An incisional hernia is a protrusion of tissue that forms at the site of a healing surgical scar. This is a type of ventral hernia and accounts for 15-20% of all abdominal hernias, occurring when improper healing from previous surgery further weakens abdominal muscles. The hernia appears as a bulge under the skin and can be painful or tender to the touch. The characteristic “bulge” of an incisional hernia can be identified when you are standing upright or are performing physical activity, such as heavy lifting. Incisional hernias do not heal on their own and require surgical treatment to repair.
Dr. Ford will look and feel for a bulge in your incision. He may ask you to lie down with your legs bent. He may also ask you to cough while standing up. You may need a CT scan to show the hernia.
People who had abdominal surgery are at risk for developing incisional hernias. They are especially susceptible three to six months following the procedure when the tissues are healing from the incision. Incisional Hernias are more likely after emergency surgery or surgery that requires a large incision. If the edges of the wound aren’t properly aligned after surgery, the incision may not heal well, increasing the likelihood of a hernia. The sewing technique used to close the incision can also play a part.
Strenuous activity, substantial weight gain, or pregnancy can cause excessive stress on the healing abdominal tissue and should be avoided during this healing window.
Several things can prevent the surgical incision from healing properly, including:
Several risk factors can increase the chances of a hernia developing after surgery, including:
The most noticeable symptom of an incisional hernia is a bulge near the incision site. It’s often most visible when you strain your muscles, such as when you stand up, lift something, or cough.
Besides a visible bulge, incisional hernias might also cause:
While you’re most likely to develop a hernia between three and six months after your surgery, hernias can occur before or after this time frame. Hernias are often categorized as reducible or irreducible:
To diagnose an Incisional Hernia, Dr. David W. Ford takes a thorough medical history and conducts a physical examination. The hernia is usually very apparent at or near an older surgical scar in the abdomen, however, if the bulge is not obvious, the patient may be asked to stand and cough so the doctor can see and feel the hernia as it protrudes from the abdominal wall. Dr. Ford checks to see if the hernia is reducible, and can be gently massaged back into its proper position in the abdomen. If not, surgery is the recommended course of treatment.
Patients most often only seek repair when Incisional Hernias cause symptoms of discomfort, pain, or cosmesis (disfiguring), with a wide variation in surgical techniques and strategies for repair. Because of this, recovery time varies depending on the size of the hernia, the technique used, and the age and health of the patient. Because large incisional hernias are often very unpleasant, many people who have them, want to have treatment. But large hernias are a lot harder to operate on than small hernias.
Women who would still like to have children are also in a special situation. Their abdominal muscles have to be able to stretch a lot during pregnancy to make room for the growing baby. Because the synthetic mesh is less elastic than natural muscle tissue, doctors are concerned that women who become pregnant will have a greater risk of complications. Unfortunately, there is very little scientific research in this area. Most women who have an incisional hernia can put off the hernia surgery until they're sure they don’t want to have any (more) children. When hernia surgery is necessary for women who might still have children, doctors tend to recommend not using mesh. But then the hernia often returns during pregnancy.
Dr. David W. Ford employs the 2 main types of surgery for hernias: Open Herniorrhaphy or Robotically-assisted laparoscopic Herniorrhaphy, both with or without a mesh (Hernioplasty). Although laparoscopic surgery, either robotically-assisted or not, is the preferred method, it does carry a higher probability of reoccurrence and often open surgery is suggested if scar tissue resectioning is involved.
As a Board-Certified General Surgeon, Dr. David W. Ford operates with a minimally invasive robotic system to repair ventral and inguinal hernias. Both minimally invasive approaches only requires a few small incisions that doctors use to insert surgical equipment and a camera for viewing.
Robotically-assisted Incisional Hernia surgery utilizes an advanced robotic platform that is not autonomous but is controlled by the surgeon who is seated in the operating room and operates via the Surgeon Console that controls the Patient Cart’s robotic devices, including various surgical instruments and a camera. The da Vinci Surgical System allows surgeons to perform minimally invasive hernia repairs with clinically supported precision and accuracy. Robotically assisted surgery uses a laparoscope (a thin lighted tube with a camera on the tip) that is inserted through one of several small incisions, made away from where the hernia has occurred. The images gathered from the laparoscope’s camera are magnified, high-definition 3D, which are sent to a monitor that Dr. David W. Ford uses to guide the surgical system during the operation. If needed, the abdomen can be inflated with a harmless gas (carbon dioxide), which creates space to allow the doctor to view the inside of the body.
