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Incisional Hernia – Causes, Symptoms & Treatment

An incisional hernia occurs when tissue or organs protrude through a weakened surgical scar in the abdominal wall. It is a common complication following abdominal surgery.

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Things worth knowing about "Incisional Hernia"

An incisional hernia occurs when tissue or organs protrude through a weakened surgical scar in the abdominal wall. It is a common complication following abdominal surgery.

What Is an Incisional Hernia?

An incisional hernia (also called a scar hernia) is a type of abdominal hernia that develops at the site of a previous surgical incision. After an operation in the abdominal region, the abdominal wall at the scar site may remain permanently weakened. Through this weak spot, portions of the peritoneum, fatty tissue, or internal organs – most commonly parts of the intestine – can push outward, forming a visible or palpable bulge beneath the skin.

Causes and Risk Factors

Incisional hernias develop when the healing of the abdominal wall following surgery is incomplete or insufficiently stable. Common contributing factors include:

Previous abdominal surgery: Particularly common after open procedures such as appendectomy, cesarean section, or bowel surgery
Obesity: Increased intra-abdominal pressure impairs wound healing
Diabetes mellitus: Impaired tissue repair due to metabolic disease
Smoking: Reduced blood flow and tissue oxygenation
Postoperative wound infections: Inflammation weakens the scar tissue
Heavy lifting or physical strain shortly after surgery
Long-term corticosteroid use: Inhibits tissue regeneration
Advanced age: Decreased tissue elasticity and healing capacity

Symptoms

Symptoms of an incisional hernia vary depending on the size and location of the defect. Typical signs include:

A visible or palpable bulge at or near the surgical scar, especially when coughing, straining, or standing up
Pulling or pressing pain in the scar area, particularly during physical activity
A feeling of fullness or pressure in the abdomen
In severe cases: incarceration (trapping) of bowel loops, causing sudden severe pain, nausea, vomiting, and bowel obstruction – this is a medical emergency requiring immediate treatment

Diagnosis

An incisional hernia is usually diagnosed through physical examination by a physician. The bulge is often visible to the naked eye or detectable by palpation. Imaging studies may be used for more precise assessment of the hernia size, location, and contents:

Ultrasound (sonography): The first-line imaging method; fast and radiation-free
Computed tomography (CT scan): Provides detailed cross-sectional images for surgical planning
MRI (magnetic resonance imaging): Used as a supplementary method in unclear cases

Treatment

An incisional hernia does not heal on its own and in most cases requires surgical repair. Conservative management with an abdominal support belt may provide temporary relief but does not resolve the underlying defect.

Surgical Techniques

The goal of surgery is to return the herniated content to the abdominal cavity and durably reinforce the abdominal wall. Several techniques are available depending on the size of the hernia and the condition of the patient:

Open hernia repair: Direct surgical access via an incision; the defect is sutured closed and typically reinforced with a synthetic mesh
Laparoscopic (minimally invasive) hernia repair: Performed through small incisions using a camera; associated with lower infection rates and faster recovery
Robot-assisted surgery: A modern variant of minimally invasive repair offering enhanced precision and control

Aftercare and Prevention

Regular follow-up examinations are important after surgery. To reduce the risk of recurrence, the following measures are recommended: weight loss in overweight patients, smoking cessation, moderate exercise to strengthen the abdominal muscles, and avoiding heavy physical strain during the healing period.

References

Muysoms F. E. et al. - Classification of primary and incisional abdominal wall hernias. Hernia, 2009; 13(4): 407-414. (European Hernia Society)
Bittner R. et al. - Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias. Surgical Endoscopy, 2014; 28(1): 2-29.
Poulose B. K. et al. - Epidemiology and cost of ventral hernia repair. Surgical Endoscopy, 2012; 26(4): 1099-1110.

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