INCISIONAL HERNIA1) An abdominal incisional hernia is a hernia through an acquired scar in the abdominal wall, caused by a previous surgical operation or injury. 2) Scar tissue is inelastic and stretches progressively if subjected to constant stress.History

1) Patients usually remember the operation or wound that caused the scar, but may not recall any complications in the original wound such as a haematoma or infection, which weakened it and made it more susceptible to the development of a hernia.

2) There may be a history of factors likely to weaken the abdominal musculature, such as chronic cough, obesity or steroid therapy.

3) Age: Incisional hernias occur at all ages but are more common in the elderly.

4) Symptoms: The commonest symptoms are a lump and pain. Intestinal obstruction can occur, causing distension, colic, vomiting, constipation and severe pain in the lump.

Examination

1) The common findings are a lump with an expansile cough impulse, beneath an old scar.

2) The defect in the abdominal wall may be palpable.

3) Incisional hernia are not infrequently irreducible, the defect being plugged with adherent omentum.

4) If the lump does not reduce and does not have a cough impulse, it may not be a hernia, but rather a deposit of tumour, a chronic abscess or haematoma, or a foreign-body granuloma. All these lesions, except recurrent tumour, appear shortly after the initial surgery.

5) Incisional herniae usually appear in the first year after surgery but may develop many years later.

6) The local tissues may be thin and weak because of local damage or general cachexia.