Incisional hernia J033

Current RMA Instruments

Changes from previous Instruments

ICD Coding

• ICD-10-AM Codes: K43.0-2

Brief description

An incisional hernia is a hernia that develops at the site of a previous abdominal surgical incision. It occurs when the fascial tissues of the abdominal wall do not heal adequately after surgery, allowing internal tissues- such as fat or bowel- to bulge through the weakened area. Incisional hernias are one of the more common types of ventral hernia following abdominal operations. 

Confirming the diagnosis

Diagnosis is based on a combination of the clinical history and physical examination, typically showing a bulge or defect at the site of a previous surgical scar. In some cases, imaging (typically ultrasound) may be used to clarify the diagnosis or severity. 

Assessment and management usually involve a general surgeon. General practitioners are also able to confirm this diagnosis based on consistent clinical assessment and imaging results. 

Additional diagnoses covered by SOP

• Nil

Conditions that may be covered by SOP 

• Ventral hernia (see comments)

Conditions not covered by SOP

• Congenital ventral hernia #
• Diastasis recti #
• Epigastric hernia #
• Femoral hernia #
• Hiatus hernia *
• Inguinal hernia *
• Lateral abdominal wall hernia (not associated with a previous incision) #
• Obturator hernia #
• Parastomal hernia # (unless arising through a surgical incision fascial plane)
• Umbilical and paraumbilical hernia #
• Spigelian hernia #
• Traumatic ventral hernia #

* another SOP applies 

# non-SOP condition

Clinical onset

Clinical onset refers to the earliest point in time when the characteristic features of an incisional hernia were first present. The condition may sometimes be asymptomatic and discovered incidentally during an examination. More commonly, a visible or palpable bulge at the site of a previous abdominal incision is noticed by the patient or clinician. There may be associated discomfort with coughing, lifting, exercise, or bowel movements, although hernias are rarely painful. Once the diagnosis is confirmed, onset may be backdated to when the bulge or symptoms were first observed after surgery. 

Clinical worsening

Incisional hernias often remain stable or progress slowly over time. Worsening may be indicated by an increase in the size of the hernia, development of new or worsening symptoms, or the onset of complications- such as incarceration or strangulation (uncommon but serious). 

Treatment may be conservative or may involve surgical repair, depending on the severity, symptoms and risk of complications. Specialist surgical review is generally required to consider whether any observed deterioration represents worsening beyond the expected course of the condition. 

Further comments on diagnosis

A ventral hernia is any bulge of abdominal tissues through a defect in the abdominal wall. While many ventral hernias are incisional hernias, ventral hernias can also be congenital or arise from trauma. These non-incisional types are not covered by the incisional hernia SOP.