Incisional hernias (alternative plural: herniae) are relatively common and along with parastomal hernias, umbilical hernias, paraumbilical hernias, and Spigelian hernias, they are usually anterior abdominal hernias.
Incisional hernias usually develop within a few months of surgery, but a small proportion can remain clinically silent for years. They typically occur after laparotomy with rates of ~7.5%.
Numerous risk factors for developing an incisional hernia have been identified 4:
- pre-operative factors: increasing age, female gender, BMI >25, increasing thickness of subcutaneous fat based on CT, pre-operative chemotherapy
- intra-operative factors: midline incision, contaminated or infected wound noted during procedure, intra-operative blood loss
- post-operative factors: surgical site infection
Incisional hernias occur most frequently through previous laparotomy scars (other incisional hernias are possible, such as a lung hernia). Widening or dehiscence of the scar allows intra-abdominal contents to herniate into the subcutaneous tissues.
Treatment and prognosis
- 1. Zafar HM, Levine MS, Rubesin SE et-al. Anterior abdominal wall hernias: findings in barium studies. Radiographics. 26 (3): 691-9. doi:10.1148/rg.263055714 - Pubmed citation
- 2. Lassandro F, Iasiello F, Pizza NL et-al. Abdominal hernias: Radiological features. World J Gastrointest Endosc. 2011;3 (6): 110-7. doi:10.4253/wjge.v3.i6.110 - Free text at pubmed - Pubmed citation
- 3. Aguirre DA, Santosa AC, Casola G et-al. Abdominal wall hernias: imaging features, complications, and diagnostic pitfalls at multi-detector row CT. Radiographics. 2005;25 (6): 1501-20. Radiographics (full text) - doi:10.1148/rg.256055018 - Pubmed citation
- 4. Itatsu K, Yokoyama Y, Sugawara G, Kubota H, Tojima Y, Kurumiya Y, Kono H, Yamamoto H, Ando M, Nagino M. Incidence of and risk factors for incisional hernia after abdominal surgery. (2014) The British journal of surgery. 101 (11): 1439-47. doi:10.1002/bjs.9600 - Pubmed