Incisional Hernia (Ventral or

Post-Operative Hernia)

•Def- An incisional hernia is one which occurs through

an acquired scar in abdominal wall caused by a
previous surgical operation or an accidental
trauma.

•Aetiology -
1) Defect with patient- a) Obese individuals with lax
muscles
b) Patient with chronic cough
c) Undue abdominal distention
d) Malnutrition- patient with
severe anaemia,vit.c deficiency
2) Fault during operation- a) Injury to motor nerves
supply area.
e.g.- Kochers sub costal
incision for cholecystectomy inflicts injury
to 8th,9th,1oth intercostal nerve.
- Battles pararectal
incision for appendicetomy
- Mc. Burneys incision for
appendicetomy may injure ilioingualnerve.
b) Care was not taken during
closure of wound particularly deeper layers.
c) Haemostasis was not
perfect or tissues were manhandled so that early
 post-operative infection was the result.
d) Certain incisions e.g.
midline infra umbilical incision for L.S.C.S
3) Post-operative- a) Infections
b) Post operative cough and
distention
c) Post operative peritonitis due to
more chance of wound infection
d) Too early removal of sutures
e) Steroid therapy in post-
operative period.
•Pathology - a) Starts unnoticed and symptomless with
partial disruption of deeper layers of
laprotomy wound during early post-operative
period. so careful closure of wound is important
to prevent incisional hernia.
b) Wound infecion often causes
disruptions of sutures thus muscles are separated by
weak scar tissue. A portion of muscles may also be
destroyed by infections which
are resolved by fibrosis, this thus causes incisional
hernia.
•Clinical Features - a) History - Patient with wound
infection
b) Age - Any age but commo
nly fatty elderly females
•Symptoms - a)Swelling and pain,
b)sometimes attack of subacute
intestional obstruction may occur leading to
 abdominal colic,
c) vomiting,
d) constipation and
e)distention of abdomen.
•On Examination - Old scar with swelling.
swelling is reducible and
expansible cough impulse is present.
Defect in abdominal wall is
palpable

When hernia is irreducible than can be differential

diagnosis can be done with -
a) A deposit of tumour.
b) Old abscess
c) Haematoma
d) Foreign body granuloma
•Types - a) Type - I ( lies in midline of lower
abdomen)
b) Type - II ( lies in lateral part of
abdomen)
Treatment - A) Preventive treatment -
-- Pt. if obese reduce weight
-- chronic bronchitis should be
treated first
-- care during operation = deeper
layers must be sutured
-- precautions to prevent
immediate post operative wound infection.
B) Conservative treatment -
 -- Done in Type - I cases if
reducible and where operation is contraindicated
due to condition of the patient.
After reducing hernia a belt is fitted with suitable
pad so that hernia doesnot come out, if this is
continued for long than there is possibility of cure.
C) Operative treatment -
-- Done in Type - II and if cases
are irreducible.