II. Epidemiology
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Incidence
- Abdominal incisions: 10-15%
- Incisions with postoperative Wound Infection: 23%
III. Pathophysiology
- Type of Ventral Hernia
- Develops in scar of prior laparotomy or drain site
- Most common in midline abdominal incisions
- Risks for post-operative Hernia development (delayed Wound Healing)
- Vertical scar more commonly affected than horizontal
- Wound Infection
- Wound dehiscence
- Malnutrition
- Obesity
- Tobacco Abuse
- Immunosuppressants
- Excessive wound tension
- Connective Tissue Disorder
IV. Signs
- Provocative maneuvers to locate Hernia
- Hernia sac will appear adjacent to scar
- Hernia sac may be obvious with patient standing
- Valsalva Maneuver
- Raise head from pillow while supine
- Large Incisional Hernias are often asymptomatic
- Often multiple defects present with several rings
- Often Irreducible Hernia due to adhesions
V. Complications
- Incarcerated Hernia is common
- Strangulated Hernia is rare
VI. References
- Goroll (2000) Primary Care Medicine, p. 431-433
- Degowin (1987) Diagnostic Examination, p. 489-96
- Stevens (2013) Crit Dec Emerg Med 27(9): 2