An incisional hernia develops when abdominal contents, like a loop of the intestines, slips through an incision scar, or even the tissues close to the scar, from a previous surgery.
Incisional hernias will not repair themselves without surgery and most patients will choose to have them fixed. Surgical repair is often recommended for hernias that are enlarging and painful. The procedure is usually non-urgent and can often be scheduled on an elective outpatient basis. However, watchful waiting is generally not recommended.
The greatest risk with prolonging surgical repair is the development of an incarcerated hernia, which can become a life threatening emergency. With an incarcerated hernia, the hernia contents become trapped in the wall of the abdomen which can cut off the blood supply to the trapped organs and tissue. You should be able to gently push the hernia back into your abdomen when you’re lying down. If you are concerned you might have a hernia, you should consult with a board certified general surgeon to discuss a plan of treatment specific to your hernia.
Some signs and symptoms of an incisional hernia include:
- A visible bulge in the area of the incision especially when coughing or straining
- Swelling in the area of the incision
- Pain and pressure at the area of the incision
Most hernias can be detected upon physical examination by a trained surgeon. Occasionally additional testing is required such as an ultrasound or CT scan. Routine blood work and heart studies such as an EKG can be ordered prior to surgery based on your age and the presence of any existing medical conditions.
You may be instructed to stop taking some medications before surgery. Make sure your surgeon knows all the prescription and over-the-counter medications you take, including natural or nutritional supplements.
The two techniques used for incisional hernia repair are traditional open surgery and laparoscopic surgery. Both techniques offer excellent outcomes and differ based on a few subtle areas. Individual patient factors will help the surgeon to decide the best choice for repair. It is important to find a surgeon who can offer both laparoscopic and open techniques.
Laparoscopic repairs involve making small incisions (usually 3 in number) at a distance from the hernia through which instruments and a video camera are introduced to perform the repair. The abdomen is inflated with carbon dioxide in order to create a work space for the surgery. In the course of repair the hernia contents are pulled back into the abdomen. The defect is sometimes sutured closed. Then a thin piece of carefully selected mesh is typically sutured or tacked to the surrounding supporting tissues covering the defect. Laparoscopic repairs may allow for an easier recovery due to reduced post-operative pain in the first few days following surgery.
Occasionally, the surgeon may recommend performing the surgery using an open technique. An open repair will usually require an incision through or near the old incision site, then reducing the hernia sac and repairing the defect. The size of the incision will depend on the size of the hernia. A carefully selected mesh is often implanted to prevent undue tension on the repair.
This varies from patient to patient. Most likely, you will have a lifting restriction of 10-20lbs (about 1-2 gallons of milk) for 4-6 weeks following your procedure. You will want to plan the appropriate recovery time from work if you have a more strenuous job, such as those requiring heavy lifting. Many patients return to desk type work in around 1-2 weeks.
While recovery instructions may be tailored to individualize a plan of care based upon your specific needs, these instructions are common following hernia repair surgery:
- You will need to arrange for a ride home the day of your surgery and we recommend someone stay with you for the first 24 hours at home.
- When you leave the facility after surgery, we will want you to go home and rest. Avoid making any other plans on the day of your surgery. Starting the following day, you can increase your activity as you feel up to it.
- Avoid fried foods, milk products and citrus juices for around one day after your surgery. Suggestions for foods to eat include soup, sandwich, pasta, potatoes, toast, and applesauce.
- You will likely be given a prescription for pain medication following your surgery. The recovery nurse will discuss a pain control plan following surgery specific to you and your needs including activities like ice applied over incisions and a medication regimen. Often times we will recommend taking Tylenol and Advil (same as Motrin, Ibuprofen) or Aleve in addition to the narcotic pain medication.
- It is often suggested to start taking a stool softener twice daily the day following your procedure. You will want to continue this regimen as long as you are taking narcotic pain medications.
- You may be able to shower within a couple of days after your surgery depending upon the type of hernia repair and you will need to plan to avoid soaking in a tub or pool for around 1-2 weeks.
- The dressings applied to your surgical site will be specific to your procedure. If surgical glue is used, there will be no dressings to remove. If bandages are applied, they can usually be removed at home in 24-48 hours. You will receive care instructions specific to your procedure.
Visit our FAQ page to hear from board certified surgeon, Dr. Nicole Spencer, as she answers your most frequently asked questions.
To Make an Appointment
To find out more about Hernia Repair services we offer, please call Columbia Surgical Associates at 573-443-8773 and schedule an appointment.