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Incisional hernia

David C Brooks, MD
John Cone, MD
Section Editor
Michael Rosen, MD
Deputy Editor
Wenliang Chen, MD, PhD


Incisional hernias are a type of ventral hernia, and by definition, these develop at sites where an incision was made for some prior abdominal procedure. Incisional hernias are due to failure of fascial tissues to heal and close following laparotomy, which may be related to poor wound healing, infection, or technical issues during closure.

The epidemiology, risk factors, clinical features, diagnosis, and treatment of incisional hernias will be reviewed here. Other abdominal wall hernias and incisional hernia following groin hernia repair (ie, recurrent inguinal hernia) are reviewed separately. (See "Overview of abdominal wall hernias in adults" and "Recurrent inguinal and femoral hernia".)


Incisional hernia can develop after any type of abdominal wall incision (eg, midline, paramedian, subcostal, McBurney, Pfannenstiel, flank incision, etc). The incidence depends upon the location and size of the incision [1,2]. The highest reported incidence is with midline abdominal incisions (3 to 20 percent), which are commonly used incisions for many open abdominal procedures [3,4]. Laparoscopic port sites can also develop incisional hernia. Vertical incisions may have a higher risk for hernia compared with transverse/oblique incisions, and upper abdominal incisions may be more susceptible compared with lower abdominal incisions [5-9]. In a systematic review, the risk of hernia was significantly increased for midline incision compared with transverse incision (relative risk [RR] 1.77, 95% CI, 1.09-2.87) and paramedian incision (RR 3.41, 95% CI 1.02-11.45, respectively) [8]. (See "Incisions for open abdominal surgery" and "Abdominal access techniques used in laparoscopic surgery", section on 'Access locations'.)

Risk factors — Factors that affect healing of abdominal incisions can be related to patient or technique-related factors. Conditions that increase the risk for incisional hernia include surgical site infection, obesity, smoking, malnutrition, immunosuppressive therapy, and connective tissue disorders, among others [10]. The effects of these conditions on wound healing are discussed in detail elsewhere. (See "Wound healing and risk factors for non-healing", section on 'Risk factors for non-healing'.)

The development of incisional hernia early in the postoperative course suggests that some local factor (infection, tension, technique) is responsible for hernia formation. Among patients with surgical site infection, up to 25 percent will develop an incisional hernia, the incidence of which may be even higher following infection in a midline incision [3,11]. Recurrent hernia following incisional hernia ranges from 18 to 50 percent [12-14]. Technique-related factors that contribute to the development of incisional hernia include excess wound tension, broken sutures, poor technique, and the need for emergency surgery. Abdominal fascial dehiscence, which may be related to broken sutures or loss of integrity of the abdominal fascia, necessarily leads to incisional hernia. Risk factors for the development of wound dehiscence include age >70 years, male gender, chronic pulmonary disease, ascites, jaundice, anemia, emergency surgery, coughing, type of surgery, and wound infection [15]. (See "Complications of abdominal surgical incisions", section on 'Fascial dehiscence'.)


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Literature review current through: Sep 2016. | This topic last updated: Oct 15, 2015.
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