Incisional Hernia Repair

Introduction

If you have noticed a bulge near an old surgical scar on your abdomen, or your doctor has told you that you have an incisional hernia, this guide is for you. An incisional hernia is one of the more common long-term issues that can follow abdominal surgery. It may appear months or even years after the original operation, and it does not heal on its own.

The good news is that incisional hernia repair is a well-established surgery. Techniques have improved steadily over the past two decades, particularly with the wider use of surgical mesh and minimally invasive approaches. Most people who undergo repair return to their normal activities and feel a clear improvement in comfort and confidence.

This article explains what an incisional hernia is, why repair is needed, who is a candidate, the surgical approaches available, what preparation and recovery look like, and what to expect in the months and years after surgery. It is written for patients who already have a diagnosis and are planning their next step.

What Is an Incisional Hernia?

A hernia is a bulge of tissue that pushes through a weak spot in the muscle or connective tissue that normally holds it in place. An incisional hernia, sometimes called a post-surgical hernia or a type of ventral hernia, is one that develops at the site of a previous surgical cut on the abdomen.

During abdominal surgery, the layers of the abdominal wall — skin, fat, muscle, and a tough fibrous layer called the fascia — are cut and then sewn back together. The skin almost always heals well. The deeper fascial layer, which provides most of the strength of the abdominal wall, does not always heal as completely. If the fascia does not knit back together fully, a gap can remain. Over time, the natural pressure inside the abdomen pushes tissue — often fat from inside the abdomen, sometimes a loop of intestine — outward through that gap. The result is a bulge under the skin near the old scar.

Key features of an incisional hernia

• It appears only at or near a previous surgical incision
• It can appear months to many years after the original operation
• It tends to grow slowly over time rather than shrink
• It does not heal on its own
• The bulge often becomes more obvious when you stand, cough, strain, or lift

Incisional hernias can range in size from very small (a one or two centimetre defect, with a small bulge that comes and goes) to very large (a defect spanning much of the abdominal wall, sometimes called a “complex” or “giant” ventral hernia). The size of the defect and the position of the hernia influence how the repair is planned.

Why Is Incisional Hernia Repair Performed?

Repair is performed to close the gap in the abdominal wall, return the displaced tissue to where it belongs, and reinforce the area so the hernia does not return. There are several reasons doctors recommend repair rather than leaving a hernia alone.

Symptom relief

Many people with an incisional hernia experience daily symptoms even if the hernia is not dangerous. These can include:

• A visible or palpable bulge near the scar
• Discomfort, aching, or a dragging sensation in the abdomen
• Pain that worsens with standing, lifting, coughing, or by the end of the day
• Difficulty with certain movements or exercise
• Skin irritation over the bulge if it is large
• Self-consciousness about the appearance of the abdomen

Repair is the only definitive way to relieve these symptoms.

Preventing the hernia from growing

Incisional hernias tend to enlarge over months and years. Once a defect is present, the constant pressure inside the abdomen tends to stretch it wider. A small hernia is generally easier to repair than a large one, and the surrounding muscle and skin remain in better condition.

Preventing serious complications

• Incarceration — the tissue inside the hernia becomes stuck and cannot be pushed back in
• Strangulation — the blood supply to the stuck tissue is cut off, which can damage bowel and become life-threatening

Strangulation is uncommon but is a medical emergency. Planned repair of a known hernia avoids the much higher risks of emergency surgery.

When urgent care is needed

If you have an incisional hernia and develop any of the following, seek emergency medical care:

• Sudden severe pain at the hernia site
• A bulge that has become firm, tender, or discoloured
• A hernia that you can no longer push back in when previously you could
• Nausea, vomiting, or inability to pass stool or gas
• Fever along with hernia-site pain

Who Is a Candidate for Incisional Hernia Repair?

Most adults with a symptomatic incisional hernia are candidates for repair. However, surgery is rarely an emergency for an uncomplicated hernia, and surgeons usually want to optimise certain health factors first to reduce the risk of complications and recurrence.

