What is an incisional hernia?
An incisional hernia is a type of hernia that occurs at the site of an incision from a previous abdominal surgery. It happens when the area of the surgical wound fails to heal properly, resulting in a weakness in the abdominal wall. This weakness allows internal tissues or organs to protrude through the incision site, creating a bulge.
Here are some key points about incisional hernias: Symptoms may include a visible bulge at the incision site, pain, and discomfort, especially when straining or lifting objects. In some cases, there might be redness, swelling, or signs of infection.
When does it happen?
An incisional hernia can occur anytime postoperatively and has been reported in some studies as late as 4 years post-surgery.
How often does it happen?
Incidents of incisional hernias have a wide variation reported in studies. Between 4-46% of liver transplant surgeries can result in an incisional hernia.
What causes an incisional hernia?
The risk factors that can predispose you to an incisional hernia include:
- Repeated surgery or previous abdominal surgery
- Chronic lung disease
- Malnutrition
- Ascites
- Postoperative wound infection
- Males are more at risk than females
- Current smoker
- Ex-Smoker
- History of Diabetes
- Obesity
Can I do anything to prevent an incisional hernia?
Personal risk factors: Address what personal risk factors you may have such as smoking cessation, diabetes management or your weight before your surgery through your prehabilitation programme.
Movement after surgery
Moving is an important part of your recovery process. You will be encouraged to sit out of bed and walk around the day after you arrive on the ward after your transplant.
It is important to avoid activities that put pressure on the wound area. This includes getting in and out of bed slowly by rolling onto your side first and then pushing up using your arms
Moving (also termed mobilising) is important for several reasons:
- Reduces back pain
- Helps bowel movement and reduces “wind pain”
- Reduces the chance of getting a chest infection
- Reduces the risk of deep vein thrombosis
- Maintains and improves movement of joints and helps strengthen muscles.
Exercise and sporting activities
For the first few days after discharge, you may feel very tired and find it easier not to have any visitors at home. It is normal to require a short nap in the afternoon. After a while, you may feel that this extra rest is not needed.
To help your recovery it is essential to take plenty of rest and regular exercise.
During the initial stages of recovery walking is an excellent form of exercise that gives a sense of personal achievement and is a good form of social activity. It encourages deep breathing, improves your blood circulation and strengthens your muscles. Daily gentle walks around your local neighbourhood or garden are a good starting point and taking a friend or family member with you will provide the support to help build up confidence.
Over a period of weeks you should gradually increase the distance you walk, but always remember that if you experience any discomfort and/or shortness of breath – stop and rest. If the symptoms persist make an appointment to see your GP.
If you are measuring your steps, try to add 10% more steps each week to your regular daily walks.
You must avoid any heavy lifting for six months after the transplant, your abdominal muscles need this time to heal properly and to avoid a hernia occurring.
If you are unsure what is heavy for you – when you move or do an activity that causes pain or discomfort around your wound, stop, rest and seek guidance from your healthcare team.
The best advice will always be personalised to your lifestyle and post-surgical recovery journey so always consult with your medical team for personalised advice.
Other Sports considerations
You must not play any contact sports (such as football and rugby), for at least six months, but other forms of exercise you may wish to consider once you regain your strength and your wound has healed include swimming, cycling, running, badminton and tennis.
We recommend that you avoid attending your local swimming pool for a period of six months, as you will be at a greater risk of contracting fungal and viral infections due to the effect of the immunosuppression therapy. You can, however, swim in the sea, off clean and uncrowded beaches once your wound has healed – weather permitting of course!
Driving
As your abdominal muscles will take some time to heal and you are likely to experience general tiredness and poor concentration, we recommend that you wait two months after your transplant before starting to drive again.
Start by taking small trips with a friend or family member until you have regained your confidence. According to the DVLA regulations, it is not necessary for you to contact them with news of your transplant. However, here are some medical conditions that you are legally obliged to declare:
- Epilepsy
- Blackouts
- Stroke
- Angina
- Pacemakers and internal defibrillators
Healthy eating advice
Once your appetite has returned to normal or you are a healthy weight, it is important that you start following a healthy, balanced diet to avoid unnecessary weight gain, which may lead to further complications.
Please let your nurse or dietitian know if you have any other dietary restrictions or food allergies.
References:
- Ayvazoglu Soy EH, Kirnap M, Yildirim S, Moray G, Haberal M. Incisional Hernia After Liver Transplant. Exp Clin Transplant. 2017 Feb;15(Suppl 1):185-189. doi: 10.6002/ect.mesot2016.P65. PMID: 28260464.
- Mireia Dominguez Bastante, Maria Carmen Montes Osuna, Alfonso Mansilla Rosello, Jesus Villar del Moral, Liver Transplant and Incisional Hernia: What Do We Know and What Can We Improve, Transplantation Proceedings, Volume 55, Issue 10, 2023, Pages 2278-2281, https://doi.org/10.1016/j.transproceed.2023.09.003.
- Ferri JVV, Dick SM, Grezzana-Filho TJM, Feier FH, Prediger L, Lazzaretti GS, Kruel CRP, Corso CO, Cavazzola LT, Chedid MF. EARLY INCISIONAL HERNIA AFTER LIVER TRANSPLANTATION: RISK FACTORS AND HERNIA REPAIR RESULTS. Arq Bras Cir Dig. 2022 Nov 4;35:e1698. doi: 10.1590/0102-672020220002e1698. PMID: 36350959; PMCID: PMC9645553.
- Heidy Cos, Ola Ahmed, Sandra Garcia-Aroz, Neeta Vachharajani, Surendra Shenoy, Jason R. Wellen, Maria MB. Doyle, William C. Chapman, Adeel S. Khan, Incisional hernia after liver transplantation: Risk factors, management strategies and long-term outcomes of a cohort study, International Journal of Surgery, Volume 78, 2020, Pages 149-153, https://doi.org/10.1016/j.ijsu.2020.04.048.
- Smith L, Meggy A, Watts T, Knight L, Torkington J, Cornish J. Incisional hernia prevention: risk-benefit from a patient perspective (INVITE) – protocol for a single-centre, mixed-methods, cross-sectional study aiming to determine if using prophylactic mesh in incisional hernia prevention is acceptable to patients. BMJ Open. 2022 Dec 30;12(12):e069568. doi: 10.1136/bmjopen-2022-069568. PMID: 36585153; PMCID: PMC9809247.
- Institutes of Liver Studies King’s College Hospital (September 2021) Part 3: POST-TRANSPLANT CARE Booklet LIVER TRANSPLANTATION AT KING’S COLLEGE HOSPITAL