Incisional Hernia?

[Susan BAV]

I read a post in another forum about incisional hernias. At the bottom of my OHS scar is a little poofy bloop that has been there since surgery and has never gone away. Is that what they're called, "incisional hernias?" Are they a problem? Does everyone have them? Are they indicative of anything, like a tendency to herniate or anything? What do you know about them?

 

[DeWayne]

check my picture under the tawdry shirt. Yep that is an incisional hernia. My primary and my cardiologist have both looked at it, and were not overly alarmed. Its there, it does not hurt, its not a problem other than it looks horrible. I was told its not necessary to repair it unless it bothers me. That it would be more for cosmetic than anything else. Mainly because its quite large. Smaller ones can be more of a problem. Mine started smaller, and has grown. Not sure what I will do about it yet. But my cardiologist told me repair is quite painful lol, So for now not sure I am ready for that.
And I am going to my 35 th class reunion in July and plan on playing golf all week so I won't do anything till after that if I do.

 

[Susan BAV]

Hi Dewayne - Thanks for the reply. You wrote that smaller ones can be more of a problem and that yours was smaller but has grown? Do you mean smaller ones can be more of a problem to repair? Do they know why yours has grown? I don't think mine could grow because it's up against my sternum and I don't think that would allow expansion. Does yours need repaired because of the growth?

Does anyone know how/why the repair of them is described as being so painful? Or how/why they even develop? I searched this site and I didn't really find answers within the hits. When I asked my cardio about it he didn't seem to know what it was. The thing at the bottom of my scar almost looks like it could just be drained or something but it also looks a bit like those things on some of the scar photos.

Anyone else have any experience with these or know anything about them?

 

[Ross]

They don't worry about it, but it feels like someone is punching me in the gut if they poke it, so I wanted mine fixed. 3 fixes and 3 faliures. I'm stuck with it.ALIEN they just plug them like most others, btu I'm thinking laproscopic might be a good way to go with these too.

 

[MrP]

My hernia is located just below my sternum at the lower part of my incision, and my cardiologist told me "the bulge" was my intestines....the weakened muscle unable to contain. He told me I could have cosmetic surgery or just continue to push the intestines back in when the bulge increases in size. I was thinking of cosmetic surgery until reading this thread and would like to hear from someone who had this fixed successfully.

 

[dcpickle]

I have one of these things, too. Mine looks somewhat like Dewayne's in his photo, but it has not really grown much over these 2 years since surgery. No one, not even my surgeon seemed to know what it was until I went to a new cardiologist a few months ago. He is a young guy, but he immediately pronounced it a something-something hernia. He said repairs were exceedingly difficult, so unless it's bothering me, I should ignore it. It doesn't hurt; it's just annoying. I wish I could get rid of it, but I guess I'm stuck with it.

David

 

[DeWayne]

They don't worry about it, but it feels like someone is punching me in the gut if they poke it, so I wanted mine fixed. 3 fixes and 3 faliures. I'm stuck with it.ALIEN they just plug them like most others, but I'm thinking laproscopic might be a good way to go with these too.

I was reading something from Emory last night that said the larger ones laproscopic seemed to be more successfuul (and less paingful)

 

[DeWayne]

Susan by small I mean usually under 3 cm. Small ones depending on where they are can cause problems from strangulation of the intestine etc. Or they go through the diaphram in this manner. Mine started out looking like a small piece of tape was under the skin, it sort of blossomed into what you see. It has remained pretty much as it looks for the past couple months or so.

 

[Susan BAV]

Interesting replies, one and all. Thank you.

I don't think my intestines could have sneaked up that far between my sternum and my scar. So I don't know what this bump of mine could be exactly.

I know regular hernias are escaped intestines but are incisional hernias always the same as that?

It doesn't bother me, and I usually do ignore it, but it looks kind of strange and I'd like to know exactly what it is, since it's evidently not going away as I thought it would. I kept thinking it was some fluid-filled sac of some kind and would probably eventually just reabsorb. But it's still there...

MrP, a member here named "Birky" was having a surgery for an incisional hernia some time ago (and this is an example of my poor memory because I see that I had posted on her threads about it quite some time ago) but I haven't searched for a followup post from her about it yet.

Dewayne, the doctors don't think yours is an urgent issue even with its quick growth?

