What are hernias?

A hernia can be simply called an abnormal bulge or an out-pouching in the body. Usually, they are the organs or tissues of the abdomen bulging out from their normal location elsewhere. Hernias are quite common and can be of numerous kinds. Here, at Chennai Hernia Center, we specialize in treating many different kinds of hernias. Our chief consultant, Dr. Rengan has more than 30 years of experience in this field and is uniquely qualified to help address your concerns regarding hernias. DR Rengan has trained in hernia surgery from some of the top hernia surgeons on the country including Dr Ramesh Punjani, who is a pioneer in hernia surgery.

What is an incisional hernia?

An incisional hernia is a unique type of hernia which happens at previous sites of surgery. They are most commonly found in the abdomen as a lump at the site. They can be tender and painful and can cause quite a bit of worry when first noticed.
Incisional Hernia surgery
It is easy to understand how incisional hernias form. First, we have to remember the organs and tissues inside our body are lumpy structures that are held back by the strong flat wall formed by our muscles. After undergoing a surgery of the abdomen, sometimes the cut muscles do not heal well together and have an area of weakness at the site of the incision (the cut). This area of weakness can now be pushed into by the organs and tissues of the abdomen, even causing an outward bulge on the outside of the abdominal wall. In mild cases, it is only a thin tissue layer pushed out into the weak space but it is not uncommon for organs to be pushed out as well.

Am I at risk for an incisional hernia?

While any previous site of incision can be a potential site for hernia formation, its usually when incisions don’t heal properly that these are seen. Common causes of poor healing after surgery are wound infection, pre-existing conditions like diabetes or kidney disease, courses of medications like steroids, obesity, smoking and many others. Also, physical factors like not getting enough rest after surgery, exercising too much , getting pregnant before full recovery etc also commonly contribute. Sometimes, there may even be no clear risk factor.

I have a lump on my stomach near where I had surgery a few years ago. Is this an incisional hernia?

This could be an incisional hernia. While you would have to come to our center and see our doctors for a definitive diagnosis, it is one of the possibilities. Although most incisional hernias occur at least 3-6 months after abdominal surgery, they have been known to occur even before or after that time frame as well. At Chennai Hernia Center, we prize safety and precision in diagnosis and we will consider all possible diagnoses carefully before treating you. We will have a detailed conversation with you about your symptoms and physical condition, followed by a thorough physical exam. While most hernias can be diagnosed by these alone, we will do some tests if necessary to further investigate, rule out other conditions or evaluate risk factors.

Will my incisional hernia go away by itself?

If you have a small hernia, you may notice that it sometimes appears and disappears by itself. However, this does not mean that the hernia will go away by itself one day and not recur. It is important to remember that the main cause of hernia formation is a weakness in the abdominal wall, and as long as that defect continues to exit, a hernia can always recur. Nevertheless, many people are comfortable with their hernias as long as they don’t cause pain or distress.
The reason why your hernia seems to disappear by itself occasionally is because it is still reducible, I.e, whatever structures are pushing out are still in a position to be able to go back inside by themselves with changes in your position and movement. However, once larger sections of your insides poke out through the defect, they have a high chance of getting stuck there between the muscle and skin and become irreducible. This when the problems usually suffered by hernia patients start, with pain and tenderness over the area. A medical emergency that can happen from this scenario is when the blood supply to the herniated insides get cut off. This can lead to severe pain, nausea, vomiting, diarrhea etc as the affected part starts to slowly die. At this point, emergency surgery is the only option as this is a life threatening condition.

Is there any non-surgical method to treat incisional hernias?

Small hernias can be left alone depending on whether they cause symptoms or not. However, surgery is the only definitive treatment to be rid of them. Many patients who visit our center with small hernias prefer to get it operated on because they do not want to take the chance of it growing bigger and causing problems. A smaller hernia operation is less complicated and recovery times are faster.
Dr.Rengan will take into account your full medical and surgical history before deciding on treatment for you. We understand that surgery is a scary concept for many people, especially when it is another surgery that has preceded this issue in the first place.

What incisional hernia surgery can you do for me?

The surgeries done to treat incisional hernias are commonly called hernia repairs. The basic aim of the surgery is to push back your insides into the abdominal cavity and then sew the offending defect up so that the hernia cannot recur. Sometimes, a mesh is placed over the defect and sewed in place in order to reinforce the wall further. The surgery can be done as open surgery or laparoscopic (key-hole) surgery.
Dr. Rengan and all his associates are experienced and familiar with both types of surgery. At our center, we will have a detailed discussion with you where we figure out the best type of surgery for you. Once the decision for surgery has been made, further pre-operative discussions will be held to further evaluate your personal and physical condition. We have a heavily patient centric approach as we believe medicine is best practised with complete mutual trust and understanding.

What happens after my incisional hernia surgery?

While some surgeries can happen on a day-care basis, often, a couple days’ admission may be required based on the patient’s physical or personal situation. We will prescribe adequate pain relief and provide all the necessary care required at that stage. Further, on discharge, we will give you detailed instructions for wound care, healthy healing and to prevent recurrence as well as fix a review appointment for you. You will be required to wear a binder for afew weeks.
Dr Rengan is one of the senior most surgeons in Chennai who specialises in hernia repair.