Recently, several patients have asked me questions on my website, saying that they have a “strange bag” on their stomach, which was small at the beginning, but gradually grew bigger and bigger, and this “strange bag” is bigger when standing or sitting, and disappears when lying down. It is really a strange thing that it can disappear when lying down and cannot be touched at all. Although these patients have different conditions, they all have a common feature, that is, they have had surgery on their abdomen for their own reasons (appendicitis, colon cancer, cholecystitis, gallstone, etc.) before the onset of the disease, and the place where the “strange bag” appeared was around the scar of the original surgery. After careful examination at the hospital, the doctor told them that the “strange bag” was not a mystery, but that they had an “incisional hernia”, which is a kind of “intestinal cascade”, as the common people call it. The doctor told them that the “strange bag” was not a mystery, but that they had an “incisional hernia”, which is a kind of “intestinal strangulation”. What kind of disease is an incisional hernia? How is it diagnosed and treated? I will tell you briefly about it below. Incisional hernia of the abdominal wall is a hernia that occurs at the site of a surgical incision and is usually seen after various abdominal surgeries, especially in the longitudinal surgical incision area of the abdomen, which means that incisional hernia is more likely to occur in vertical incisions than in horizontal incisions. After healing of the abdominal surgical incision, if there is a local defect in the abdominal wall tissue, the intra-abdominal organ tissue may protrude beyond the plane of the normal peritoneal wall layer, which is called an incisional hernia of the abdominal wall. The etiology is related to the systemic and local factors suffered at the time of the original surgery. After abdominal surgery, the incidence of incisional hernia is usually less than 1% if the incision is healed in one stage, but can be up to 10% if the incision is infected; it can even be up to 30% if the wound is open. Incisional infection is the most important cause of incisional hernia. After infection, the incision heals in phase II, there is much scar tissue, the abdominal wall has different degrees of defects, and the strength of the abdominal wall at the incision site is significantly reduced. According to statistics, the incidence of incisional hernia after incisional infection is 5 to 10 times higher than that of phase I healing incision. Prevention of incisional infection is the most important measure to reduce the incidence of incisional hernia. As mentioned earlier, a straight incision is more prone to incisional hernia than a transverse incision because all layers of the abdominal wall muscles (except the fibers of the rectus abdominis muscle, which run longitudinally), fibers of the tendon and fascia, and nerves run transversely, and a straight incision is bound to sever all these layers. In addition, the straight incision after suturing is always under the tension of transverse traction. If the abdominal wall is weak and the intra-abdominal pressure is high, the incision is prone to splitting. Obviously, the incidence of incisional hernia is much lower in transverse incisions than in straight incisions, and the transverse tension of the layers of abdominal wall tissue facilitates the alignment of the transverse incision. Other factors include weakness of the abdominal wall or chronic disorders that increase intra-abdominal pressure, which predispose to incisional hernia and are therefore more common in older or obese patients. Other factors related to the original surgery are poor intraoperative anesthesia, forced abdominal wall alignment, or inaccurate alignment of the abdominal wall layers during suturing. The main symptom of an incisional hernia of the abdominal wall is the gradual bulging of the abdominal wall incision and the appearance of a mass. The mass is usually more pronounced when standing or exerting force, and shrinks or disappears when resting. If the hernia is large and has more organs and tissues protruding, there may be a pulling sensation in the abdomen, with loss of appetite, nausea, constipation and vague abdominal pain. Most incisional hernias do not have an intact hernia sac, and the contents of the hernia can often adhere to the extraperitoneal abdominal wall tissue and become a refractory hernia, sometimes accompanied by incomplete intestinal obstruction. On examination, a mass at the incisional scar can be seen, ranging from a few centimeters in diameter in small cases to l0-20 cmn in large cases or even larger. The patient is asked to lie down and put his fingers into the defective part of the abdominal wall, and then the patient is asked to exhale to clearly find the edge of the hernia ring and understand the size of the defect and the strength of the marginal tissue. Sometimes the contents of the hernia can be subcutaneous. At