Surgery Book

Painful Conditions

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Hernia

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Incisional Hernia

Aka: Incisional Hernia
  1. See Also
    1. Hernia
    2. Inguinal Hernia
    3. Inguinal Hernia in Children
    4. Sports Hernia
    5. Inguinal Hernia
    6. Femoral Hernia
    7. Umbilical Hernia
    8. Paraumbilical Hernia
    9. Epigastric Hernia
    10. Spigelian Hernia
    11. Diastasis Recti
    12. Hernia Reduction
  2. Epidemiology
    1. Incidence
      1. Abdominal incisions: 10-15%
      2. Incisions with postoperative Wound Infection: 23%
  3. Pathophysiology
    1. Type of Ventral Hernia
    2. Develops in scar of prior laparotomy or drain site
    3. Most common in midline abdominal incisions
    4. Risks for post-operative Hernia development (delayed Wound Healing)
      1. Vertical scar more commonly affected than horizontal
      2. Wound Infection
      3. Wound dehiscence
      4. Malnutrition
      5. Obesity
      6. Tobacco Abuse
      7. Immunosuppressants
      8. Excessive wound tension
      9. Connective Tissue Disorder
  4. Signs
    1. Provocative maneuvers to locate Hernia
      1. Hernia sac will appear adjacent to scar
      2. Hernia sac may be obvious with patient standing
      3. Valsalva Maneuver
      4. Raise head from pillow while supine
    2. Large Incisional Hernias are often asymptomatic
    3. Often multiple defects present with several rings
    4. Often Irreducible Hernia due to adhesions
  5. Complications
    1. Incarcerated Hernia is common
    2. Strangulated Hernia is rare
  6. References
    1. Goroll (2000) Primary Care Medicine, p. 431-433
    2. Degowin (1987) Diagnostic Examination, p. 489-96
    3. Stevens (2013) Crit Dec Emerg Med 27(9): 2

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