What is an incisional hernia?
An incisional hernia may appear months or years after an abdominal operation as a swelling beneath or beside the scar. It can enlarge and cause pain, difficulty with activity, bowel symptoms or loss of abdominal-wall strength.
Previous wound infection, obesity, diabetes, smoking, emergency surgery and repeated operations increase risk. There may be more than one defect, muscle separation or mesh from an earlier repair.
What are the symptoms of an incisional hernia?
An incisional hernia can appear months or years after an abdominal operation. Common symptoms are:
- A bulge under or beside an old surgical scar, often clearer when you stand or strain
- Discomfort or pulling during activity or lifting
- A feeling that the abdominal wall is weak
- Bowel symptoms such as bloating or constipation
- Sudden severe pain at the scar with vomiting, which needs emergency care
How is an incisional hernia assessed?
The surgeon examines the scars, skin, defect size, muscle function and whether the hernia reduces. CT of the abdomen and pelvis is commonly used for a moderate, large, recurrent or complex hernia. The actual images show the muscles, bowel, old mesh and tissue planes needed for planning.
Blood count, nutrition, diabetes, smoking, weight, breathing and heart health are reviewed. Previous operation notes and mesh records are particularly useful.
When does an incisional hernia need surgery?
Repair is considered when the hernia causes pain, enlarges, affects daily activity, threatens the skin or causes episodes of obstruction. An incisional hernia does not close by itself and tends to enlarge, so earlier repair is usually simpler.
Before planned reconstruction, smoking cessation, diabetes control, treatment of anaemia, nutritional correction and a realistic weight plan can reduce wound problems. Urgent symptoms still need prompt assessment.
How is an incisional hernia repaired, and what are the risks?
The aim is to close the gap in the muscle and strengthen it with a wide mesh. The mesh is usually placed in a protected layer behind the long tummy muscles, called a sublay or retrorectus repair. When the gap is too wide to close, the side muscles are carefully released so the middle can be brought together without tension; this is called component separation, or TAR. The repair may be open, laparoscopic or robotic. The method (such as IPOM Plus, Ventral TAPP, PeTEP, sublay repair or TAR) depends on the size of the gap, earlier scars and scar tissue inside the abdomen.
If the area is infected, or part of the bowel has to be removed during the operation, a permanent mesh may not be safe. A biological mesh or a slowly dissolving mesh is then used, because it copes better with infection. Risks include fluid collecting under the wound (seroma), bleeding or bruising, wound breakdown, wound or mesh infection, injury to the bowel, blood clots, long-lasting discomfort, a slow return of bowel function for a few days, and the hernia coming back.
Recovery after incisional hernia repair
The length of stay depends on the size of the repair and the type of reconstruction. Walking, breathing exercises, clot prevention and pain control begin early. Drains or an abdominal binder may be used for specific reasons.
Activity increases gradually while the repair heals. Seek review for fever, persistent vomiting, breathlessness, increasing wound pain, redness, discharge or a rapidly enlarging swelling.
When to seek urgent care
Seek emergency care for sudden severe pain, a firm swelling that will not reduce, vomiting, abdominal distension, fever, skin colour change or inability to pass stool or gas. These may indicate obstruction or trapped bowel.