If you notice a lump where there used to be a scar, don't ignore it: it may need to be repaired.
An eventration - also known as an incisional hernia - is a relatively common complication following abdominal surgery. It occurs when, through an old surgical scar, a defect forms in the abdominal wall that allows internal contents (such as fat or intestine) to protrude. Although it may not initially cause discomfort, its progression can lead to pain, entrapment or even urgent surgery. if not treated in time.
What is an eventration and how does it form?
An eventration is a hernia that appears at a previous surgical incision siteusually in the abdomen. It is caused by a failure of the muscle wall to heal, allowing some of the intra-abdominal contents to push out through the defect.
This failure may be due to multiple factors that hinder proper tissue repair during the postoperative period.
Risk factors
Some conditions increase the risk of developing an eventration after abdominal surgery:
- Surgical wound infection.
- Obesity or sudden weight gain.
- Intense physical exertion after surgery.
- Chronic cough or severe constipationwhich increase intra-abdominal pressure.
- Malnutrition or protein deficiency, which hinders healing.
- Multiple surgeries in the same area.
- Chronic smoking.
- Advanced age.
The type of surgical technique used and the way the wound is closed also play a role.
What are the symptoms?
The main sign of an eventration is the appearance of a soft lump in the area of an old scar, especially when coughing, straining or standing up. There may be:
- Mild to moderate painespecially at the end of the day.
- Feeling of heaviness abdominal pain or discomfort when bending over.
- Spontaneous reduction of the lump when lying down (in early stages).
When the hernia becomes large or complicated, it may cause:
- Severe and continuous pain.
- Reddening of the skin.
- Difficulty in reducing the bulge (sign of incarceration).
- Vomiting and symptoms of intestinal obstructionif there is strangulation.
In these cases, it is a surgical emergency.
How is it diagnosed?
Diagnosis is usually clinical (by physical examination), but in doubtful cases or for planning surgery, it may be required:
- Abdominal wall ultrasound.
- Tomography (CT)to measure the size of the defect and assess the herniated content.
Is it necessary to operate on all eventrations?
Not all, but yes the majority. In general, surgery is recommended if:
- The hernia causes persistent discomfort.
- It progressively increases in size.
- There is a risk of incarceration or strangulation.
- Compromises the patient's quality of life or functionality.
In cases of low risk, small size and very fragile patients, conservative treatment with follow-up and abdominal bracing can be considered, although it is not a definitive solution.
What does the surgery consist of?
The aim is to repairing the defect in the abdominal wall and, in most cases, to reinforce it with a prosthetic mesh to reduce the risk of recurrence.
There are various techniques depending on size and location:
- Traditional open surgery.
- LaparoscopyLess invasive, less postoperative pain and faster recovery.
- Hybrid or robotic techniques in specialised centres.
The choice depends on the size of the hernia, the patient's general condition and the experience of the surgical team.
An eventration is not just a cosmetic problem. If left untreated, it can become enlarged, painful or even life-threatening if the bowel becomes trapped. Early consultation with a digestive surgeon helps to avoid complications and to opt for a safe and effective surgical technique.