Trocar hernias and incisional hernias

Trocar hernias and incisional hernias are late effects of abdominal and thoracic surgery. For successful treatment, it is important that these are surgically closed quickly before internal organs are trapped or the weak point can open up further.

Vice-abdominal surgery, especially abdominal wall surgery, always carries a certain risk. In around 10 to 20 % of cases, incisional hernias can occur at the sutures inside the abdomen in the months or years that follow. This is caused by sutures that have never healed properly. This is particularly common with sutures on the muscle envelope. Over time, these sutures can partially or even completely open and lead to weaknesses in the abdominal wall. In addition, the scar tissue does not have the same strength and elasticity as the regular tissue and there is a greater risk of a hernial orifice forming in these areas. The peritoneum and internal organs can then be pushed out of the abdominal cavity through the weak point in the abdominal wall. As these bridges occur in the area of scars from a previous operation, they are known as incisional hernias.

The surgeon's incision technique, the suturing technique and the suture material used all have an influence on the development of incisional hernias. However, far more important factors come from the patient. A high proportion of fatty tissue makes it more difficult for the surgeon to suture the wounds accurately and being overweight increases the pressure in the abdominal cavity, so that incisional hernias develop more quickly. Diseases such as diabetes, wound healing disorders, collagen disorders or connective tissue metabolism disorders also have a negative effect on scar healing. Smoking even increases the risk of incisional hernias fourfold. In most cases, an incisional hernia does not pose a major risk to the patient, provided it is treated immediately. However, if organs and intestines become trapped in the hernia, this can lead to an intestinal obstruction, which can be life-threatening if not treated immediately.

Incisional hernias used to occur much more frequently after major abdominal and thoracic surgery, as open surgery was usually performed. In the age of minimally invasive surgery, this has become much rarer. However, laparoscopic surgery can lead to so-called trocar hernias. Trocars are pin-shaped puncture instruments that are used to give the surgeon access to the body cavity. Surgical instruments or cameras can be inserted through the trocars, a type of access tunnel into the abdominal cavity or chest cavity. The risk of developing a trocar hernia is around 1% and is therefore much lower than that of an incisional hernia. However, even these small openings can ultimately cause scars in the tissue or weak points in the fascia. Tissue from the abdominal cavity can become trapped at these points and cause pain. Trocar hernias usually occur in the area of the navel or in the pit of the stomach, i.e. between the lower ribcage and the navel.

Large scars are much more dangerous than trocar accesses, as parts of the intestine can also become trapped there, which in the worst case could lead to an intestinal obstruction. However, it is also possible that other internal organs are gradually pushed through the weak points. If the corrective operation is performed too late, it may even be difficult to close the abdomen correctly again. It is particularly important to recognize an incisional hernia at an early stage. If the patient has a corresponding protrusion in the area of a former surgical scar or pain at this point, they should have this clarified immediately by a specialist. Rapid action is essential, especially in the event of a possible bowel obstruction.

An ultrasound examination can be used to detect exactly where the scar has broken through and opened and how large the resulting gap is. In addition, a computer tomography may be necessary, during which the so-called Valsalva maneuver is performed. The patient presses gently during the examination so that the full extent of the hernia, i.e. the incisional hernia, becomes visible. How the operation is then performed in detail depends on the size of the incisional hernia and its contents, as well as the acute stage and, of course, the patient's previous operations. Whenever possible, visceral surgery attempts to correct the incisional hernia using minimally invasive techniques. In the case of large hernias, however, it is often necessary to open the old scar completely and attempt a complete reclosure. In the vast majority of cases, this also requires reinforcement by implanting a permanent or dissolvable plastic mesh. Following this operation, the hernia center usually advises a six-week rest period to relieve the abdominal muscles. Following the stay in the clinic, the muscles must be built up and strengthened in order to achieve lasting stability.

Do you possibly suffer from a trocar hernia or an incisional hernia? Or do you have problems with hernias? Contact the Hernia Center - we will provide you with competent and professional advice