Incisional hernia – causes, symptoms, treatment

Causes: How does an incisional hernia develop?

Incisional hernias occur when the abdominal wall in the area of a healed surgical scar no longer has the full load-bearing capacity. Several causes and risk factors can contribute to the formation of an incisional hernia:

• Wound healing disorders: Infections or complications at the surgical wound delay healing. As a result, less stable scar tissue forms, which can later give way under strain.
• Early or heavy strain: If the abdominal wall is subjected to heavy physical strain too soon after an operation (e.g. heavy lifting, straining during bowel movements, coughing violently), the fresh scar can be overstretched.
• Increased internal abdominal pressure: Being overweight (obesity) or chronic coughing (e.g. smoker’s cough) increases the pressure in the abdominal cavity. This encourages tissue to be pushed out through weaker areas of the abdominal wall.
• Weak connective tissue: Some people have naturally weaker collagen tissue or connective tissue weakness (favored by age, genetic predisposition or the use of cortisone, for example). In these cases, scars heal less stably.
• Multiple previous operations: Each additional operation at the same site can reduce the stability of the abdominal wall. Repeated operations on a scar in particular increase the risk of a hernia.

It is often a combination of several factors. Even with optimal surgical technique, an incisional hernia can occur if unfavorable conditions are present. Important to know: Once a gap has formed in the abdominal wall, it does not close again by itself – the incisional hernia remains or can enlarge if nothing is done.

Symptoms: How do you recognize an incisional hernia?

An incisional hernia typically manifests itself as a protrusion and pulling pain at the affected scar. Look out for the following symptoms of an incisional hernia:

• Protrusion on the scar: A soft, often clearly visible or palpable “lump” or bump along the old surgical scar, which becomes more prominent, especially when standing or pressing.
• Pressure or pulling pain: Dull pain, a feeling of pressure or pulling may occur at the fracture site, especially when the abdomen is strained (lifting, coughing, getting up from a lying position).
• Change in size: The bulge can become larger over time. Initially it is usually easy to push back (the contents of the hernia slide back into the abdominal cavity, especially at rest or when lying down). This can become more difficult over time.
• Feeling of weakness: Some patients describe a feeling of weakness or instability in the abdominal wall at the scar site.
• Rare alarm signs: In rare cases, acute severe pain, redness, nausea or vomiting may occur. This may indicate an incarceration of parts of the intestine in the incisional hernia – an emergency that requires immediate medical attention.

Have you noticed such a protrusion on an old surgical scar? Then you should consult a specialist as a precaution. Our Hernia Center Berlin (VenaZiel) will be happy to help you. The earlier an incisional hernia is recognized and assessed, the better complications can be avoided.

Diagnostics: Examination for suspected incisional hernia

An incisional hernia can usually be diagnosed during a physical examination. The specialist palpates the abdominal wall along the scar. Typically, the gap in the abdominal wall can be felt as a hernial orifice and the hernial sac that has been pushed out can be moved.

In addition, imaging procedures are often used to accurately assess the size and contents of the hernia:

• Ultrasound (sonography): A painless ultrasound examination of the abdomen can make the incisional hernia clearly visible. The hernia gap and whether there are intestinal loops or other tissue in it can be recognized.
• Computed tomography (CT) or MRI: A tomography scan can be useful for larger or complicated abdominal wall hernias. A CT or MRI shows the abdominal wall in great detail and helps with surgical planning, especially if there are adhesions or multiple hernias.

At the VenaZiel Hernia Center Berlin, we rely on modern diagnostics directly on site. Our experienced hernia specialists will examine you thoroughly and explain to you clearly whether you have an incisional hernia and what treatment options are available.

Incisional hernia surgery: outpatient and modern treatment

The good news for patients with incisional hernias: nowadays, incisional hernias can usually be operated on gently, minimally invasively and on an outpatient basis. At our hernia center at Checkpoint Charlie in Berlin, we offer modern incisional hernia surgery that is tailored to your needs.

Does every incisional hernia require surgery?

As a general rule, an existing incisional hernia can only be permanently repaired by surgery. Without surgery, the gap will remain and the hernia may become larger over time. In addition, there is always a risk of intestinal loops becoming trapped. Doctors therefore recommend surgery in most cases, especially if you have symptoms or the hernia becomes larger.

In some exceptional cases – for example, if the hernia is very small and asymptomatic or if severe concomitant diseases pose a high surgical risk – a wait-and-see approach can be discussed temporarily. However, the hernia must be checked regularly by a doctor. Wearing a hernia band (special belt) can also provide relief as a temporary solution. However, this does not replace surgery, but at most delays it. In the long term, there is no way around incisional hernia surgery if you want to eliminate the cause.

