Incisional hernia

A ventral or incisional hernia specifically describes a hernia, often in the middle of the abdomen, that occurs after a prior incision was made during a prior operation.

The iatrogenic incisional hernia develops as a late complication of about 10% of abdominal surgery. The hernia may be apparent within the first year post-operatively, but may not develop for up to 5 years. Despite awareness of the predisposing factors, the incidence is not decreasing.

During closure of a laparotomy, the linea alba is reapproximated and the rectus muscles are returned to midline

• integrity of the repair is dependent on suture fixation until the load-bearing properties of the scar become equal to or surpass that of the suture
• fundamental pathophysiology of ventral incisional hernia is lateral migration of the rectus muscle with loss of function commonly referred to as ‘loss of domain’

Usually, the incisional hernia presents as a bulge in the abdominal wall near a previous wound. The condition is often asymptomatic but occasionally, a narrow-necked hernia occurs and presents with pain or strangulation. Once developed, it tends to enlarge progressively and may become a nuisance cosmetically or for dressing.

Treatment is by repair. Small hernia's recur in 2-5% of cases; medium sized hernias recur in 5-15%; and large hernias recur in 5-15%.

Reference:

• Xing L, Culbertson EJ, Wen Y, Franz MG. Early laparotomy wound failure as the mechanism for incisional hernia formation. J Surg Res. 2013;182:e35–42