A new bulge near an old abdominal surgical scar may be an incisional hernia. These hernias develop when the abdominal wall does not maintain full strength at the site of a previous incision. They range from small defects that cause little trouble to complex hernias that affect comfort, activity, and abdominal-wall function.
What is an incisional hernia?
An incisional hernia forms through a weakness in the abdominal wall at or near a prior surgical incision. The bulge may contain fat, intestine, or other abdominal contents. It can appear months or years after the original operation.
Risk is influenced by the type and location of the original incision, wound infection, obesity, smoking, diabetes, tissue quality, and other factors that affect healing. Midline abdominal incisions have a higher incisional-hernia risk than many off-midline incisions.
What symptoms can it cause?
- A lump or bulge near a previous incision
- Pressure, aching, or pain with lifting, coughing, or exercise
- A bulge that becomes more visible when standing and smaller when lying down
- Difficulty with certain activities because of abdominal-wall discomfort
A painful bulge associated with vomiting, abdominal distention, inability to pass stool or gas, or a hernia that becomes firm and cannot be gently pushed back can mean the intestine is blocked or tissue is trapped and warrants urgent evaluation.
How is an incisional hernia diagnosed?
Some incisional hernias are obvious on examination. A CT scan is useful when the defect is difficult to define, when the patient has had multiple prior operations, or when a surgeon needs to understand the size and anatomy of a more complex defect before repair.
Does every incisional hernia need repair?
The goal of elective incisional-hernia surgery is usually to improve symptoms, function, and quality of life while preventing progression or complications when appropriate. A small hernia that causes few symptoms may not require immediate surgery. A symptomatic, enlarging, or functionally limiting hernia is more likely to justify repair.
Why mesh is commonly used
Modern guidelines recommend mesh-based repair for most midline incisional hernias because the hernia is more likely to return after repair with stitches alone. For many midline defects, guidelines favor closing the opening in the strong abdominal-wall layer and reinforcing it with mesh rather than simply covering the gap.
The exact mesh position and surgical approach depend on the anatomy. Current European guidance favors placing mesh behind the abdominal muscles for many hernias along the middle of the abdomen, but open, laparoscopic, and robotic techniques each have appropriate roles. Complex abdominal-wall reconstruction is a different problem from a small straightforward incisional hernia, so the operation should be matched to the defect.
Preparation can affect the result
For elective repair, smoking cessation, diabetes control, weight optimization when appropriate, and treatment of active infection can reduce avoidable wound problems and the chance that the hernia returns. In a recurrent hernia, reviewing prior operative reports and knowing what mesh was previously placed can be especially helpful.
Have a bulge near a previous surgical scar?
Bring any prior operative reports or abdominal imaging you have available. They can make the consultation more useful.