Factors that favour proceeding with repair

• Symptoms that affect daily life
• A hernia that is enlarging
• A hernia at risk of incarceration (for example, a narrow defect with a larger sac)
• Reasonable overall fitness for general anaesthesia

Factors surgeons typically want to address before elective repair

• Smoking — smoking reduces wound healing and increases recurrence. Most surgeons ask patients to stop smoking for several weeks before and after surgery.
• Uncontrolled diabetes — high blood sugar increases infection risk. Good glucose control before surgery improves outcomes.
• Obesity — a higher body weight is associated with higher recurrence rates and wound complications. Surgeons may recommend weight reduction before elective repair, particularly for large hernias.
• Chronic cough or constipation — persistent straining stresses the repair. Treating these issues first is helpful.
• Nutritional status — healing depends on adequate protein and overall nutrition.

For people with an emergency presentation (such as a strangulated hernia), surgery proceeds without the luxury of pre-optimisation. For elective repairs, the surgeon will discuss a timeline that may include weeks or months of preparation if it will meaningfully improve the result.

Non-Surgical Management and Alternatives

Incisional hernias do not resolve without surgery. However, there are situations where surgery is delayed, avoided, or replaced with conservative measures.

Watchful waiting

For people with a very small, painless hernia and high surgical risk (for example, advanced age combined with serious heart or lung disease), surgeons may discuss watchful waiting. This means monitoring the hernia rather than repairing it, with clear instructions to seek care if symptoms develop or change.

Abdominal binders and support garments

A well-fitted abdominal binder can reduce the sensation of the bulge and ease discomfort during daily activities. Binders do not repair the hernia or stop it from growing. They are used as a temporary measure — for example, while preparing for surgery, or for someone who is not a surgical candidate.

Lifestyle measures

Reducing intra-abdominal pressure can ease symptoms and may slow enlargement. Useful measures include weight reduction, treating constipation, treating chronic cough, and avoiding heavy lifting. These measures are valuable both as preparation for surgery and as part of long-term care after repair.

It is important to be clear: these alternatives manage symptoms or buy time. They do not fix the abdominal wall defect. Surgical repair remains the only definitive treatment.

Surgical Approaches to Incisional Hernia Repair

There are three main surgical approaches used today: open repair, laparoscopic repair, and robotic repair. The choice depends on the size and location of the hernia, the patient’s body habitus, prior surgical history, and the surgeon’s experience. In nearly all approaches, a piece of surgical mesh is used to reinforce the repair.

Open repair

Open repair involves a single longer incision, usually directly over the hernia. The surgeon opens the layers of the abdominal wall, pushes the protruding tissue back into the abdomen, closes the defect in the fascia, and places a mesh either above, below, or within the layers of the abdominal wall.

Open repair is often chosen for:

• Large or complex hernias
• Hernias where significant scar tissue from previous surgery is expected
• Cases that need more advanced reconstruction of the abdominal wall (such as component separation techniques, where muscle layers are released and re-approximated to close large defects)
• Patients in whom laparoscopic surgery is not safe or feasible

The trade-offs of open repair are a longer skin incision, more post-operative pain in the first days, and a longer hospital stay compared with minimally invasive options. For large or complex hernias, however, open techniques may give the surgeon the best access to perform a durable reconstruction.

Laparoscopic repair

Laparoscopic repair is a minimally invasive technique. The surgeon makes several small incisions, usually less than a centimetre each, away from the hernia itself. A camera and long instruments are inserted, and the abdomen is gently inflated with carbon dioxide gas to create a working space. The hernia contents are pushed back, the defect is identified from inside, and a mesh is fixed across the defect from within the abdomen.

Compared with open repair, laparoscopic repair generally offers:

• Smaller skin incisions
• Less wound-site pain in the early days
• Fewer wound infections
• A shorter hospital stay
• Faster return to daily activities

Laparoscopic repair is well suited to small and medium-sized hernias and to patients with higher body weight, in whom wound complications after open surgery are more common. It is less suitable for very large hernias, hernias with a great deal of internal scar tissue from previous surgeries, or hernias where loss of abdominal wall structure means reconstruction is needed.

