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Hernia

What is a hernia

A scar hernia, also known as a so-called incisional hernia in technical jargon, is a breakthrough in a surgical scar.
The incisional hernia occurs most frequently in the middle abdominal area after an operation there and should be treated surgically as it progresses.
An incisional hernia is one of the postoperative complications and occurs particularly as a result of multiple operations, obesity or wound healing disorders.

causes

Various factors can be considered as causes of an incisional hernia. It is important to mention those diseases or circumstances that lead to weak connective tissue and high pressure inside the abdomen.

The following diseases or circumstances can lead to a hernia:

Wound healing disorders
Wound infections
multiple operations in the same place
Obesity
Nicotine consumption
Peritonitis

Chronic constipation
Diabetes mellitus
Anemia
Permanent glucocorticoid treatment
Lung diseases with increased breathing resistance (asthma, COPD)
Collagen diseases

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A hernia is particularly common there

Most often, hernias occur on the central abdomen after an operation.

The surgical cut leading to the hernia is the so-called median laparatomy cut, which is made vertically in the middle of the abdomen.
At this point on the abdomen, the so-called linea alba, made of tight connective tissue, runs along which the incision is made.
This line is a tendon interweaving where the lateral abdominal muscles originate and attach.

This article might also interest you: Scar care

This hernia is particularly dangerous

A hernia becomes particularly dangerous if the intestines (often parts of the intestine) are trapped in what is known as a hernia.
Such entrapment is an urgent emergency and must be treated immediately.

Such an entrapment often manifests itself as very severe abdominal pain, possibly accompanied by nausea, fever and vomiting. The bulge can then no longer simply be pushed back into the interior of the abdomen.

Incisional hernia after a caesarean section

Even after a caesarean section, an incisal hernia can occur as a complication later after the operation.
For this reason, for example, the abdominal muscles should not be excessively strained in the first months after the procedure. This is to prevent the scar from being put under too much tension and the pressure inside the abdominal cavity being greatly increased.
Even during bowel movements, strong pressure can lead to strong tension in the abdominal muscles, which irritates the scar.

The scar from your caesarean section hurts? Read our article on this:

Caesarean scar pain

Incisional hernia on the abdomen

The incisional hernia on the abdomen is by far the most common hernia.
There the incisional hernia often occurs after a so-called median laparotomy incision in the middle of the abdomen.
This incision is made lengthways along the so-called Linea Alba made of tight connective tissue. The linea alba is an interwoven tendon that serves as the place of origin and insertion of the lateral abdominal muscles.

Incisional hernia after an operation

An incisional hernia usually occurs after an operation on a scar.
The tissue on the scar does not have the same stability and elasticity as on intact connective tissue. There is therefore a weak point here where the abdominal wall or skin can break more easily.
Such an incisional hernia often occurs as a complication of an operation one year after the operation.

Find out more about this topic:

Postoperative Complications - What Are There?

diagnosis

The diagnosis of the hernia is made by talking to the patient and palpating the affected area.
If a hernial sac can be felt in this clinical examination, the hernia is diagnosed quickly.

Ultrasound can also be used for clarification.
Further measures, such as imaging diagnostics using an X-ray or computer tomography, are only necessary in exceptional cases for a specific clarification.

You can recognize a hernia by these symptoms

The most obvious thing about an incisional hernia is a visible and palpable protrusion in the area of the surgical scar, which can be pushed back into the abdominal cavity.
Usually, this bulge becomes larger and more noticeable over time.

In the further course there may be pain at this point - especially if the pressure inside the abdomen is increased.
This happens e.g. when coughing, straining when defecating, laughing hard or doing sports.

If the intestines are trapped by the hernia, further symptoms express themselves:

severe abdominal pain in the affected area,
Nausea,
Vomiting and
Fever can occur here.

The hernial sac can then often no longer be pushed back into the interior of the abdominal cavity.

Pain from a hernia

A new incisional hernia does not necessarily have to lead to pain.
If the break is very small and fresh, it can occur without any discomfort. Nevertheless, you should always have this assessed by a doctor.

