Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Bulge elicited by the Valsalva maneuver immediately over or adjacent to a laparotomy incision• Main complaint associated with ventral hernias is the cosmetic appearance• Patients may note discomfort or a heaviness sensation associated with the hernia bulge• Small incisional hernia defects appear to be most dangerous and are more commonly associated with an incarcerated presentation• The fascial defects progressively increase in size and may result in loss of abdominal domain• Classification of incisional hernias:-Reducible: Visceral contents of the hernia sac able to retract into the abdominal cavity-Incarcerated: Visceral contents cannot be returned to the abdominal cavity-Strangulated: Incarcerated hernia where the blood flow to the entrapped viscera is compromised +++ Epidemiology + • 11% of all laparotomies result in incisional hernia formation• Incidence of this iatrogenic hernia is not diminishing despite awareness of the many causative factors• Highest incidence associated with midline and transverse incisions +++ Symptoms and Signs + • Asymptomatic bulge associated with prior laparotomy incision most common presentation• Patients may complain of a discomfort, fullness or heaviness associated with the hernia bulge• The fascial defects progressively increase in size• Hernia bulge may or may not be reducible• Incarcerated hernias are exquisitely painful to palpation• Patients with a strangulated hernia may present with an acute abdomen• Small bowel obstructive symptoms may be present with incarcerated incisional hernias +++ Imaging Findings + • Plain films are typically normal• US can be used to detect fascial defects as well as differentiate between an incarcerated incisional hernia and a solid mass• Abdominal pelvic CT scan is excellent in the detection of incisional hernias and characterization of involved viscera-CT is particularly useful in diagnosing acute incarceration in morbidly obese patients in whom physical exam is difficult and unreliable + • Diastasis recti• Stitch granuloma• Epigastric hernia• Incisional metastasis• Desmoid tumor• Parastomal hernia• Chronic incisional seroma +++ Rule Out + • Incarcerated or strangulated hernia• Incisional metastasis or other primary abdominal wall neoplasm + • Thorough history and physical exam usually will accurately diagnosis incisional hernia• Abdominal CT scan when diagnosis is in doubt or to anatomically define the adjacent intestinal viscera in complicated cases +++ When to Admit + • Depends on the magnitude of repair and comorbidities-Patients may require postoperative hospitalization +++ When to Refer + • Plastic surgery referral may be advantageous in instances where alloplastic reconstruction contraindicated: -Infected wound-Fistula present-No omentum present to bridge between bowel and mesh + • Minimize or eliminate medications deleterious to wound healing, such as corticosteroids• Weight loss in obese patients• Preoperative pulmonary conditioning in patients with large hernias who smoke or are chronically ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.