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 its full load-bearing capacity. Several causes and risk factors can contribute to the formation of an incisional hernia:

• Impaired wound healing: Infections or complications at the surgical wound delay healing. This results in less stable scar tissue that may give way later under stress.
• 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 intra-abdominal pressure: Obesity or chronic coughing (e.g., in smoker’s cough) increase the pressure in the abdominal cavity. This favors the expression of tissue through weaker areas of the abdominal wall.
• Weak connective tissue: Some people naturally have weaker collagen tissue or connective tissue weakness (favored by age, genetic predisposition, or e.g., taking cortisone). In them, scars heal less stably.
• Multiple prior surgeries: Each additional surgery at the same site can reduce the stability of the abdominal wall. In particular, repeated procedures on a scar increase the risk of a rupture.

Often it is an interaction 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 as a bulge and pulling pain at the scar in question. Pay attention to 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).
• Size change: The bulge may become larger over time. Initially, it can usually be easily pushed back (the contents of the hernia slide back into the abdominal cavity, especially at rest or when lying down). Over time, this can become more difficult.
• 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 incarceration of intestinal parts in the incisional hernia – an emergency that requires immediate medical attention.

Have you noticed such a bulge on an old surgical scar? Then you should consult a specialist as a precaution. Our Hernia Center Berlin (VenaZiel) is at your disposal. The earlier an incisional hernia is detected and assessed, the better complications can be avoided.

 

Diagnostics: Examination for suspected incisional hernia

The diagnosis of an incisional hernia can usually be made by 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 extruded hernial sac is mobile.

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. This reveals the hernial gap and whether there are intestinal loops or other tissue in it.
• Computed tomography (CT) or MRI: For larger or complicated abdominal wall hernias, a sectional image can be useful. A CT or MRI shows the abdominal wall in great detail and helps with surgical planning, especially if adhesions or multiple hernial gaps are present.

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 in an understandable way whether an incisional hernia is present and what treatment options are available.

 

Incisional hernia surgery: outpatient and modern treatment

The good news for patients with incisional hernia: Nowadays, an incisional hernia can usually be operated on gently, minimally invasively and on an outpatient basis. In our Hernia Center at Checkpoint Charlie in Berlin, we offer you a modern incisional hernia surgery that is tailored to your needs.

Does every incisional hernia require surgery?

As a matter of principle, an existing incisional hernia can only be permanently corrected by surgery. Without surgery, the gap remains and the hernia can become larger over time. There is also always a risk of intestinal loops becoming trapped. Therefore, doctors advise surgery in most cases, especially if you have symptoms or the hernia is getting larger.

In some exceptional cases – for example, if the hernia is very small and asymptomatic or if severe comorbidities pose a high surgical risk – a temporary wait-and-see approach can be discussed. However, the hernia must be checked regularly by a doctor. Wearing a truss (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 as gently as possible. In the minimally invasive method (keyhole surgery), only a few small incisions (approx. 5-12 mm) are made in the abdominal wall. We insert a tiny camera and the finest instruments through these accesses.

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. In the case of 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: Protruded tissue is brought back into the abdominal cavity. The gap in the abdominal wall is then closed from the inside.
4. Mesh insertion: To prevent recurrence, a special plastic mesh is attached to the abdominal wall. This hernia mesh strengthens the scar from the inside and firmly fuses with 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:

Thanks to the keyhole technique, you usually have less postoperative pain, only tiny skin scars and recover faster. After just a few weeks, you can usually resume your usual activities. In addition, the risk of infection at the wounds is lower than with a large open operation.

Of course, there are cases in which an open surgical procedure is necessary – for example, in the case of very large or complicated incisional hernias. Here, too, our Hernia Center uses the most modern 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: You can return home on the same day of the operation after a reasonable 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 questions or problems that arise after the procedure. In addition, you will receive timely appointments for follow-up examinations in 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 the 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 in hernias (ruptures). Our team operates on abdominal wall hernias every day – this experience ensures the highest treatment quality.
• Minimally invasive expertise: We prefer to use gentle, minimally invasive procedures. As a result, our patients have less pain and recover faster.
• Outpatient surgery in top quality: We perform your incisional hernia surgery in Berlin on an outpatient basis, without compromising on safety. Our state-of-the-art Class 1 operating rooms 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, a surgery appointment quickly. Long waiting times for an incisional hernia surgery are eliminated 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 reach us easily by public transport. The central location also makes it easier for your relatives to travel.
• Personal support: From the first examination to aftercare, you will receive individual support. We take time for your questions and concerns. Your trust and well-being are our top priority.