Minimally invasive hernia surgery: gentle surgical procedures

Our specialists for minimally invasive hernia surgery in Berlin use state-of-the-art surgical procedures to close your incisional hernia with as little tissue damage as possible. With the minimally invasive method (keyhole surgery), only a few small incisions (approx. 5-12 mm) are made in the abdominal wall. We use these incisions to insert a tiny camera and the finest instruments.

Procedure for minimally invasive incisional hernia surgery

1. Anesthesia: The operation is usually performed under general anesthesia so that you do not feel any pain. For smaller hernias, regional anesthesia or local anesthesia with twilight sleep are also possible in individual cases.
2. Laparoscopy: The surgeon uses a camera to obtain an overview of the hernia site from the inside via small incisions in the skin.
3. Hernia closure: Protruding tissue is brought back into the abdominal cavity. The gap in the abdominal wall is then closed from the inside.
4. Mesh insert: To prevent recurrence, a special plastic mesh is attached to the abdominal wall. This hernia mesh reinforces the scar from the inside and grows firmly into the tissue. Modern meshes are well tolerated and ensure long-term stability.
5. Conclusion: The instruments are removed and the small incisions are sutured. Only very small scars remain.

Advantages of the minimally invasive method:

The keyhole technique usually results in less post-operative pain, only tiny skin scars and a faster recovery. You can usually return to your usual activities after just a few weeks. In addition, the risk of infection in the wounds is lower than with major open surgery.

Of course, there are cases in which open surgery is necessary – for example in the case of very large or complicated incisional hernias. Here too, our hernia center uses the latest techniques and mesh materials to achieve the best possible result.

Outpatient surgery with rapid recovery

A special feature of the VenaZiel Hernia Center is that we can perform most incisional hernia operations on an outpatient basis. Outpatient means that you can return home on the same day as the operation after an appropriate recovery period.

How does an outpatient incisional hernia operation work? On the day of the operation, you will come to our clinic at Checkpoint Charlie in the morning or in the morning. After preparation and the gentle, minimally invasive hernia operation, you will recover for a few hours in our recovery area under supervision. As soon as you are awake and stable and have eaten something, you will be accompanied home. We will ensure that you are fully informed before discharge – e.g. about rules of conduct, painkillers and follow-up appointments.

Your advantages of outpatient hernia surgery:

• Home environment: You often recover faster and more relaxed at home than in hospital.
• Lower risk of infection: shorter hospital stays mean less risk of hospital-acquired infections.
• No overnight stay: You save yourself an inpatient stay and are back in your familiar surroundings with your family more quickly.
• Flexible scheduling: Outpatient procedures can be scheduled promptly with us – there are no long waiting times for a hospital bed.

Despite the outpatient procedure, you are in safe hands with us. Our team is always available to answer any questions or problems that may arise after the procedure. You will also receive prompt follow-up appointments at our Hernia Center Berlin to monitor the healing process.

Why VenaZiel? – Your advantages at the Hernia Center Berlin

The treatment of an incisional hernia is a matter of trust. At VenaZiel Hernia Center Berlin, you are in experienced hands. Our center specializes in hernia surgery and offers you a modern, patient-oriented environment. Your advantages at a glance:

• Specialized hernia surgeons: At VenaZiel, you will be treated by proven experts for hernias. Our team operates on abdominal wall hernias every day – this experience ensures the highest quality of treatment.
• Minimally invasive expertise: We prefer to use gentle, minimally invasive procedures. As a result, our patients experience less pain and recover more quickly.
• Top-quality outpatient surgery: We perform your incisional hernia surgery in Berlin on an outpatient basis, without compromising on safety. Our state-of-the-art Class 1 operating theaters meet the highest clinical standards, comparable to a hospital – but with the comfort of a private clinic.
• Short waiting times: With us, you will receive a consultation appointment promptly and, if necessary, an operation appointment quickly. There are no long waiting times for incisional hernia surgery at the hernia center VenaZiel.
• Central location: Our practice is located in the heart of Berlin (Kreuzberg), directly at the historic Checkpoint Charlie. You can easily reach us by public transportation. The central location also makes it easier for your relatives to reach us.
• Personal care: From the first examination to aftercare, you will receive individual care. We take time for your questions and concerns. Your trust and well-being are our top priority.

All these factors make VenaZiel the first port of call for patients who want to have an incisional hernia or other abdominal wall hernia treated. See our hernia center for yourself – we are ready to help you.

Frequently asked questions about incisional hernia (FAQ)

What is an incisional hernia and what causes it?

An incisional hernia is a hernia in an old surgical scar. After abdominal surgery, the scar can form a weak point through which tissue or intestine protrudes. Common triggers are impaired wound healing, too early weight bearing after the operation, obesity or congenital weakness of the connective tissue. The combination of these factors means that the scar cannot withstand the internal pressure and a hernia forms.

How do I know if I have an incisional hernia?

