Understanding the condition
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.
How it is 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 is surgery considered?
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.
Surgery and important risks
Incisional hernia repair requires precise anatomical closure of the abdominal wall defect reinforced with a broad mesh in a well-supplied tissue plane, predominantly the retrorectus (sublay) space behind the rectus muscles. For wider or complex defects, component separation releases deeper muscular layers to achieve tension-free midline closure. Repair may be open, laparoscopic or robotic. Options include IPOM Plus, Ventral TAPP (laparoscopic or robotic), PeTEP, sublay (retrorectus) repair and TAR, depending on the size of the gap, previous scars and adhesions.
In contaminated surgical fields, previous wound sepsis or when bowel resection is performed, permanent synthetic mesh cannot always be placed safely. In these complex scenarios, biological mesh or slowly absorbable synthetic mesh is selected to reconstruct the abdominal wall, support tissue ingrowth and prevent chronic mesh infection. Risks include seroma, haematoma, wound breakdown, infection, temporary bowel sluggishness and recurrence.
Recovery and follow-up
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.