Incisional Hernia

What causes an incisional hernia

After surgery, the layers of the abdominal wall are stitched back together. The tough fascia layer takes months to regain strength. If it heals poorly, a gap can form, and abdominal pressure gradually pushes fat or bowel through it. Most incisional hernias appear within 1 to 3 years of surgery.

Risk factors

• wound infection after surgery (surgical site infection)
• obesity
• smoking
• diabetes
• steroid or immune-suppressing medicines
• malnutrition
• chronic cough (COPD), constipation or straining
• large or midline incisions, and emergency operations
• previous hernia repair
• pregnancy after abdominal surgery
• connective tissue disorders and abdominal aortic aneurysm
• a separation of the abdominal muscles (diastasis recti), which is not a true hernia but can coexist

Symptoms

• a soft bulge near a surgical scar, more obvious when standing, coughing or lifting
• the bulge often disappears when lying down
• aching, pulling or burning discomfort
• larger hernias may cause bloating, constipation or a feeling of heaviness
• skin changes over very large hernias

Strangulated or incarcerated hernia

An incarcerated hernia (see abdominal hernia for other types) is stuck and cannot be pushed back. A strangulated hernia has its blood supply cut off, which can kill the trapped bowel within hours. Warning signs:

• sudden severe pain at the hernia
• a firm, tender bulge that does not go back
• red, purple or dark skin over the bulge
• nausea, vomiting, fever
• inability to pass gas or stool (signs of bowel obstruction)

Call 911 or go to the ER immediately.

Diagnosis

Most incisional hernias are diagnosed by examination, feeling the bulge while you stand and cough. Imaging helps plan surgery or find small or hidden hernias:

• CT scan: shows the size of the defect, its contents, and other hernias along the scar
• ultrasound: useful for small hernias

Treatment

Watchful waiting

Small hernias that cause no symptoms can sometimes be monitored, especially in people with high surgical risk. You should know the warning signs of strangulation. Many hernias grow over time and eventually need repair.

Preparing for surgery

Results are better and recurrence lower when risk factors are addressed first:

• stop smoking at least 4 to 6 weeks before surgery
• lose weight if body mass index is high
• control blood sugar
• treat skin infections

Surgical repair

• Mesh repair is standard for most hernias larger than about 1 cm, because simple stitching has much higher recurrence rates.
• Open repair: the mesh is placed in the abdominal wall layers; may include component separation for large hernias.
• Laparoscopic or robotic repair: through small incisions, often with mesh placed inside the abdomen; associated with fewer wound complications in suitable patients.

Choice depends on hernia size, location, previous surgeries and overall health.

Abdominal binders

A supportive binder can relieve symptoms for people waiting for surgery or unable to have it. It does not fix the hernia.

Recovery

• Most people go home the same day or within a few days.
• Walk from the first day.
• Avoid heavy lifting for about 4 to 6 weeks, or as your surgeon advises.
• Return to desk work in 1 to 3 weeks depending on the size of repair.
• Recurrence happens in a minority, more often with large hernias, obesity, smoking and infection.

Complications of repair

• seroma (fluid collection under the skin)
• wound infection
• mesh infection or chronic pain (uncommon)
• recurrence
• bowel injury (rare)

Prevention

After abdominal surgery:

• avoid smoking
• avoid heavy lifting for at least 4 to 6 weeks
• treat constipation and chronic cough
• keep blood sugar controlled
• maintain a healthy weight
• surgeons may use specific closure techniques or prophylactic mesh in high-risk patients

Frequently asked questions

What are the symptoms of an incisional hernia?

The main sign is a bulge near a surgical scar that becomes more noticeable when standing, coughing or straining and often disappears when lying down. It may cause aching or pulling discomfort. Severe pain, a hard bulge or vomiting need emergency care.

How soon after surgery can an incisional hernia occur?

Most incisional hernias develop within the first 1 to 3 years after abdominal surgery, but they can appear many years later. Early wound infection, obesity and smoking increase the risk.

Does an incisional hernia need surgery?

Not always. Small hernias without symptoms can sometimes be watched. Most hernias that cause discomfort, are growing, or have a narrow opening with a higher risk of trapping bowel are repaired, usually with mesh.

Is incisional hernia repair surgery painful?

Some pain is expected for the first 1 to 2 weeks and is managed with pain medicines. Keyhole repairs often have smaller wounds but can cause temporary discomfort from mesh fixation. Most people return to light activities within days.

Can an incisional hernia come back after repair?

Yes, recurrence is possible, especially with large hernias, obesity, smoking, diabetes and wound infection. Mesh repair and addressing risk factors before surgery reduce the chance of it returning.