However, pain at the site of the scar is very typical with a hernia. These occur more frequently when the pressure inside the abdomen is increased. This happens, for example, when coughing, laughing hard, exercising or straining hard when defecating.

If the pain is very severe and is accompanied by other symptoms such as nausea, vomiting and fever, organs may be trapped in the hernia. This is an emergency and requires direct surgery.

Read more on the subject at: Pain after surgery

Which doctor treats the hernia?

Since a hernia usually requires surgical treatment, you should see a surgeon. The surgeon will plan with you when an operation makes sense and what urgency it is.

A small incisional hernia that hardly causes any discomfort does not have to be treated as an emergency or particularly quickly. Since an incisional hernia operation is performed on an area that has already been operated on and has already been damaged, it is recommended that this be surgically straightened between 3-12 months after the previous operation.

If it is an emergency incisional hernia with entrapment, this guideline value does of course not apply and an operation should be initiated immediately.

treatment

A hernia is usually treated surgically.
Various surgical techniques come into question:

The choice of technique depends on the type and extent of the hernia and the previous surgery. A rough distinction is made between open surgery and minimally invasive surgery.
The open surgical technique is more often chosen, in which the protruding hernial sac is exposed and brought back into the interior of the abdominal cavity.

There are also differences in the closure of the operating area.
For example, a plastic mesh can be inserted for additional stability before the wound is closed. Your attending surgeon will explain to you in detail which surgical technique is the most optimal in your case and how it will actually work.

Read more on the subject at: Minimally Invasive Surgery

These bandages can help

Wearing a bandage over the hernial port is not a substitute for surgery. The use of these bandages is very controversial depending on the use.
Constantly wearing a tight bandage weakens the surrounding muscles. It is also important that a bandage does not cause the break point to grow together. According to the literature, the bandage even leads to dangerous organ entrapment more often than without the bandage.
Wearing a bandage is therefore to be assessed critically and should definitely be discussed with the treating doctor.

However, after a successful operation of the umbilical hernia, temporarily wearing an abdominal bandage can help stabilize the abdominal wall.
It is best to discuss with your surgeon whether a bandage is recommended in your case after the operation.

belt

The postoperative abdominal bandage can also be called an abdominal belt because it is wrapped around the stomach like a belt.
The same applies to the belt as to the belly bandages.
They cannot replace surgery and may even have a negative impact on the course. The attending surgeon may recommend wearing a sling for a few weeks after an operation.

When do you need an operation?

As a rule, the vast majority of incisional hernias are treated surgically.
This is because the hernias tend to break through over time.
If the hernia slowly becomes larger, surgical treatment is recommended. Without the operation, the intestine can otherwise become trapped with serious complications.

However, if the hernia does not cause any discomfort, is only very small and does not tend to get larger, further surgery may be dispensed with in consultation with the treating doctor. The age of the patient, previous illnesses and medical history must also be taken into account.
As a rule, an operation is nevertheless strongly recommended, because without an operation there can be no cure.

forecast

A hernia is usually treated surgically without any problems. The operation is a standard operation that is performed frequently and is a routine procedure.
Should it come to an entrapment and emergency surgery, the need for treatment is indicated more quickly. If the hernial sac is treated immediately, further complications are not necessarily to be expected.

The scar hernia occurs again in about 5% of patients.
To prevent this, you should definitely avoid carrying heavy loads in the first time after the operation. Weight loss and the failure to engage in risky behavior such as nicotine consumption can also prevent a hernia from recurring.

Hernia and exercise

You should not carry or lift heavy loads in the first weeks to months after the operation.
Contact your surgeon for more detailed information on the recommendations in your case. As a rule, after a minimally invasive operation, you should avoid heavy stress for about 6 weeks. Due to the significantly larger scar, you should be aware of this for up to 3 months after an open operation.

You should also refrain from doing abdominal muscle training at first. You should neither bathe nor swim in the first two weeks after the operation.

Daily exercise and light sport are allowed on a small scale as long as you are not in pain.