After abdominal surgery, there is a bulge at the incision when I stand up. Is it a tumor?

Author: Chen Jie, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Reviewer: Liang Zhen, Chief Physician, Peking University Cancer Hospital

Some patients who have undergone abdominal surgery will find a bulge at the incision site, and this bulge is very obvious when coughing or standing up, but disappears after lying down. Many patients will ask the doctor if they have a tumor.

In fact, this situation is generally not a tumor, but an incisional hernia under the surgical incision.

1. What exactly is abdominal wall incisional hernia?

After abdominal surgery, if the wound does not heal well, the muscle layer and fascia layer of the wound will split. We call this split a defect.

Most of the contents of the abdominal cavity are intestines, and of course there is also the greater omentum or other organs. They drill out from the defect, reach under the skin, and bulge out as a big bag, which is called an incisional hernia.

In essence, what ordinary people see is a bulge, but in the eyes of doctors, this incisional hernia is a hole, a defect. There is a cracked hole below the incision, and the contents of the abdominal cavity are displaced through this hole. This is the so-called incisional hernia.

Incisional hernias are divided into small incisional hernias, medium incisional hernias, large incisional hernias and giant incisional hernias. Incisional hernias less than 4 cm are called small incisional hernias, 4-8 cm are called medium incisional hernias, 8-12 cm are called large incisional hernias, and incisional hernias with a defect of more than 12 cm are called giant incisional hernias.

Figure 1 Original copyright image, no permission to reprint

In addition, if the defect is less than 12 cm, but a lot of contents have escaped, it can also be called a giant incisional hernia. It is like a room that originally had one room, but now has another room. That is, the contents in the abdominal cavity that should have stayed in the original room have moved to the other room. If the contents that have escaped exceed 15% of the volume of the room, it is also called a giant incisional hernia.

2. What are the symptoms of patients with giant incisional hernia of the abdominal wall?

Patients with giant incisional hernia often have more severe symptoms, and most people have a more obvious feeling of heaviness and distension.

Many patients will experience recurrent incomplete intestinal obstruction because the intestines can never go back after they drill out, or they cannot be completely returned after drill out, and the intestines will make many bends in the secondary abdominal cavity.

As a result, patients may experience abdominal distension, incomplete intestinal obstruction, constipation, and even poor digestion.

Of course, if adhesions occur, complete intestinal obstruction may also occur. Complete intestinal obstruction is more troublesome, and the patient cannot eat or drink, and stops passing gas and defecation. Incarceration may occur, which means the intestines are stuck, and the intestines may become necrotic or perforated. In severe cases, it may be life-threatening and cause severe septic shock, which is more serious.

Therefore, giant incisional hernia of the abdominal wall should be actively treated with surgery.

3. Is there a high risk in surgery for giant abdominal wall hernia?

The surgical risk of giant incisional hernia of the abdominal wall is very high, so you must find an experienced doctor to perform the surgery.

For example, after surgery for a giant incisional hernia, the problem of intra-abdominal hypertension is prone to occur. This is because the contents of the abdominal cavity have already gone outside, and the patient's abdominal cavity has become accustomed to the original pressure. When these contents are suddenly put back in, it is equivalent to raising the diaphragm, compressing the heart and lungs, causing intra-abdominal hypertension. The increased intra-abdominal pressure can cause organ dysfunction, which is abdominal compartment syndrome.

The mortality rate of this type of patients is very high, with foreign literature reporting a rate of up to 70%, and domestic literature reporting a rate of 40%-100%. The overall estimate is around 60% to 70%.

Therefore, patients with giant incisional hernia have this risk after surgery, which needs our attention.

Figure 2 Original copyright image, no permission to reprint

4. What should you pay attention to after surgery for giant abdominal wall incisional hernia?

First, most patients with giant incisional hernia are overweight. Therefore, after surgery, reducing food intake and controlling weight are the first priority. Eating less can also reduce abdominal pressure to a certain extent.

Second, proper exercise can not only enhance immunity, but also help you lose weight and beautify your body, so this is the second most important thing.

Third, do not do strenuous exercise or engage in heavy physical labor within three months to six months after the operation, because when the patch of the incisional hernia has not yet grown well, strenuous exercise may cause the patch to shift or tear off, that is, the stitches or nails between the patch and the tissue may slip off.

In addition, coughing, constipation, sneezing, etc., which increase abdominal pressure, should also be avoided as much as possible. The use of cough suppressants, maintaining smooth bowel movements, and preventing allergic rhinitis and colds are also things that need to be paid attention to after surgery.