Abdominal incisional hernias
What is an abdominal incisional hernia?
The word “hernia” indicates a condition in which organs and other tissues do not remain in their original location inside the body, but are protruding through a weak area in the muscular wall covering the body to form a bulge under the skin. The scar that remains after the wound of abdominal surgery has healed, is weaker than the surrounding tissue, and the intestines may bulge through this weakness to form an abdominal incisional hernia. One can usually see an obvious bulge through the surface of the abdomen, which becomes larger when pressure is put on the stomach. In Japan approximately 10,000 people undergo surgery for this condition annually.
Why do abdominal incisional hernias occur?
An incision is made in the abdomen to perform surgery for intestinal cancer or other conditions, which is stitched together when the surgery has been completed.
This wound, however, may not heal well due to obesity, smoking, emergency surgery, abscess formation of the wound, poor nutritional status of the patient, or other factors that affect wound healing, like the effect of medications taken by the patient for underlying diseases, etc.
If the wound does not heal well, and the surrounding muscles or fascia do not remain connected by the stitches, an opening forms and the content of the abdominal cavity can protrude through this opening underneath the skin, forming a hernia. This occurs in approximately 11% to 20% of all cases of abdominal surgery.
Can an abdominal incisional hernia heal spontaneously?
No, an abdominal incisional hernia cannot heal by itself. The only treatment available at present is surgical repair.
What happens if an abdominal incisional hernia is not repaired surgically?
The hernia bulge can usually be “reduced” or pushed back into the abdominal cavity when pressure on the stomach muscles is released. When one stands up, or pressure on the abdomen increases in other ways, the bulge appears again.
It may sometimes become impossible to push the bulge back into the abdominal cavity, and such a situation is called incarceration.
Incarceration is a very dangerous condition that requires emergency surgery. If the intestines become entangeled, which is called strangulation, and the blood flow to the intestines, or part of the intestines is thus cut off, or if such a part of the intestines becomes necrotic, it is a life-threatening situation that can be fatal.
If an abdominal incisional hernia is not surgically treated, 13% to 33% of patients will undergo surgery within 4 to 5 years for any of the following varied reasons:
- The hernia becomes painful
- The bulge becomes larger
- Seeing the bulge becomes a concern and is bothersome.
- The patient requests surgery.
- Emergency surgery becomes necessary.
Emergency surgery is performed in approximately 1.7% to 7.7% of cases.
Which treatment methods are available?
【1. Using the patient’s own tissue to repair the hernia】
With this treatment method, a patient’s own tissue is used to repair the weakened area by stitching it.
One advantage of this method is that infection is less likely to develop than with a synthetic membrane (mesh) patch since the patient’s own tissue is used.
A disadvantage of the method, however, is that already weakened tissue in the area is used for the surgery, increasing the possibility of recurrence, and patients also may have stronger post-operative pain that lasts longer.
This classical method is presently only used under very special circumstances.
【2. Using synthetic mesh to repair the hernia】
The weakened part of the abdominal wall is reinforced using a mesh patch made of synthetic material that does not cause any problems when implanted in the human body.
The surgeon will determine which kind of surgery would be most appropriate based on the kind of treatment the patient has received before, the site where the hernia has formed and its size, and the patient’s general condition, and will then discuss the options with the patient to decide on the final procedure.
The incidence of recurrence is generally considered to be 32% to 10%.
At this hospital over 150 surgical repair procedures for abdominal incisional hernia have been performed since 2014, and the recurrence rate was 0.7%.
Since 2014, laparoscopic repair is also performed for abdominal incisional hernias, and there have been no cases of recurrence with this procedure so far.
In Japan there is not an official certification system for hernia repair techniques, but certification is available for laparoscopic hernia repair, and of the only 66 surgeons who have received certification as of July 2017, two are performing laparoscopic hernia repair procedures at this center on a full-time basis.