Hidden dangers of surgical incisions - knowledge on the prevention and treatment of incisional hernias

Author: Liu Yiting, attending physician at Beijing Chaoyang Hospital, Capital Medical University

Reviewer: Shin Youngmo, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

In the field of hernia surgery, abdominal wall hernia is a common disease that affects the quality of life of patients. Among them, incisional hernia is an important type of extraperitoneal hernia. Although its incidence is not as high as that of inguinal hernia, it is equally important.

Incisional hernia, as the name implies, refers to a hernia formed at the site of a surgical incision. From a medical definition, a hernia refers to a defect or weakness in the abdominal wall tissue, which causes the abdominal organs to protrude outward through this area, forming a palpable mass. Incisional hernia, as a type of abdominal wall hernia, is closely related to a variety of factors, including poor healing of surgical incisions, infection, and hematoma. According to statistics, the incidence of incisional hernia is about 1% among all patients who have undergone abdominal surgery, and in the case of infection or rupture of the surgical wound, the incidence can be as high as 10%-30%.

The formation of incisional hernia is mainly attributed to two core factors: weak abdominal wall tissue and increased abdominal pressure. Tissue damage caused by surgical incisions and poor healing directly lead to weakened abdominal wall strength, which becomes the basis for hernia formation. Increased abdominal pressure is often induced by daily behaviors such as strenuous activities, coughing, and constipation. These factors cause abdominal organs such as the small intestine and colon to protrude outward through weak areas of the abdominal wall, forming a hernia.

In addition, the patient's nutritional status and weight status are also important factors that affect the formation and development of hernia. Poor nutritional status will weaken the tissue's ability to repair and regenerate, exacerbating abdominal wall weakness. Obesity not only directly increases abdominal pressure due to its increased intra-abdominal fat volume, but also because obese people's muscle tissue is relatively loose, further increasing the risk of hernia. It is worth noting that obesity is also an important risk factor for recurrence after hernia repair surgery, because its complex physiological mechanism increases the difficulty of postoperative recovery and the possibility of recurrence.

The early symptoms of incisional hernia are mainly manifested as a reducible mass on the abdominal wall, that is, the mass is obvious when standing, moving or coughing, but the mass disappears when lying flat or pressing with hands. As the disease progresses, the hernia mass may gradually increase in size, accompanied by symptoms such as a feeling of heaviness, nausea, and indigestion. If the hernia mass cannot be retracted for a long time, it may also cause serious consequences such as intestinal obstruction and intestinal strangulation, and even endanger life.

Figure 1 Original copyright image, no permission to reprint

There are many ways to classify incisional hernias, but the two most commonly used classification methods in clinical practice are based on the location and size of the hernia. According to the location, incisional hernias can be divided into median incisional hernias, paramedian incisional hernias, lateral abdominal wall incisional hernias, etc.; according to the size, they can be divided into small incisional hernias, medium incisional hernias, large incisional hernias, and giant incisional hernias. The treatment strategies for incisional hernias of different sizes and locations are also different.

Surgery is currently the only effective means of curing incisional hernias. The surgical method has evolved from traditional suture repair to modern patch repair. Traditional suture repair is suitable for small incisional hernias (now mostly less than 4 cm), and the abdominal wall tissue is freed and sutured to achieve the repair purpose. However, due to the high trauma and high recurrence rate of this method, it has gradually been replaced by patch repair. Patch repair uses artificially synthesized biomaterials or biological patches to reinforce and repair the abdominal wall defect, which has the advantages of less trauma, faster recovery, and lower recurrence rate.

Figure 2 Original copyright image, no permission to reprint

In terms of the timing of surgery, it is generally recommended that patients wait at least six months after their last surgery before undergoing incisional hernia repair. For patients with infected wounds or malignant tumors after surgery, it is necessary to observe wound healing or tumor recurrence for a longer period of time to ensure the safety and effectiveness of the surgery.

In addition, for patients who cannot tolerate surgery, conservative treatments such as abdominal bands can be used to temporarily relieve symptoms, but it should be noted that abdominal bands cannot cure incisional hernias, they can only prevent and delay the progression of the disease.