David, my cardio didn't know what the thing was either. He didn't seem concerned though. I'm glad yours said don't worry also.

Ross, do you have three plugs on top of each other or did they take each old one out to put in each new one? I guess they can't use a screen mesh with one up that high, can they?

 

[Ross]

Ross, do you have three plugs on top of each other or did they take each old one out to put in each new one? I guess they can't use a screen mesh with one up that high, can they?

Dr. Meyerhoefer tried mesh screening the first time around and it did not hold at all. Next up was a single plug, which again failed a short time later. Finally, during my AVR he used a plug and fashioned some sort of upside down basket and put those both in there. You can see it sticking out today, so it didn't work either. He's ongoing advice--forget it!

 

[MrP]

Susan BAV, I don't know if there's a distinction but do know that my intestines at the lower end of my incision buldge out. The hernia was a direct result of surgery. I can push the bulge in (about an inch in diameter) and eventually it enlarges again...sometimes right away. Although pushups are ill-advised after surgery, I tried doing pushups one time about 9mos to a year post op and caused my intestines to bulge out immediately quite a bit. My cardiologist reassured me it was no big deal and can be fixed quite easily if I elect to do this.

 

[Susan BAV]

Found this in Answers.

Found this in Answers.

That should have said, Found this in Answers.Com:

Description

"An incisional hernia can develop in the scar tissue around any surgery performed in the abdominal area, from the breastbone down to the groin. Depending upon the location of the hernia, internal organs may press through the weakened abdominal wall. The rate of incisional hernia occurrence can be as high as 13% with some abdominal surgeries. These hernias may occur after large surgeries such as intestinal or vascular (heart, arteries, and veins) surgery, or after smaller surgeries such as an appendectomy or a laparoscopy, which typically requires a small incision at the navel. Incisional hernias themselves can be very small or large and complex, involving growth along the scar tissue of a large incision. They may develop months after the surgery or years after, usually because of inadequate healing or excessive pressure on an abdominal wall scar. The factors that increase the risk of incisional hernia are conditions that increase strain on the abdominal wall, such as obesity, advanced age, malnutrition, poor metabolism (digestion and assimilation of essential nutrients), pregnancy, dialysis, excess fluid retention, and either infection or hematoma (bleeding under the skin) after a prior surgery.

Tension created when sutures are used to close a surgical wound may also be responsible for developing an incisional hernia. Tension is known to influence poor healing conditions because of related swelling and wound separation. Tension and abdominal pressure are greater in people who are overweight, creating greater risk of developing incisional hernias following any abdominal surgery, including surgery for a prior inguinal (groin) hernia. People who have been treated with steroids or chemotherapy are also at greater risk for developing incisional hernias because of the affect these drugs have on the healing process.

The first symptom a person may have with an incisional hernia is pain, with or without a bulge in the abdomen at or near the site of the original surgery. Incisional hernias can increase in size and gradually produce more noticeable symptoms. Incisional hernias may or may not require surgical treatment.

The effectiveness of surgical repair of an incisional hernia depends in part on reducing or eliminating tension at the surgical wound. The tension-free method used by many medical centers and preferred by surgeons who specialize in hernia repair involves the permanent placement of surgical (prosthetic) steel or polypropylene mesh patches well beyond the edges of the weakened area of the abdominal wall. The mesh is sewn to the area, bridging the hole or weakened area beneath it. As the area heals, the mesh becomes firmly integrated into the inner abdominal wall membrane (peritoneum) that protects the organs of the abdomen. This method creates little or no tension and has a lower rate of hernia recurrence, as well as a faster recovery with less pain. Incisional hernias recur more frequently when staples are used rather than sutures to secure mesh to the abdominal wall. Autogenous tissue (skin from the patient's own body) has also been used for this type of repair."

There was more information there also, in Answers.Com, regarding different surgery options, etc.

 

[DeWayne]

Interesting replies, one and all. Thank you.

I know regular hernias are escaped intestines but are incisional hernias always the same as that?


Dewayne, the doctors don't think yours is an urgent issue even with its quick growth?

That is what they have said. And the cardiologist saw it about a week and a half ago. And yes the protrusion is intestines. When I went to my primary for an infection a couple months ago, I pointed it out, he told me what it was. He said make sure my cardiologist saw it when I had my 6 month. So neither of them has been overly concerned about its appearance.