| disease | Abdominal Incisional Hernia |
Incisional hernia is a hernia where abdominal organs or tissues protrude through an abdominal wall incision.
bubble_chart Etiology
The disease cause is related to systemic and local factors present during the original surgery.
Incision infection This is the primary disease cause of incisional hernia. After infection, the incision heals in the intermediate stage [second stage], resulting in excessive scar tissue and varying degrees of abdominal wall defects, significantly reducing the strength of the abdominal wall at the incision site. Statistics show that the incidence of incisional hernia after infection is 5 to 10 times higher than that of incisions healing in the initial stage [first stage]. Preventing incision infection is the most critical measure to reduce the incidence of incisional hernia.
Incision type Incisional hernias are more common with straight incisions. The fibers of the abdominal wall muscles (except for the longitudinal fibers of the rectus abdominis), tendon membranes, and fascial membranes, as well as nerves, all run transversely. A straight incision inevitably cuts through these layers of tissue. Additionally, a sutured straight incision continuously bears transverse tensile forces. If the abdominal wall is weak or intra-abdominal pressure is high, the incision is prone to dehiscence. Clearly, the incidence of incisional hernia is much lower with transverse incisions, as the transverse tension of the abdominal wall layers facilitates better alignment of the transverse incision.
Other factors A weak abdominal wall or chronic conditions that increase intra-abdominal pressure can easily induce incisional hernias, making them more common in elderly or obese patients. Other factors related to the original surgery include inadequate anesthesia during the procedure, forced approximation of the abdominal wall, or improper alignment of the abdominal wall layers during suturing.
bubble_chart Clinical ManifestationsThe main manifestation is the protrusion of a hernia mass at the incision site when standing, which becomes more pronounced during coughing or exertion. Typically, the hernia ring is large, and the hernia mass spontaneously reduces and disappears when lying flat. If the hernia mass is large and involves more organs and tissues protruding, there may be discomfort such as abdominal dull pain or a dragging sensation. Due to the wide hernia ring, incarceration or strangulation rarely occurs. Instruct the patient to lie flat and insert a finger into the abdominal wall defect area, then ask the patient to hold their breath to clearly palpate the edges of the hernia ring, assessing the size of the defect and the strength of the surrounding tissues. When the abdominal wall defect is only covered by skin, intestinal peristalsis may be visible.
bubble_chart Treatment Measures
Surgery is the primary treatment, but for elderly and frail patients or those with chronic diseases that increase intra-abdominal pressure, conservative treatment can be considered, using an elastic abdominal belt to prevent hernia protrusion.
A detailed analysis of the cause of the disease must be conducted before surgery. If the underlying disease cause persists, recurrence may occur postoperatively. Additionally, obese individuals should lose weight before undergoing surgery.
For incisional hernias, simple repair suturing is often performed, with hernioplasty being less common.
Simple repair suturing: Incisional hernias often lack a complete hernia sac, and the hernia contents usually protrude through the abdominal wall defect and adhere to superficial abdominal tissues or even the skin. A fusiform incision should be made along the normal abdominal wall at the edge of the original incision to avoid accidentally damaging organs adhered beneath the incision. Adhesions should be separated, hernia contents reduced, and the hernia ring and surrounding scar tissue excised. The abdominal wall should then be sutured in layers without tension. Sometimes, the fascia can be overlapped and sutured to reinforce the abdominal wall.
