The extent of the herniation (fascial defect and identification of hernial sac) usually can be felt by hand (palpated).
In general, the mass that protrudes through the incision site can be pushed back into the abdominal cavity with a finger (reducible).
Incisional hernia results from the weakened condition of the superficial sheet of connective tissue that covers and joins the rectus abdominis muscles (fascial tissue called linea alba) along the surgical incision line.
Weakness occurs most commonly following lower midline abdominal surgeries (34%) (Deveney).
Herniation is more likely in vertical incisions than in horizontal (transverse) incisions.
Normal tissue is replaced by scar tissue along the incision as part of the healing process, but scar tissue is not as strong and is more subject to tears.
Physical exam: Examination is performed with the patient lying down and standing.
The incision sometimes is closed using a patch of polypropylene mesh material as added support for weakened fascia.As an alternative to open surgery, incisional repair with mesh implantation may be done using a lighted, flexible fiberoptic device (laparoscope) that allows visualization of the wound and inner abdomen.If the individual does not want surgery or is a poor risk for the procedure, manual reduction may be performed followed by use of an elastic corset to support the weakened area and control symptoms.Individuals over age 35 tend to have a longer period of disability. An incisional hernia is the protrusion of abdominal organs through a weakened area in the abdominal wall at the incision site of a previous abdominal surgery with a well-healed skin wound.
Although it is a treatment-related (iatrogenic) hernia, certain lifestyle factors and physical conditions may predispose individuals to develop of this type of hernia.An incisional hernia is not to be confused with a surgical wound dehiscence; in an incisional hernia, the skin is healthy and has healed.