All about Incisional Hernias

Incisional hernias often require the use of mesh during the surgery to repair the hernia, but the mesh can be defective and cause injuries. When injuries occur due to a defective hernia mesh, you may be entitled to compensation.

Incisional hernias arise after a patient has already undergone some sort of abdominal surgery (laparotomy). They occur at the site of the incision or the surgical scar and may arise after an operation to remove a hernia. Additionally, they may occur after

  • Appendectomy
  • Cesarean delivery
  • Bowel surgery
  • Organ transplant
  • Exploratory surgery

After abdominal surgery, the stomach muscles have been cut and therefore weakened. The incisional hernia, like all hernias, occurs when the tissue inside the body can bulge out of the hole in the weakened muscle.

To a certain extent, incisional hernias are an unavoidable risk of abdominal surgery. However, they can also be caused by improper surgical techniques, faulty medical devices (such as hernia mesh), and/or improper care. Read on to learn about the symptoms, risks, and appropriate measures to prevent and treat incisional hernias.

Hernia mesh
Incisional hernias often require the use of mesh during the surgery to repair the hernia, but the mesh can be defective and cause injuries.

1. What are the rates and chances of recurrence?

Incisional hernias are the second most common type of hernia in the United States, behind inguinal hernias. They represent 15-20% of all hernias, and 100,000 to 150,000 operations to correct incisional hernias are performed each year. 1

All laparotomies (stomach surgeries) carry with them a 33% chance of a postoperative incisional hernia, meaning that about one-third of patients will experience them after surgery. 2

2. What are the risk factors?

All patients who have undergone abdominal surgery are at risk for developing incisional hernias. However, they are more likely to occur if the patient

  • Experiences rapid weight gain after surgery
  • Becomes pregnant
  • Participates in strenuous activity.

Incisional hernias are most likely to occur three to six months after a surgery, but they can occur at any time at or near the surgical scar.

3. How do you prevent incisional hernias after abdominal surgery?

In order to lower the chance of developing an incisional hernia, physicians recommend taking precautions. All patients who have undergone a hernia repair or any other kind of abdominal surgery should take care to

  • Avoid straining the abdominal muscles by treating constipation
  • Reduce stress when coughing or sneezing
  • Limit the physical pressure put on the wound
  • Keep the wound clean to prevent infection, which can contribute to hernia development
  • Use prescribed gels and medication to encourage healing

In addition, your physician's surgical technique can contribute to the prevention or development of incisional hernias. Failing to take these considerations into account may actually cause the patient harm or necessitate further surgeries.

4. What are the possible complications?

Most incisional hernias should be manageable and operated on in a timely manner. The most serious complication of an incisional hernia is its capacity to become incarcerated or strangulated.

  1. Incarcerated hernias occur when the tissue is caught in the abdominal muscle and will not go back into the body, even when the patient is relaxed.
  2. Strangulated hernias refer to a hernia which has lost blood flow. This condition can result in permanent damage if not treated immediately.

Unfortunately, incisional hernias can be particularly complicated because they arise at the site of a previous surgery. The tissue surrounding the original incision site may be compromised. If the abdominal wall is still weak or healing from the surgery, it can be more difficult to complete the repair, and a more skilled surgeon is required. 3

Factors to consider include

  • The number of previous surgeries
  • The size of the hernia and the amount of viable tissue
  • Current health of the patient
  • Patient characteristics such as age, chronic diseases, and genetic factors.

Your doctor is responsible for evaluating all of the possible risks and complications and advising you as to the best course of action in treating your incisional hernia.

5. What does corrective surgery involve?

If you present with an incisional hernia, your doctor will likely recommend immediate surgery to fix it, as these hernias typically will not resolve on their own. To repair this hernia, you will undergo one of two types of surgery.

  1. Laparoscopic surgery refers to a technique in which the surgeon makes four small incisions around the hernia and uses small surgical instruments inside of the body to replace the tissue and repair the hole. A fiber optic cable is used to light this procedure.
  2. Open surgery may be required, depending on the case. In open surgery, your doctor will make one long incision above the hernia, replace the tissue, and stitch or otherwise attach the abdominal walls together again.

In either of these surgeries, your doctor may choose to use mesh in order to hold the abdominal wall closed after replacing the tissue of the hernia. Larger hernias may require mesh while smaller ones can be closed with strong sutures. 4

6. What is hernia repair mesh?

Mesh is very commonly used in incisional hernia repair. Since incisional hernias occur after surgery, the fascia (tissue surrounding the muscle or organ) can be compromised or even missing. While, when used correctly, mesh can improve patient outcomes. Unfortunately, hernia repair mesh can also cause serious complications, including

Some types of synthetic hernia repair mesh are more closely associated with these complications. 5 Some forms of surgical mesh have been recalled due to defects and unnecessary injury arising from their use. Incisional hernias can arise from improper use of mesh or mesh defects. Medical manufacturers, medical supply companies, and hospitals all have a responsibility to protect patients from unnecessary harm and trauma.

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7. When should you consult a personal injury attorney?

Incisional hernias can be particularly painful and cause distress because the patient has already undergone one surgery. Instead of healing, the patient is forced to endure another operation.

If you have any reason to suspect that your incisional hernia was not a routine complication, it is always best to contact a personal injury attorney about the possibility of a hernia mesh lawsuit. Defective hernia mesh can cause unnecessary complications after surgery. Medical devices should be properly tested and evaluated before use on a patient, and you have a right to understand the risks associated with your surgery.

References

  1. Castilo, Juan Luis. Laparoscopic Incisional Hernia Repair. Medscape. Nov, 2017.
  2. Johns Hopkins Health Library. Incisional Hernias.
  3. Emegoakor, CD, El Dike, and FC Emegoakor.Unusual Complications of Incisional Hernias. Annals of Medical and Health Sciences Research. 2014 Nov-Dec; 4(6): 971–974.
  4. Dietz, Ulrich A., Simone Menzel, Johan Lock, and Armin Wiegering. The Treatment of Incisional Hernia. Dtsch Arztebl Int. 2018 Jan; 115(3): 31–37.
  5. US Food and Drug Administration. Hernia Surgical Mesh Implants.

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