Do you remember having an operation on your stomach, that is, after a surgery, sometimes you have noticed that the scar of the wound looks like a small lump coming up? Or has this happened to someone you know? Most of the time this is nothing to worry about, but it is very important to be aware of this. This is what we medically call an Incisional Hernia , or in Sinhala,
What is this (Incisional Hernia)? Let's understand it simply!
Imagine that you have had surgery, that is, an operation, on your abdomen for some reason. It could be a surgery that is done through a large incision, which we call a laparotomy . Or it could be a surgery that is done through a few small incisions (laparoscopic surgery) , or it could be a new method (robotic surgery) .
No matter how the surgery is done, the muscles in the abdomen weaken a little after the surgery. It's like when a small spot in a piece of cloth gets torn. Then, the intestines inside the abdomen, or the layers of fat in the abdomen, push out through those weakened muscles. They push out like that, and look like a small lump or swelling under the skin in the area where the operation was performed. This is what we call an Incisional Hernia.
This is a very common condition. Studies show that about 20 out of 100 people who have undergone major abdominal surgery, such as a laparotomy, will develop a hernia. Also, this hernia can occur immediately after the surgery, or it can appear months or even years later.
Most of the time, these (Incisional Hernias) are not a major medical emergency. However, sometimes if this hernia gets bigger, it can lead to serious complications. Therefore, it is important to be aware of this.
The usual treatment for this is to perform another surgery to put the parts of the intestine that came out back into the abdomen and strengthen the weakened muscles.
What are the symptoms of an Incisional Hernia? How do you recognize it?
If the hernia is small, about two inches (5 centimeters) wide or long, you may not notice any symptoms. However, if the hernia is larger, for example, more than four inches (10 centimeters), you may feel pain. Also, a lump or swelling may be clearly visible in the area of the surgical scar.
This pain can sometimes feel like a sharp stabbing pain, or it can feel like a heavy throbbing pain. This pain can be especially severe when you lift something heavy, cough, or sneeze.
That lumpy appearance can become more prominent when you stand up or when you put pressure on your stomach muscles (for example, when straining when you're constipated).
Why does this (Incisional Hernia) occur? What are the factors that affect it?
As we have discussed before, the main cause of abdominal muscle weakness after abdominal surgery is a weakened abdominal muscle. This risk is especially high after a large incision (laparotomy). However, this condition can also occur after surgeries performed with small incisions, such as laparoscopic or robotic surgery.
After surgery, these muscles take time to recover, or heal. Certain activities and medical conditions can delay this healing time and increase the risk of an incisional hernia. These include:
- Becoming too active too soon after surgery: This means doing heavy work or doing things that strain the body without proper rest.
- Diabetes Mellitus: People with diabetes have delayed wound healing.
- Obesity: This risk is also higher for people who are overweight.
- Lung diseases: Especially for people with diseases that cause a persistent cough, such as COPD (Chronic Obstructive Pulmonary Disease) , frequent coughing puts pressure on the abdominal muscles.
- Long-term use of immunosuppressants or corticosteroids.
- Surgical site infections: Muscle weakness can also occur due to things like wound infection.
How can this risk be reduced?
In fact, the best thing you can do is give your body the time it needs to heal. Take it easy for a few days after the operation. Avoid lifting weights or doing strenuous activities for a while. It's best to ask your surgeon when you can resume normal activities.
What are the possible complications of an Incisional Hernia?
Although rare, sometimes an incisional hernia can lead to serious conditions. One is an incarcerated hernia . This is when a portion of the intestine that has slipped into the hernia cannot go back into the abdomen and becomes trapped between the muscles.
Another dangerous condition is a strangulated hernia . In this case, the strangulated part of the intestine is under severe pressure and loses blood flow. When this happens, that part of the intestine begins to die. In medicine, we call this (necrosis) .
An incarcerated hernia and a strangulated hernia are serious medical conditions that require immediate treatment. In these cases, you may experience sudden, severe pain at the site of the hernia, and the skin in that area may change color. The skin may become pale and then turn dark. If you have these symptoms, you should go to a hospital emergency room immediately.
How do doctors know exactly if you have an Incisional Hernia?
When you go to see a doctor, they will first do a physical examination . They may ask you to sit down, then stand up, and then they will look for any lumps or bumps that may be moving around. They will also ask about other symptoms you may have and try to determine if you have a condition like an incarcerated hernia. Sometimes they may also do a CT scan .
How is an Incisional Hernia treated?
Treatment depends on your symptoms. For example, if you have a small hernia that is not painful or bothersome, you may not need treatment. However, an incisional hernia can get bigger over time. As the hernia gets bigger, the risk of complications increases. Therefore, if your hernia is large or causing symptoms, a doctor may recommend hernia repair surgery .
This surgery can be done as an open hernia repair or as a laparoscopic hernia repair surgery. In both procedures, the part of the intestine or tissue inside the hernia is put back into the abdomen to strengthen the weakened abdominal muscles. Sometimes, a mesh-like structure is used to strengthen these muscles. This reduces the risk of a hernia recurring.
How long does it take to heal?
Recovery time varies from person to person. Most people can return to their normal activities within a few days. However, everyone is different, so it's best to ask your surgeon how long it will take and what to expect.
When should I see a doctor after surgery?
Minor complications can sometimes occur after surgery to repair an incisional hernia. Therefore, if you experience any of the following, notify your doctor immediately:
- If the wound is bleeding.
- If you see signs of an infection: fever, pus-like fluid draining from the wound.
What should someone with an incisional hernia expect?
Surgery to repair a large (incisional) hernia often completely cures the condition. However, sometimes the hernia can recur.
How long can you live with an Incisional Hernia?
If your hernia is not incarcerated, you can live with it for a long time. However, an incarcerated hernia can become strangulated. If that happens, it can develop into a serious medical condition that can even be life-threatening .
It can be quite unexpected to develop an incisional hernia after abdominal surgery. It can be really distressing to think that after having surgery for one condition, another problem will arise. However, this new condition does not always require surgery again. However, since a large incisional hernia can cause serious complications, if you have a lump or swelling where you had an operation, you should definitely see a doctor and get advice. He or she will tell you what is the best thing to do.
The most important things for you to remember (Take-Home Message)
- An incisional hernia is when parts of the intestine, such as the intestines, protrude through the incision site after abdominal surgery.
- This is often not a major emergency , but sometimes it can be serious.
- If there is a lump, swelling, or pain in the area of the surgical scar, seek medical advice.
- If the pain increases when lifting weights or coughing, that is also a symptom.
- An incarcerated or strangulated hernia is a medical emergency. It can cause severe pain and discoloration.
- The treatment is usually surgery.
- Getting plenty of rest after surgery and following your doctor's instructions is very important for a speedy recovery.
If you want to know more about this, or if you have any concerns, don't hesitate to talk to a doctor. Stay healthy!
` Hernia, incisional hernia, postoperative hernia, abdominal surgery, incisional hernia, prolapsed intestine, hernia surgery
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