Yes, a person can develop a hernia following surgery, a recognized and relatively common post-operative complication. This condition, specifically known as an incisional hernia, results from a weakness in the abdominal wall where a surgical incision was previously made. Estimates suggest that up to 20% of patients who undergo open abdominal surgery may develop one. It occurs when the natural healing process fails to restore the full strength of the muscle and fascial layers, allowing internal pressure to create an opening.
Understanding Incisional Hernias
An incisional hernia is the protrusion of abdominal contents, such as fat or a loop of intestine, through the defect created by a surgical cut. The mechanism involves the failure of the fascia, the strong connective tissue layer that closes the muscle, to knit back together completely. Unlike other types of hernias that occur at natural points of weakness, this type is directly attributable to the site of a previous operation.
The contents of the abdomen push outward through this acquired weak spot, forming a hernia sac beneath the skin. The appearance of an incisional hernia can be delayed, often surfacing between three and six months after the initial procedure, though they can manifest years later.
Factors That Increase Hernia Risk
The development of an incisional hernia involves patient health characteristics and elements related to the surgical procedure. Patient-specific factors that impair healing significantly increase the risk, such as obesity and diabetes mellitus, which compromise tissue strength and wound healing.
Smoking is a major contributor, as it reduces oxygen delivery to tissues essential for scar formation and repair. Additionally, chronic conditions that increase pressure within the abdomen, such as chronic obstructive pulmonary disease (COPD) causing persistent coughing, place excessive strain on the healing incision. Advanced age and the use of certain medications, including steroids, can also weaken connective tissue.
Surgical and post-operative variables also play a role. Developing a wound infection after the initial surgery is a strong predictor of subsequent hernia formation, as it disrupts the integrity of the closing tissue. The choice of incision is also relevant; a midline incision carries a higher risk compared to a transverse incision.
Premature or excessive physical activity, such as heavy lifting or strenuous straining too soon after the operation, can mechanically force the healing layers apart. Emergency surgery also tends to carry a higher risk compared to elective procedures, potentially due to the urgency preventing optimal wound closure technique or patient preparation.
Identifying Symptoms and Diagnosis
The most recognizable symptom of an incisional hernia is a visible bulge or lump near the surgical scar. This protrusion often becomes more noticeable when the patient is standing, coughing, sneezing, or engaging in any activity that increases intra-abdominal pressure. Patients may also experience a dull ache, pressure, or heaviness in the area, particularly with physical exertion.
Diagnosis typically begins with a medical history and a physical examination. The doctor will palpate the area and may ask the patient to cough to confirm the presence of a reducible lump that protrudes under strain. Imaging tests are frequently used to confirm the diagnosis, determine the exact size of the defect, and identify the contents of the hernia sac.
An ultrasound, CT scan, or MRI scan provides detailed information necessary for planning treatment. In rare but serious cases, an incisional hernia can become incarcerated (contents are trapped) or strangulated (blood supply is cut off). Signs of this complication, such as severe pain, fever, rapid heart rate, or nausea and vomiting, require immediate medical attention.
Surgical Repair Options
Surgery is the standard treatment for incisional hernias, as the defect in the abdominal wall will not close on its own. The goal is to return the protruding contents into the abdominal cavity and reinforce the weakened area to prevent recurrence. Several surgical approaches are tailored based on the hernia’s size and the patient’s overall health.
One method is primary repair, or herniorrhaphy, where the surgeon stitches the edges of the fascial defect back together. This technique is typically reserved for very small hernias, as there is a higher chance of recurrence due to tension on the stitched tissue.
For larger or recurrent hernias, the preferred approach is hernioplasty, which involves closing the defect and reinforcing the area with a synthetic or biologic mesh. The mesh acts as a scaffold to provide long-term structural support, significantly lowering the risk of recurrence.
Repair can be performed using an open approach, which involves a single, larger incision directly over the hernia site. Alternatively, a laparoscopic or robotic-assisted approach uses several small incisions to insert a camera and specialized instruments, often resulting in a faster recovery and reduced risk of wound infection.