Incisional Hernia – What It Is and Why It Happens

Hey, what’s up you guys? My name is Buck Parker. I am a board-certified general surgeon.

In this video, we’re gonna talk about incisional hernias. So if you don’t know what a hernia is, check out my other videos. I have lots of videos on hernias and one on the definition of a hernia, and you can check out the definition there. But this one, we’re gonna talk about specifically incisional hernias.

So hernias is basically an abnormal hole in the structure, okay? So in this case, we’re talking about the abdominal wall. And when you have surgery, okay? Let’s do a little anatomy first. We cut through the abdominal wall, or multiple layers of the abdominal wall, okay? And most of the time, when we’re talking about hernias, or incisional hernias, we’re talking about the abdomen. Now I guess you can get one, maybe in the chest or something like that too. And it’s basically the same types of principle.

So the strong layers of the abdomen and/or chest hold all the contents of our bellies inside. So the organs and things. And when we make an incision, say we make an incision around your belly button. And we go in, and maybe we fix some valves. Or we’re taking your appendix out or take your gallbladder out or something like that. We are cutting through the strong layer of the abdominal wall, and the incisional hernia is later down the line if that incision does not heal. If the layer underneath, the strong layer underneath, does not heal – by the way, that’s usually the anterior rectal sheath for you nerds out there. But the anterior rectal sheath does not heal back together, and that forms a little hole there. Then you have an incisional hernia, so that is not from just being human. It’s because you had a surgery, and you had an incision there. So we call it an incisional hernia.

So just like a regular hernia, there are a couple problems with incisional hernias. And that is if you have abdominal contents go through that hole and get stuck, so the most common ones are the omentum. The omentum is this big, fat layer. It’s almost like a drape. A gross, big, fat drape. Would you wanna hang fat drapes on your front of your window? Just roll them up, roll them down? Probably not.

Anyway, you have this fat drape that goes over the top of the bowels. And a lot of times, that will get pushed up into the hole from the incision and get stuck. And that can cause pain, maybe a little bit of bloating, maybe some fevers and chills too. But typically, it’s just painful. And it swells, so that’s not terribly bad. But nobody wants pain, so you should probably get that fixed.

The other problems are when the bowels go through, especially the small bowel. The small bowel can get obstructed if it sticks through that hole, and it loops around. And it sticks in there really bad. Then that small bowel can get obstructed, and that can be a problem because then you can’t eat. And everybody likes eating, I tell you what! Nobody likes to not eat. And I know this because I was on a TV show, Bear Grylls, called The Island. And I barely ate a damn thing for 28 days. We had, basically like, 100 calories a day. It was terrible. It was a great experience, and I suggest if you can go eating 100 calories a day for 28 days, you should do it because you’ll appreciate every single morsel of food after that. But it was very tough, and I’m not sure it’s something you wanna do in your daily life.

That’s your incisional hernias, so what you wanna do for incisional hernia. Unfortunately, when you have your appendix out or when you have your gallbladder out or you have another operation on your abdomen and you then have a hernia after that, you need another surgery to fix that problem with the first surgery, which sucks. So this is why you wanna pay attention and follow the doctor’s rules and orders after your appendix surgery, after your gallbladder surgery, after your hernia surgery because you can have another hernia surgery for the hernia surgery, which is a bummer. So you wanna pay attention. No lifting much more than 20 pounds. I usually say two to four weeks, depending on who you are and what you do before. And no increasing abdominal pressure, things like that. So you wanna pay super good attention because you don’t want one surgery to turn into two.

So how do you fix an incisional hernia? Basically, it depends on the size of the incisional hernia. So if you have a little teeny one, it’s a couple centimeters, and there’s not a bunch of stuff getting stuffed through that, then maybe it’s a small couple sutures. In and out surgery type of thing. Now if it’s a really big one and your abdominal wall doesn’t connect anymore and they’re very, very separated, that’s a bigger surgery. That’s more like what we call abdominal wall reconstruction where we have to move the layers of your abdomen around a little bit, and sometimes that requires mesh.

And then there’s the ones in between that are bigger than about three centimeters, so if you fix them just primarily – and by primarily, I mean just with a suture. Just a little sewing like this. This is the universal sign for sewing like that, so if you just fix them with the suture and not a mesh, then those have a higher likelihood to come back, depending on who you are.

So that’s my spiel on incisional hernias. I hope that helps you a little bit. If you liked this video, well, you should like the video. Then click the button, the little thumbs up thing. Click that little thumbs up. That’d be awesome. Maybe share it, and subscribe to my channel if you would. That’d be sweet, and I’ll see you in the next one. Take care.

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