A typical symptom is a soft protrusion on the former surgical scar, which is particularly noticeable when standing or pressing (coughing, lifting). This is often accompanied by a pulling or pressure sensation in this area. If you notice such a bump, which may disappear when you lie down, you should consult a doctor. If you experience sudden severe pain, redness or nausea at a scar site, you should suspect an incarceration – in this case, go to hospital immediately!

Is an incisional hernia dangerous?

In itself, an incisional hernia is not usually life-threatening, but it can enlarge and cause increasing discomfort. The greatest danger is the incarceration of parts of the intestine in the hernia. This interrupts the blood supply to the intestine – an acute emergency that requires immediate surgery. If left untreated, an incarceration can lead to intestinal obstruction or death. An incisional hernia should therefore not be taken lightly.

Does every incisional hernia require surgery?

In most cases, surgery is recommended as this is the only way to permanently close the cause – the gap in the abdominal wall. Without surgery, the hernia usually enlarges over time. Surgery is particularly recommended if you are in pain or the hernia is getting bigger. Only in a few cases (very small, asymptomatic hernia and high risk of surgery) can you wait and see. Even then, regular check-ups are important. In the long term, however, incisional hernia surgery is the only curative treatment.

How is an incisional hernia operated on?

The standard procedure today is to reinforce the abdominal wall with a synthetic mesh. The operation can often be minimally invasive (laparoscopic): The surgeon makes several small incisions, inserts a camera and places the mesh on the hernia site from the inside. In the case of larger incisional hernias or certain situations, surgery must be performed in an open procedure. Even then, a mesh is usually sewn in to ensure stability. The exact surgical method depends on the size and location of the hernia as well as your individual factors, which will be discussed with you in advance.

What anesthesia is required for hernia surgery?

Most incisional hernia operations are performed under general anesthesia so that you are absolutely pain-free and the abdominal wall is completely relaxed. In some cases, surgery can also be performed under partial anesthesia (spinal anesthesia) or local anesthesia – the latter especially for smaller hernias and open techniques. Our anesthetists will discuss the safest and most comfortable solution with you.

How long does the procedure and hospital stay take?

An uncomplicated incisional hernia operation usually takes between 45 minutes and 2 hours, depending on the size of the hernia and the surgical method. Thanks to our outpatient concept, you can usually return home on the same day. In total, you will only spend a few hours at our surgery center, including preparation and recovery. This eliminates the need for a longer stay in hospital.

Will I have severe pain after the operation?

Thanks to modern, gentle surgical techniques and effective pain therapy, the pain after an incisional hernia operation is easy to control. You will be given painkillers immediately after the operation so that you feel very little pain. In the days afterwards, you will often experience soreness or aching muscles in your abdomen, but this can be easily treated with tablets. Many patients are surprised at how well the pain is tolerated – especially after laparoscopic surgery. It is important that you take the prescribed painkillers as required and take it easy physically.

What do I need to consider after the operation?

After an incisional hernia operation, you should take it easy physically for a few weeks. In particular, avoid heavy lifting (nothing over approx. 5-10 kg for the first 4-6 weeks, depending on your doctor’s instructions). Sports activities should also be resumed gradually and only after clearance from the doctor. The wounds must be kept clean and dry; you will be given detailed care instructions. At our Hernia Center, we will arrange follow-up appointments to monitor the healing process. We are also available at any time to answer any questions you may have or if any complaints arise.

When can I return to work?

This depends on the type of work you do and the size of the hernia. In the case of predominantly sedentary work, many patients can return to work after 1-2 weeks, provided there are no complications. For physically demanding jobs or larger hernias, it may be necessary to take several weeks off work (up to 4-6 weeks). Your surgeon will give you a recommendation at the final consultation as to when you will be able to return to work.

Does health insurance cover the costs of treatment?

Yes, the treatment of an incisional hernia is a medically necessary measure and is generally covered by statutory and private health insurance. At VenaZiel Hernia Center Berlin, you can be treated as a statutory or private patient. Any co-payments (as is usual for outpatient operations) or formalities will be explained to you transparently in advance. So do not hesitate to postpone an examination or treatment for cost reasons – your health has priority and we will be happy to assist you with any questions regarding cost clarification.

How quickly can I get an appointment at the Hernia Center Berlin?

We will endeavor to offer you an appointment as quickly as possible. As a rule, you will receive a consultation appointment with our hernia specialists within a few days. If an operation is necessary, this can often be scheduled promptly – we do not have long waiting times like some large clinics. You can simply make an appointment by telephone or online (via our website). We will also find a quick solution for you in the event of acute problems.

Your trust is important to us. If you have any further questions about incisional hernia, please do not hesitate to contact us. The team at the VenaZiel Hernia Center Berlin will be happy to help and advise you. Together we will find the best way to treat your incisional hernia gently and restore your quality of life.