What is an incisional hernia?
After abdominal surgery, if the abdominal-wall tissue at the surgical incision does not heal securely, the area is left with a relatively weak defect. When abdominal pressure rises — with coughing, straining, or prolonged standing, for example — bowel or fatty tissue may protrude through that defect, forming a bulge along the direction of the original vertical incision. This is called an incisional hernia. In the literature, the proportion of people who develop an incisional hernia after abdominal-wall surgery is roughly 2%–10%; the actual rate varies with the surgical approach, wound care, and individual factors.
Why do incisional hernias occur?
The following groups have a relatively higher chance of developing an incisional hernia after abdominal surgery:
- Excess body weight
- Older age
- Long-term steroid use
- Chronic coughing after surgery, such as from chronic obstructive pulmonary disease
- A previous wound infection or more than one operation through the same incision
- An unsuitable wound-closure method or poor healing
Inflammation, a hematoma, or a seroma during wound healing can also prevent complete healing and increase the chance of an incisional hernia later on. Chronic coughing, long-term straining from constipation, pregnancy, ascites, and other conditions that raise pressure within the abdomen likewise increase the risk.
Symptoms
- A sense of fullness or a bulge at the incision that becomes more noticeable after prolonged standing, sitting, or lifting heavy objects
- Pain or persistent discomfort at the incision
- A sensation that something is pressing outward through the incision
Diagnosis
During diagnosis, the doctor will take a detailed history, paying particular attention to previous operations and wound healing. They will also assess the degree of pain and discomfort and whether the bulge has grown. During the physical examination, the doctor feels the affected area for a mass and may ask you to cough, strain, or bend over to see whether the hernia sac enlarges. If the diagnosis is uncertain, an ultrasound may be arranged, or in special circumstances a CT scan, to further confirm the hernia's size and details.
How can the risk be reduced?
Although it cannot be entirely prevented, the following measures can reduce the risk:
- After surgery, use an abdominal binder as directed by your doctor to provide appropriate support for the incision
- Manage chronic coughing, constipation, and other conditions that raise abdominal pressure
- Care properly for the wound and return promptly if signs of infection, such as redness, swelling, or drainage, appear
- Manage body weight to reduce the long-term load on the abdominal wall
Treatment
An incisional hernia also requires surgical repair of the defect, and there remains some possibility of recurrence after each repair. The choice of treatment — for example, whether to use synthetic mesh or reconstruct with the patient's own tissue — needs to take account of the defect's size, the condition of the abdominal wall, and the history of previous surgery. For more detail, see Hernia Surgery Explained.
Key takeaways
- Incisional hernias occur at the site of a previous abdominal surgical incision; the rate reported in the literature is roughly 2%–10%
- Obesity, older age, steroid use, chronic coughing, and wound infection are common risk factors
- Poor wound healing, including inflammation, hematoma, or seroma, increases the risk
- Using an abdominal binder, managing factors related to abdominal pressure, and proper wound care can help reduce the risk
- There remains some possibility of recurrence after repair, so it is important to discuss an appropriate surgical approach with a doctor
