Abdominal Wall / Incisional Hernia

Symptoms
These hernias occur if the patient has discovered a swelling in the region of a scar on the abdominal wall from a previous operation. This swelling becomes more noticeable, particularly when the patient presses, coughs or sits up from previously lying down. The swelling is usually less recognisable in the latter position.

Cause
After an operation has been completed in the abdominal cavity, the abdominal wall is sutured shut, including the latter’s layers of muscle and connective tissue. These sutures are meant to create a permanent seal and firm scar. It is, however, possible for the scar to weaken in 10-15 % of all cases, creating a gap in the abdominal cavity. The contents of the abdomen, e.g. intestines or fatty tissue, are thus more prone to push through this gap. The following factors increase the risk of suffering from an incisional hernia: misuse of alcohol or nicotine, acute or chronic respiratory diseases, artificial respiration occurring after an abdominal operation, ascites, weakened connective tissue, intestinal obstruction, protein deficiency, cough, kidney function disorder, tumours, being overweight, wound infection, diabetes mellitus, repeated abdominal wall incisions, inaccurate wound closure technique.

Is surgery necessary?
If the contents of the hernial sac have incarcerated themselves (rarely occurs) and it is not possible to push them back into the abdominal cavity anymore, an operation needs to be conducted immediately (within 4-6 hours) as an emergency. The patient will suffer from severe pain, nausea and vomiting in such a situation. Those incisional hernias, which are characterised by a relatively small gap caused by the rupture, are particularly prone to incarceration. Due to this imminent danger being present constantly, it is advisable to undergo surgery. Should the skin in the incarcerated area undergo any changes, e.g. become thinner or even inflamed, an operation should be a necessary priority.
As for all other soft tissue ruptures, it needs to be stressed that these abdominal wall / incisional hernias will not diminish, quite the opposite, they will in fact gain in size over time. Thus it is important to highlight the fact that particularly younger patients should not rule out surgery immediately.

Surgical Procedure
If the ruptures are less than 3 cm in size, it usually suffices to suture the edges of the rupture back together. Various types of research, however, have shown that this surgical procedure can cause repeated ruptures, particularly if the rupture is bigger than 3 cm. This is due to the fact that the patient’s tissue already suffers from a dysfunctional scar formation and thus repairing the defect with the patient’s own tissue does not provide a promising outlook onto the situation. It is only possible to achieve long-term stability by covering the gap, which was caused by the rupture, with a synthetic net. The determination of the issue into which layer of the abdominal wall the synthetic net is planted into during the operation, is dependant on several different factors. This issue can only partially be resolved during the actual surgery. If the rupture is quite large in size, the net needs to overlap with the hernial orifices by 5 cm in all directions, in order to avoid further ruptures in the future. Thus these operations can only be conducted under general or spinal anaesthesia. It is possible for the patient to feel foreign body sensations in the abdominal wall, if large synthetic nets were implanted.

The risk of relapsing has decreased significantly since the medical world started using nets during procedures. The size of the rupture as well as several other factors, determine whether the procedure can be conducted on an out-patient basis or whether a short in-patient stay is required. This will all be clarified during your consultation with us.


Aftercare
Immediately after surgery the patient will be able to conduct normal day-to-day activities (such as clothing him/herself, personal hygiene, walking). A patient will be able to resume normal physical activities, such as household chores, easy work in the garden, cycling and driving a car, once the wound has healed at the latest (approx. 10-14 days). More difficult or serious physical activities may be taken up again approx. 3-6 weeks after surgery, if the patient feels capable of doing so.