Postoperative hernia

Incisional hernia (Lat. hernia cicatricalis) is a surgical complication involving the formation of a defect in the abdominal wall at the site of a previous surgical incision, through which the displacement of abdominal organs or their fragments occurs. This condition develops as a result of wound healing process disturbances, weakening of fascial structures, and the effect of chronic intra-abdominal pressure. Incisional hernias constitute a significant clinical problem due to the risk of defect enlargement, complications, and the necessity of repeated surgical intervention. Their incidence is estimated at 10–20% after laparotomy, while the risk increases with the presence of systemic and local factors.

Postoperative hernia – symptoms

The clinical presentation of an incisional hernia depends on the size of the defect, its location, and the contents of the hernia sac. In the initial stages, the lesions may remain asymptomatic; however, with progression, characteristic symptoms occur.

The most common symptoms include:

a bulge within the surgical scar, which intensifies during coughing, physical exertion, or standing up,
a sensation of pulling, discomfort, or pain, especially with increased tension of the abdominal wall,
visible asymmetry of the abdominal wall,
difficulty maintaining muscle tension in the operated area.

In more advanced cases, symptoms of complications may occur, such as:

hernia incarceration – inability to reduce its contents,
intestinal obstruction – manifesting as abdominal pain, bloating, nausea, and vomiting,
bowel ischemia and necrosis – a condition requiring urgent surgical intervention.

A clinical examination remains an essential element of diagnostics, supplemented when necessary by imaging tests such as ultrasonography (USG) or computed tomography (CT), which allow for an accurate assessment of the defect size and hernia contents.

Incisional hernia – treatment

Treatment of incisional hernia is primarily surgical, as spontaneous closure of the fascial defect does not occur. The therapeutic strategy depends on the size of the hernia, symptoms, risk of complications, and the general condition of the patient.

Conservative treatment

Non-surgical management has limi

Conservative treatment

Non-surgical management has limited application and mainly concerns patients with contraindications for surgery. It includes:

using hernia belts to stabilize the abdominal wall,
weight reduction in case of obesity,
avoiding increases in intra-abdominal pressure (e.g., chronic cough, constipation, lifting weights),
optimization of comorbidities (e.g., diabetes).

This approach is symptomatic in nature and does not eliminate the cause of the condition.

Surgical treatment

Surgical intervention is the method of choice. Contemporary surgical techniques include:

hernia repair using a synthetic mesh (so-called hernioplasty) – the standard of care, allowing for reinforcement of the abdominal wall and reduction of the risk of recurrence,
laparoscopic techniques (IPOM) – less invasive, associated with a shorter recovery time,
open surgeries – used in the case of large hernias or complications,
reconstructive techniques (e.g., component separation) – used in extensive abdominal wall defects.

Qualification for surgery

The decision on surgical treatment is based on:

size and progression of the hernia,
presence of clinical symptoms,
risk of incarceration or complications,
general condition of the patient and comorbidities.

In patients with high surgical risk, prior optimization of health status is necessary, including metabolic control and improvement of the body's functional capacity.

Postoperative complications

Despite the progress in surgical techniques, the treatment of incisional hernias carries a risk of complications, which include:

hernia recurrence (especially in the case of large defects),
surgical site or mesh infection,
chronic postoperative pain,
formation of a seroma (fluid collection),
damage to internal structures.

Proper patient preparation, choice of surgical technique, and the experience of the surgical team are of key importance for minimizing the risk of complications and achieving a lasting therapeutic effect.

mited application and mainly concerns patients with contraindications for surgery. It includes:

using hernia belts to stabilize the abdominal wall,
weight reduction in case of obesity,
avoiding increases in intra-abdominal pressure (e.g., chronic cough, constipation, lifting weights),
optimization of comorbidities (e.g., diabetes).

This approach is symptomatic in nature and does not eliminate the cause of the condition.

Surgical treatment

Surgical intervention is the method of choice. Contemporary surgical techniques include:

hernia repair using a synthetic mesh (so-called hernioplasty) – the standard of care, allowing for reinforcement of the abdominal wall and reduction of the risk of recurrence,
laparoscopic techniques (IPOM) – less invasive, associated with a shorter recovery time,
open surgeries – used in the case of large hernias or complications,
reconstructive techniques (e.g., component separation) – used in extensive abdominal wall defects.

Qualification for surgery

The decision on surgical treatment is based on:

size and progression of the hernia,
presence of clinical symptoms,
risk of incarceration or complications,
general condition of the patient and comorbidities.

In patients with high surgical risk, prior optimization of health status is necessary, including metabolic control and improvement of the body's functional capacity.

Supportive management and procedures improving tissue quality

In the context of preparing for surgical treatment and improving the quality of tissue healing, supportive measures are important, including:

improving blood supply and nutrition of tissues,
stimulation of regenerative processes,
microcirculation support.

In clinical practice, the following are used, among others:

regenerative therapies (e.g., platelet-rich plasma – PRP),
needle mesotherapy improving the trophicity of the skin and subcutaneous tissue,
physical treatments supporting microcirculation (e.g., carboxytherapy).

Their role is complementary and does not replace surgical treatment; however, it can beneficially influence the healing processes and the quality of tissues within the postoperative scar.