Hernia Risk After Open-Heart Surgery: Causes & Prevention

Sternal and Incisional Hernias After Cardiac Surgery

Median sternotomy creates a midline defect. While sternal dehiscence is the immediate concern, true incisional hernias can develop later.

Risk Factors

• Sternal wound infection/dehiscence: Disrupts healing; #1 risk factor.
• Patient factors: Obesity (BMI>30), diabetes, COPD/steroid use, smoking, malnutrition, age >70.
• Technical: Wire technique (figure-8 vs. cerclage), number of wires, bone quality.
• Post-op: Early heavy lifting, chronic cough, constipation/straining.

Types

• Sternal non-union/dehiscence: Wires break/pull through; instability.
• Incisional hernia: Fascial defect at sternotomy site; abdominal contents protrude.
• Parasternal hernia: Through costochondral junctions.

Prevention

• Rigid fixation (plates, cables) in high-risk patients.
• Aggressive glucose control, smoking cessation pre-op.
• Respiratory therapy (cough suppression, incentive spirometry).
• Weight management.
• Activity restrictions: No lifting >10 lbs x 8-12 weeks; gradual return.

Management

• Asymptomatic small hernias: Observe, binder.
• Symptomatic/large: Surgical repair (mesh reinforcement, often component separation).
• Infected mesh: Removal, staged reconstruction.

Multidisciplinary cardiac surgery follow-up catches early signs.