this time, the intestinal pattern and intestinal peristaltic waves can often be seen in the thinner part of the skin, and the gurgling sound of the intestinal canal can be felt on palpation. After the mass is repositioned, the edge of the hernia ring formed by the splitting of the abdominal muscle can mostly be felt. In the case of abdominal wall laxity due to weakness of the abdominal muscles after intercostal nerve injury, there is localized bulging, but there is no mass with clear margins and no clear hernia ring to be found. The hernia ring in incisional hernias is usually wide. Intussusception rarely occurs. If a CT examination of the abdomen is performed at the hospital, the herniated abdominal contents can be seen, with the small intestine and large omentum being the most common. How should I treat an incisional hernia in the abdominal wall? In principle, early surgical repair is advisable if there are no special contraindications. The longer the delay, the faster the hernia sac enlarges, the weaker the muscles around the abdominal wall, and the chance of successful surgery decreases accordingly. On the other hand, incisional hernia is mostly the sequelae of incisional infection, and the scar is still congested and edematous within a short period of time after the incision is healed, and even hidden infection still exists, so it is not easy to succeed in the repair surgery too early. Therefore, it is generally appropriate to perform repair surgery six months after the incision has healed, and in the case of infected, scar-healed wounds, it is appropriate to perform repair surgery one year later. If the patient has a serious cardiovascular system and other diseases that are not suitable for surgery, conservative treatment with lap band protection can slow down the progress of the disease. A detailed analysis of the cause of morbidity must be performed before surgery. If the cause continues to exist, recurrence may occur after surgery. In addition, obese patients should be advised to lose weight. There are several methods of surgical repair: simple repair and suturing Incisional hernias are often without an intact hernia sac, and the hernia contents often protrude from the defective part of the abdominal wall and adhere to the superficial tissues of the abdominal wall and even to the skin. It is advisable to make a shuttle incision in the normal abdominal wall at the edge of the original incision to avoid accidental injury to the subincisional organs. The adhesions are separated, the hernia contents are retracted, the hernia ring and its surrounding scar tissue are excised, and the abdominal wall is closed in layers without tension, and sometimes the abdominal wall can be reinforced by overlapping fascial sutures. It is to sew the muscle tissue and myofascial tissue, because this piece of skin was not split, and the place of peritoneum is impossible to block the abdominal pressure, especially when coughing and sneezing, only muscle tissue and myofascial tissue can eat, and there is no muscle tissue and myofascial tissue, there is nothing to resist its pressure, so the top bulges, so when sewing should sew this place, and this muscle tissue The muscle tissue is already atrophied, and if you force it together, it will soon split. Because of the high recurrence rate of simple repair sutures, reported in the literature to be up to 50%; above, the concept of patch implantation is gradually being accepted by more and more domestic physicians and patients. The implantation of a synthetic patch in the weak abdominal wall can reduce the recurrence rate to about 10%. This patch is just like the patch that people say, for example, there are only two ways to make up for the broken clothes, one is to take the thread and sew it on, and the other is to make a patch, of course the patch will be much stronger. This patch is a tension-reducing surgery, which is done between normal tissues, so that there is no tension between the tissues, and the tension is transferred between the tissues and the patch, which can ensure a good healing condition between the tissues and the tissues, and fundamentally reduce the chances of recurrence. In addition, with the popularity of laparoscopic techniques, laparoscopic incisional hernia repair has become an alternative treatment modality. The advantages are small incision, minimal trauma, short hospital stay, low complication rate, and even lower recurrence rate, making the tension-free repair of incisional hernia a truly precise repair and minimally invasive procedure. The disadvantage is that the cost is relatively high and the learning curve for the surgeon is long, so the surgeon needs more time for training before he/she can master the surgical technique. It is believed that with the popularization of laparoscopic technology and advances in material engineering, minimally invasive surgery will become the standard procedure for incisional hernia surgery in the abdominal wall, and more patients will benefit from it.