All these factors make VenaZiel a prime address for patients who want to treat an incisional hernia or other abdominal wall hernia. See for yourself at our Hernia Center – 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 at 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 strain after surgery, obesity, or congenital connective tissue weakness. The combination of these factors leads to the scar not being able to withstand the internal pressure and a hernia forming.

How do I know if I have an incisional hernia?

Typical is a soft bulge at the former surgical scar, which protrudes especially when standing or straining (coughing, lifting). In addition, there is often a pulling or pressure sensation in this area. If you notice such a lump on yourself, which may recede when lying down, you should see a doctor. If there is sudden severe pain, redness, or nausea at a scar site, there is suspicion of incarceration – in that case, go to the hospital immediately!

Is an incisional hernia dangerous?

In itself, an incisional hernia is usually not life-threatening, but it can enlarge and cause increasing discomfort. The greatest danger lies in the incarceration of intestinal parts in the hernia (incarceration). This interrupts the blood supply to the intestine – an acute emergency that must be operated on immediately. If left untreated, incarceration can lead to bowel obstruction or necrosis. Therefore, an incisional hernia should 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 advisable if you have pain or the hernia is getting larger. Only in a few cases (very small, asymptomatic hernia and high surgical risk) can you initially wait. Even then, regular monitoring is important. In the long term, however, incisional hernia surgery is the only curative therapy.

How is an incisional hernia operated on?

The standard today is to reinforce the abdominal wall with a synthetic mesh. Often, the operation can be performed minimally invasively (laparoscopically): The surgeon makes several small incisions, inserts a camera, and places the mesh from the inside at the hernia site. For larger incisional hernias or certain situations, an open procedure must be performed. 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 completely pain-free and the abdominal wall is completely relaxed. In some cases, surgery can also be performed under regional anesthesia (spinal anesthesia) or local anesthesia – the latter especially for smaller hernias and open techniques. Our anesthesiologists 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 lasts 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 go home the same day. Overall, you only spend a few hours with us in the OP center, including preparation and recovery phase. This eliminates the need for a longer hospital stay.

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 well controllable. Immediately after the operation, you will receive pain medication so that you feel little. In the days that follow, you will often experience wound pain or muscle soreness in the abdomen, which can be treated well with tablets. Many patients are surprised at how tolerable the pain is – especially after laparoscopic surgery. It is important that you take the prescribed pain medication as needed and take it easy physically.

What do I need to consider after the operation?

After an incisional hernia operation, you should maintain physical rest for a few weeks. In particular, avoid heavy lifting (nothing over approx. 5-10 kg in the first 4–6 weeks, depending on the doctor’s instructions). You should also gradually resume sporting activities and only after approval by the doctor. The wounds must be kept clean and dry; you will receive detailed care instructions. In our hernia center VenaZiel, we arrange check-up appointments to monitor healing. We are also available for your questions or any complaints that may arise.

When can I return to work?

This depends on the type of your activity and the size of the hernia. For predominantly sedentary activities, many patients can start working again after 1–2 weeks, provided there are no complications. For physically strenuous occupations or larger hernias, a break of several weeks (up to 4–6 weeks) may be necessary. Your surgeon will give you a recommendation at the final consultation as to when you will be able to work again.

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 companies. In the VenaZiel Hernia Center Berlin, you can be treated as a statutory or private patient. We will explain any co-payments (as is usual with outpatient operations) or formalities to you transparently in advance. So don’t hesitate to postpone an examination or treatment for cost reasons – your health takes precedence, and we are happy to support you with all questions regarding cost clarification.

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

We strive to offer you an appointment as soon as possible. As a rule, you will receive a consultation appointment with our hernia specialists within a few days. If an operation is necessary, it can often be planned promptly – long waiting times like in many large clinics do not arise with us. You can simply make an appointment by phone 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 hernias, please do not hesitate to contact us. The team at the VenaZiel Hernia Center Berlin is at your side with advice and assistance. Together, we will find the best way to gently treat your incisional hernia and regain your quality of life.