An incisional hernia occurs when tissue pushes through a weak area in the abdominal wall at the site of a previous surgical incision, usually through a scar from earlier surgery. This incision may have been made to access an internal organ, such as during an appendectomy or a caesarean section.
An incisional hernia is different from a recurrent hernia. After the original operation, the surgeon closes the layers of the abdominal wall with stitches. In some cases, this closure does not heal properly, weakens over time, or comes apart, allowing a hernia to develop.
The British Hernia Centre - How can we help?
The British Hernia Centre is the UK’s first and only dedicated specialist hernia centre, with over 30 years of experience. Its track record supports this distinction, and it now performs more hernia operations and incisional hernia operations than any other surgical unit worldwide. Contact the team at The British Hernia Centre for more information or to book a consultation.
How common are Incisional Hernias?
Remarkably common, really. It is estimated that at least 12-15% of abdominal surgery / operations lead to an incisional hernia.
Historically, and even today, the success rate for repairing them is quite poor with a high incidence of complications and failure. In some reports from other surgeons 50-60% of incisional repairs have failed within 2 years.
Are incisional Hernias dangerous?
As with all hernias, a strangulated hernia occurs when the hernia contents, such as part of the intestine, become trapped and lose their blood supply, a serious and potentially life-threatening condition.
Can I leave it?
If you do, it will almost certainly enlarge. It will just get bigger and probably become more and more unsightly and uncomfortable.
Do I have any non-surgical options?
You can try wearing a corset or a belt. Not ideal, as it can cause additional problems and it is difficult to find a good one.
What is the best hernia repair method?
That is one of the really important questions. We have extensive experience in hernia repair and today most hernia surgeons agree:
a) using mesh gives the best results.
b) both open and keyhole (laparoscopic) hernia repairs are effective when performed by experienced specialists. The choice of technique depends on factors such as the type of hernia, the presence of additional gaps in the abdominal muscles (a common finding), the condition of the surrounding muscles and the degree of muscle separation. The repair should always be tailored to the individual patient by a skilled surgeon.
c) the layer of the abdominal wall in which the mesh is placed is a really important factor. A sub-lay mesh technique where a mesh is placed between the abdominal muscle layers is considered to be superior to an on-lay mesh technique where the mesh over the muscles (and under the skin) after they have been stitched together. A sub-lay technique is associated with greater success in terms of long term durability of the repair and lower risk of infection
Is mesh always used?
It should be. Sutured repairs have a really high failure rate
Biological meshes are unproven, and there are few long-term results available. So far in the majority of cases, when the mesh dissolves, the hernia returns.
Is the old cut reopened?
For open repairs, yes it is. If done well it’s an excellent operation. Some claim that the risk or incidence of infection is high. We think that this a reflection of poorly performed surgery. Often incisional hernias could be associated with ugly scars from the previous surgery and the open operation is also an opportunity to refashion the scar.
How good is the keyhole repair?
It depends on the type of repair and who does it. The traditional keyhole repair, where the mesh is placed against the inside of the abdomen to cover the hernia defect, does not bring the edges of the hole together, so if there is a really wide gap the result may be disappointing, with quite a big bulge remaining. In those cases, there are other keyhole techniques where the muscles can be stitched together. In the hands of expert keyhole surgeons, the repair can be associated with less pain and a quicker recovery.
Complex incisional hernias
Incisional hernias are complex when they have been repaired before and have reoccurred and when there is significant separation of the muscles or the muscles are extremely weak. In these cases, in order to stitch the muscles together and get the mesh coverage quite wide, there is a need for significant abdominal wall reconstruction (AWR).
The decision about open or keyhole surgery and the need for abdominal wall reconstruction is based on the site and size of the hernia and the defect, other associated defects in proximity to the main hernia, the extent of separation of the muscles and the quality of the muscles. Proper planning, including the use of the CT scan, leads to the development of an approach that is individualised to each person.
The BHC manages all types of incisional hernias varying from small simple ones in the scars from previous keyhole surgery (after prostate and gall bladder surgery seems like a common occurrence) to extremely large complex ones which have been repaired elsewhere and have recurred. We often operate patients with such hernias who have been turned down for surgery elsewhere because the appropriate surgical expertise wasn’t available. (link to Jimmy’s story)