For the Incisional Hernia Repair, the inner lining of the abdomen is cut to allow Dr. David W. Ford to see the weakness in the abdominal wall. The surgery can also cut into the peritoneum (the sac created around the old scar tissue) or it can repair and push fatty tissue, muscle and intestines back in without cutting the peritoneal sac. Reconstruction of the abdominal wall, removal of extraneous fat, tissues or scar tissue occurs at this time. Surgical mesh material is usually inserted to strengthen the weakened area and reconstruct the abdominal wall, although sometimes a suture-only repair is needed, especially in child-bearing women. After the procedure is completed, the small incisions in the abdomen are closed with a stitch or two or with surgical tape and a drain may be inserted at the incision site if needed. Dr. David W. Ford’s use of the state-of-the-art da Vinci Surgical System in his robotically assisted hernia repair surgeries has allowed him to set a very high standard of expertise that can combine this method with traditional Open Surgery if required.
Many robotically-assisted surgical systems are FDA approved and in use today. However, many are specially designed for specific organs, procedures, or conditions, such as lung or pulmonary surgeries or knee and other extremity replacement surgeries. The da Vinci Robotic Surgical System is the premier system specialized in hernia repair surgery. Dr. David W. Ford is not only an expert board-certified surgeon but also certified in the use of this leading-edge technology.
This robotic platform offers Dr. David W. Ford fully wristed instruments and a 3D high-definition camera with 10x magnification. As a result, the repair can be done with more precision, and complex hernias can be fixed with small incisions. Furthermore, the robot doesn’t get tired and Dr. Ford sits during surgery, so there is less surgeon fatigue. For the patient, this translates into quicker recovery, less pain, and fewer complications. This is the preferred approach for medium to large hernias and many inguinal hernias as it combines the best of open and laparoscopic surgeries. Also, Dr. Ford is more likely to be able to sandwich the mesh between layers of the abdominal wall to keep the mesh from coming into contact with the intestines.
Other benefits of robotic hernia surgery include:
Should robotically-assisted surgical laparoscopic surgery be recommended as part of treatment for your hernia repair, Dr. David W. Ford and his team will have the best state-of-the-art technology at their disposal to usher in your recovery.
Da Vinci surgical systems are comprised of three components: surgeon console, patient-side cart, and vision cart.
The patient-side cart is positioned near the patient on the operating table. It is where the instruments used during the operation move in real time in response to your surgeon’s hand movements at the surgeon console.
A camera provides a high-definition, 3D magnified view inside your body. Every hand movement your surgeon makes is translated by the da Vinci system in real time to bend and rotate the instruments with precision.
The vision cart makes communication possible between the components of the system possible, and supports the 3D High Definition vision system.
"The da Vinci Surgical System allows me to make smaller incisions, resulting in reduced risk of infection, minimize scarring, reduce pain, and accelerate recovery time, allowing my patients to return to normal activities more quickly."
In open incisional hernia repair, also called herniorrhaphy, the patient is given general anesthesia as a sedative, and this is often augmented with epidural anesthesia to improve recovery time and pain control. Then Dr. David W. Ford makes an incision on the abdomen, releases scar tissue, moves the hernia contents (often bowel or fat) back into the abdomen, and reinforces the muscle wall with stitches.
Usually, the area of muscle weakness is reinforced with a synthetic or biologic mesh to provide additional support to reduce the likelihood of recurrence (Hernioplasty), however, the Open Incisional Hernia Repair can be done with or without the mesh insertion. A drain at the incision site may also be needed.
This surgical method generally takes about 3 hours, and one can expect to stay at the hospital for observation for 2-5 days.
Hernia repair involves an operation, with overall one of two main approaches:
Post-operative Treatment of Incisional Hernias will vary due to the repair surgical procedure chosen, the severity of the hernia, its location, and any complexities in either surgery or comorbidities of the patient. Without any complications, a simple incisional hernia repair usually requires a hospital stay of 2-5 days. If internal stitches were substantial, additional observation may be required. At first, you may need to rest in bed with your upper body raised on pillows, to help you breathe easier and lessen post-surgery hernia pain. Both cold and heat can help lessen some types of post-op pain.
After recovery, you can usually return to work or school within a week. You will not be able to lift anything over 10 pounds, climb, or do strenuous activity up to 4 to 6 weeks following surgical repair of an Incisional Hernia. Always wash your hands before and after touching near your incision site. A truss or belt to help alleviate pressure at the incision site may be prescribed.
Losing weight relieves excess pressure on the abdomen, which can prevent a hernia from developing, improve hernia symptoms, and avoid complications such as strangulation. High fiber foods are recommended to avoid straining during bowel movements during healing in the first weeks to months after surgery.
Prescription Refill Hours:
Monday – Thursday 8:30 AM – 4:30 PM
Friday before 2:00 PM
Other alternative recommendations, as needed – Use at least one if have not had a BM for 2 days: