What is an incisional hernia?
An incisional hernia, also known as a ventral hernia, is a bulging of intestines or fatty tissue through a weakened area in the abdominal wall following a previous surgery. This weakness occurs in the scar from the initial operation, where the abdominal wall has not healed optimally, leading to a bulge around the scar area. Incisional hernias can vary significantly in size and can occur in any part of the abdominal wall, depending on where the initial operation was performed.
Why do incisional hernias occur?
An incisional hernia occurs when the abdominal wall has not healed strongly enough after surgery. This can be due to factors such as wound infection, repeated strain on the abdominal wall, obesity, smoking, or other causes of poor wound healing. Patients who have experienced complicated wound healing or infections after surgery have a higher risk of developing an incisional hernia. There is also likely a genetic component, as individuals with a specific connective tissue weakness may be more prone to hernias. Additionally, patients undergoing multiple surgeries in the same area have an increased risk.
Risk of complications with incisional hernias
In some cases, an incisional hernia may become stuck or strangulated, compromising blood flow to the hernia. This can cause acute pain and requires immediate surgical treatment to avoid serious complications, such as tissue death. Due to the hernia's size and location, large incisional hernias can also lead to other issues, including discomfort and reduced quality of life.
The patient's journey from general practitioner to specialist
When a patient notices a bulge at the scar from a previous surgery, they often consult their general practitioner. If the hernia causes discomfort or poses a risk of complications, the patient is referred to a surgical department. Here, the surgeon and the patient will evaluate whether surgery is necessary and which type of surgery is most appropriate. Depending on the hernia’s location and size, a CT scan may be performed to help plan the surgery.
Historical development of surgical techniques
In the past, incisional hernias were mainly treated without the use of mesh, leading to a high risk of recurrence. Today, synthetic mesh is often used to reinforce the abdominal wall around the hernia and reduce the risk of recurrence. Techniques range from open surgery to laparoscopic (keyhole) methods, where the mesh is placed on the inside of the abdominal wall through small incisions, minimizing healing time and reducing the risk of infections. Newer techniques and materials allow for more tailored treatments to suit the individual patient's needs and risk factors.
Risk of recurrence and chronic pain
Although modern surgical techniques have reduced the risk of recurrence, some patients may still experience chronic pain after the procedure. The risk factors for recurrence and pain are complex and may include the size of the scar, the location of the hernia, and the patient’s overall health. Researchers continue to work on ways to improve long-term outcomes and reduce chronic pain and recurrence after incisional hernia surgeries. The "AfterHernia" project is part of this research activity, aiming to provide better treatment for individual patients in the future.
Current and future research areas
Research in incisional hernia treatment focuses on developing new materials and methods to strengthen the abdominal wall without causing discomfort or increasing infection risk. Experiments are ongoing with biocompatible mesh materials that can integrate naturally into the body, as well as methods to strengthen the abdominal wall using growth factors that promote wound healing. There is also ongoing research to understand the genetic and environmental factors that increase the risk of incisional hernias, with the goal of more accurately predicting and preventing hernias. The future may bring even more personalized solutions that consider the patient's individual risk profile and health status.