Every abdominal operation leaves a scar in the abdominal wall, and scar tissue can withstand less than healthy tissue. If the suture gives way at one point, the peritoneum and sometimes parts of the bowel bulge outwards through the gap, the hernial orifice: an incisional hernia. It can appear after a few months or only many years after the procedure.
How high the risk is depends on many circumstances – on the size and position of the original incision, on wound healing problems or infections afterwards, on excess weight, smoking, diabetes and weak connective tissue. Constant pressure from heavy lifting, a chronic cough or constipation adds to this; abdominal walls that have been operated on several times are particularly susceptible.
Usually a bulge is noticed on or next to the scar, which becomes more pronounced when sitting up or straining, together with a pulling sensation on exertion. Left untreated, an incisional hernia generally grows slowly, and as the gap grows, so does the effort needed to close it. If the bulge suddenly becomes hard and painful and can no longer be pushed back, this is an emergency for the emergency department.
Incisional hernias vary greatly in size and position, so the medical history is the key to planning: which procedures have there been, where are the incisions, has a mesh already been inserted? This determines the examinations and the choice of procedure.