall incision hernia usually does not require special inspection. Sometimes the preoperative evaluation needs to understand the primary disease. The image can be used to see the contents of the hernia. In particular, the CT can clearly see the continuous interruption of the anterior wall of the abdomen and the contents of the hernia. outward.

Incisional hernia diagnosis

Medical history

Patients with incisional hernias have a recent history of abdominal surgery, often with incisional infections, dehiscence, or emergency surgery; or patients with poor general conditions; or a history of preoperative smoking and chronic diseases.

2. Clinical characteristics

A reductive mass appeared in the incision, and a physical examination revealed the border of the hernia ring formed by dehiscence of the abdominal muscles.

3. Auxiliary inspection

The contents of the hernia were visible on imaging examination.

Incisional hernia treatment

Abdominal wall incision hernia should be mainly treated by surgery, but for elderly and frail patients with chronic diseases that increase intra-abdominal pressure, advanced cancer and critically ill patients with internal and surgical surgeries, non-surgical treatment includes: protecting incisional hernia, preventing Injury of hernia contents; local use of elastic abdominal bands or abdominal girth to prevent hernia block from protruding; deal with systemic conditions such as cough and constipation.

Timing of surgery

After the incision hernia is formed, the local tissue needs to be reshaped, which takes about 6 months. In order to prevent recurrence after surgery, the repair of incisional hernia should be carried out 6 months after the onset of hernia. Because of inflammatory adhesions in the abdominal organs after the first operation, repair surgery was performed earlier, which easily damaged the intestines.

2. Principles of surgery

Resection the scar. The layers of the abdominal wall were clearly dissected along the edges after the hernia ring was exposed. After receiving the contents of the hernia, repair the layers of abdominal wall tissue without tension or low tension.

3. Patching method

(1) Direct suture . Small incision hernia rings with a diameter of 5cm or a strong fascial incision hernia can be directly sutured. First, dissect the edge of the defect, remove scar tissue, and suturing the fascia layer by layer; if the structure of the abdominal wall is unclear, 10 Intermittent suture on the abdominal wall of No. silk thread. For larger incisional hernias, or incisional hernias with atrophy of abdominal wall muscles and weak fascia, the fascia can be reduced and sutured on both sides of the incision. Do not pull the suture forcibly and the fascia tears, or the postoperative recurrence caused by increased abdominal pressure Of course, graft repair is a safe and effective method.

(2) Autologous tissue transplantation Repairing hernia rings> 5cm incision hernias. Autogenous tissues commonly used are autogenous dermis such as the broad rectus abdominis anterior sheath gracilis. This repair is traumatic and causes new tissue defects, so it has been replaced by synthetic material repair. However, for the grassroots hospitals in areas where the economy is not yet developed, autologous tissue transplantation repair is still a cost-effective repair method.

(3) Synthetic material repair There are three kinds of synthetic materials commonly used in clinical practice: polyesters, polypropylenes, and expanded polytetrafluoroethylene (e-PTFE). At present, there are biological patches that can self-degrade and the price is relatively expensive.

(4) Laparoscopic repair Laparoscopic inguinal hernia repair has accumulated a lot of experience abroad, and is also being developed in China. Due to the difficulty of surgery, there are relatively few cases of laparoscopic incision hernia repair.

Incisional hernia prevention

1. Well-designed cutout

To avoid the occurrence of incisional hernia, the clinician should carefully design the incision according to the purpose of treatment, and use as few transabdominal and pararectus incisions as possible, and replace them with transverse incisions, median incisions, and paramedian incisions.

2. Improve healing ability

Strengthening nutritional support for patients, correcting anemia and hypoproteinemia, supplementing vitamin C, K, etc., improving the general condition of patients and improving healing ability

3. Actively treat comorbidities or complications

Diabetes, coagulopathy, respiratory dysfunction, liver dysfunction, kidney dysfunction and other complications or complications affecting tissue healing should be actively treated. Elective surgery must be performed after the above conditions have been corrected or controlled.

4. Actively deal with factors that cause increased abdominal pressure

Before the operation, actively treat diseases that increase intra-abdominal pressure such as pulmonary infection, chronic obstructive pulmonary disease, a large amount of peritoneal effusion, constipation or dysuria, and prevent and deal with abdominal distension, vomiting, hiccup, cough, sneezing, etc. caused by surgery Factors of increased internal pressure while using an abdominal band.

5. Prevent incision infection

Actively treat patients' skin, nasopharyngeal gastrointestinal infections before surgery. Shaving in the operation area may damage the skin or cause tiny skin wounds. Instead of shaving, the method of cutting or depilation should be used, and the time from skin preparation to surgery should be shortened as much as possible.