A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; furthermore: Inspection (viewing). Skin and mucous membranes Abdomen (abdomen) [inspection while lying down and standing]. Shape of abdomen? [non-sided abdominal shape?] Skin color? Skin texture? Redness in the area of the hub? … Incisional Hernia (Scar Hernia): Examination
The diagnosis of incisional hernia (scar hernia) is made on the basis of history and physical examination. 2nd order laboratory parameters – depending on the results of the history, physical examination, etc. – for differential diagnostic clarification Small blood count Differential blood count Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate).
The diagnosis of incisional hernia (scar hernia) is made on the basis of history and physical examination. Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics, and obligatory medical device diagnostics – for differential diagnosis. Abdominal ultrasonography (ultrasound examination of the abdominal organs) – for visualization of the … Incisional Hernia (Scar Hernia): Diagnostic Tests
According to current doctrine, an incisional hernia (scar hernia) should be operated on. Incisional hernia surgery can be performed as conventional open surgery or laparoscopically (via laparoscopy). Surgical Procedures Treatment by direct suture; indication: smaller scar hernias (< 2-4 cm). Implantation of a synthetic mesh (open or laparoscopic technique). Sublay mesh position (retromuscular/posterior to muscle). … Incisional Hernia (Scar Hernia): Surgical Therapy
To prevent incisional hernia (scar hernia), attention must be paid to reducing individual risk factors. Behavioral risk factors Consumption of stimulants Tobacco (smoking) Physical activity Heavy physical work Underweight (reduced nutritional and general condition). Overweight (BMI ≥ 25; obesity). Surgical measures for the prophylaxis of an incisional hernia. Continuous all-layer abdominal wall closure. Thread length-to-wound … Incisional Hernia (Scar Hernia): Prevention
The following symptoms and complaints may indicate an incisional hernia (scar hernia): Visible swelling/protrusion/nodule or palpable protrusion in the area of the surgical scar (in the majority of cases) Initial appearance e.g. after physical work, lifting heavy loads, sports – spontaneous disappearance at rest. Later persistent (persistent) Note: The examination must be performed with the … Incisional Hernia (Scar Hernia): Symptoms, Complaints, Signs
Pathogenesis (development of disease) In incisional hernia, the hernial orifice is formed by a scar that passes through all layers of the abdominal wall. Under stress, this diverges due to its lack of elasticity. Cicatricial hernia is the most common late complication of previous abdominal surgery. Approximately 20% of all abdominal surgery patients develop an … Incisional Hernia (Scar Hernia): Causes
General measures Recurrence prevention: to prevent recurrence of incisional hernia, the affected person should try to relieve the abdominal wall during all movements after surgery. Lifting and carrying heavy loads should be avoided for the first 3-6 months. Nicotine restriction (refrain from tobacco use) – leads to wound healing disorder due to negative influence on … Incisional Hernia (Scar Hernia): Therapy
Medical history (history of the patient) represents an important component in the diagnosis of incisional hernia (incisional hernia). Family history Social history What is your occupation? Do you work physically hard? Current medical history/systemic history (somatic and psychological complaints). Do you have frequent pain in the area of the surgical scar? Have you noticed any … Incisional Hernia (Scar Hernia): Medical History
Musculoskeletal system and connective tissue (M00-M99). Rectus diastasis – separation of the straight abdominal muscles (Mm. recti abdominis) in the area of the linea alba (vertical suture of connective tissue in the middle of the abdomen; extends from the processus xiphoideus (lower part of the sternum) to the symphysis pubica (pubic symphysis)); DD scar hernia … Incisional Hernia (Scar Hernia): Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by an incisional hernia (scar hernia): Skin and subcutaneous (L00-L99). Skin lesions over the hernia sac Mouth, esophagus (food pipe), stomach, and intestines (M00-M67; M90-M93). Inflammatio herniae (hernia inflammation). Ileus (intestinal obstruction) Incarceration – entrapment of the hernia with the risk … Incisional Hernia (Scar Hernia): Complications
Classification of incisional hernias Type Hernia gap extent in fascia level:Hernia gap in cm. Visibility, type of finding, reponibility (restoration to normal position). I <2 cm Hardly visible when standing or lying down; sonographic (ultrasound) or palpation (palpation) findings. II <4 cm Visible as a protrusion when standing, flat or spontaneously reducible when lying down … Incisional Hernia (Scar Hernia): Classification
