Scar fracture

A scar rupture, also called an incisional hernia, occurs when the peritoneum bulges on the exact spot of a previous scar in the abdominal wall. This can occur in different places depending on previous surgeries. Some scar fractures are small while others can be very large and contain a lot of abdominal contents.

How does a scar fracture occur?

Scar fractures are always the result of previous surgery. Several factors can affect the healing process and pressure in the abdomen, increasing the risk of scar fracture. Smoking, obesity, diabetes and the use of immunosuppressants are important risk factors in this regard.

Symptoms

The most common complaint is swelling on or around the scar, which gets larger when squeezing or coughing. The severity of symptoms is often related to the size of the fracture. Large fractures may feel heavy or tense and sometimes even cause skin problems. Pain varies and is especially common with smaller fractures where tissue can become pinched. This can cause severe pain and lead to bowel obstruction, with symptoms such as vomiting and abdominal bloating, which may require emergency surgery. 

Diagnosis

A diagnosis is made primarily through physical examination. This involves looking at the size of the opening, the condition of the skin and whether the fracture can be pushed back. A CT scan gives a good overview of the abdominal wall and can help detect any other fractures. For large or complex fractures, a pulmonologist or cardiologist may be involved, especially with previous health problems.

Treatment

Treatment depends on the size and complexity of the fracture and the health of the patient. Simple fractures under 10 cm without major risk factors can often be repaired through keyhole surgery (laparoscopy) or robotic surgery, usually in day admission.

Keyhole surgery (laparoscopy)

More complex fractures often require open surgery and sometimes preparation, such as botulin injections into the abdominal muscles to shrink the fracture. It is also important to address risk factors such as smoking and obesity as much as possible for a better recovery.

After surgery to repair a scar fracture, the following complications may occur:

  • Wound infections: especially in large wounds or in patients who smoke, have diabetes or are overweight.
  • Post-bleeding: usually without treatment, but sometimes a new procedure is needed.
  • Temporary stoppage of the gastrointestinal system.
  • Fluid accumulation (seroma): usually disappears on its own.

Contact your doctor immediately if there is a persistent fever, chills, increasing swelling or pain in the abdomen, continued nausea or vomiting, persistent cough or difficulty breathing, or if fluid leaks from a wound.

How does an admission go?

On the day of surgery, you will report to the hospital at the appointed time in the morning. Before leaving for the operating room, you will be asked to urinate, remove all jewelry and tools, and put on a surgical apron. The duration of the procedure depends on the complexity.

You will not be allowed to eat or drink immediately after surgery, but you will be allowed to rinse your mouth. A nurse regularly checks your condition and wounds, and takes care of your pain management. Sometimes a one-time bladder tube may be needed if urination is difficult. You'll get help standing up for the first time because of possible dizziness. Your surgeon will visit you after surgery to give an update and to answer questions. A consultation will determine when you may go home.

Aftercare

You will be given instructions on wound care, an appointment to see your doctor and surgeon, and a prescription for pain medication. For the first two weeks you may not bathe, only shower. For four weeks after surgery, you must not do any heavy lifting or exercise. You must also wear a belly band for four weeks, day and night for the first two weeks, then only during the day.

Departments

Would you like more information or to make an appointment? If so, please visit the department(s) below.

General and abdominal surgery

Would you like to know more about abdominal wall surgery?

For more information, take a look at the website of the abdominal wall center Limburg.

Abdominal wall center Limburg