Robotic repair

Robotic repair is a newer form of minimally invasive surgery. The surgeon operates instruments through small incisions, but the instruments are controlled by a robotic system that gives the surgeon a magnified three-dimensional view and greater dexterity inside the abdomen.

Robotic platforms allow surgeons to perform certain steps — particularly suturing the fascia closed and placing mesh between muscle layers — more easily than with standard laparoscopy. This can extend the range of hernias that can be repaired minimally invasively. The recovery experience is broadly similar to laparoscopic repair.

The availability of robotic surgery varies between hospitals. Where it is offered, the surgeon will discuss whether it is suitable in a specific case.

The role of mesh

For most incisional hernias, surgeons reinforce the repair with a sheet of surgical mesh. Mesh is used because repairs without mesh (sometimes called “suture-only” or “primary” repairs) have substantially higher recurrence rates for incisional hernias. Major hernia societies, including the European Hernia Society and the Americas Hernia Society, favour mesh reinforcement for most incisional hernia repairs because of the lower recurrence rates seen in clinical studies.

Different types of mesh exist. Most are made from synthetic polymers such as polypropylene, polyester, or PTFE. Some are designed with special coatings on one side so they can safely sit against the bowel. In specific situations — for example, when there is contamination or infection — biologic or specially designed mesh may be considered. The surgeon chooses the mesh based on the type of repair, where it will sit in the abdominal wall, and the individual case.

• Onlay — on top of the closed fascia, beneath the skin and fat
• Inlay — bridging the defect (less commonly used now)
• Sublay or retromuscular — behind the muscle, in front of the deepest layers
• Intraperitoneal — inside the abdomen, against the inner abdominal wall (used in most laparoscopic repairs)

The position of the mesh affects how it shares load with the abdominal wall and how the wound heals. Retromuscular placement is favoured by many hernia specialists for larger repairs because of its durability.

Preparing for Surgery

Good preparation reduces the risk of complications and supports a smoother recovery. The exact plan will depend on the surgeon, the hospital, and individual health factors.

Pre-operative assessment

You will usually meet the surgical and anaesthesia teams for an assessment before the date of surgery. This may include:

• A detailed history and physical examination, including review of records from your previous abdominal surgery
• Imaging — typically an ultrasound or, more commonly for surgical planning, a CT scan of the abdomen and pelvis
• Blood tests
• An ECG and, if needed, additional heart or lung assessment
• Review of all medications, including over-the-counter and herbal preparations
• Anaesthesia review and discussion of pain control

Optimising health before surgery

Your team may ask you to address certain factors in the weeks before surgery:

• Stop smoking — ideally at least four to six weeks before surgery, and to continue not smoking afterwards
• Control blood sugar — if you have diabetes, work with your doctor to bring HbA1c and daily glucose into a good range
• Weight reduction — for larger hernias and higher body weight, even modest weight loss can reduce wound complications
• Treat chronic cough or constipation — so that straining does not stress the new repair
• Nutrition — eat a balanced diet with adequate protein in the weeks before surgery
• Medication adjustments — blood thinners, certain diabetes medications, and some other drugs may need to be paused or changed before surgery, on your doctor’s advice

The day before and the day of surgery

You will be given specific instructions about when to stop eating and drinking, usually from the night before. You may be asked to shower with an antiseptic soap, and to avoid creams or lotions on the abdomen. Bring a list of your medications and any imaging or reports the team has requested.

What Happens During Surgery

Incisional hernia repair is performed under general anaesthesia, meaning you are fully asleep. The length of the operation varies from about an hour for a small straightforward hernia to several hours for a large or complex repair.

General sequence

1. You are taken into the operating theatre and the anaesthesia team puts you to sleep.
2. The skin of the abdomen is cleaned with an antiseptic solution and sterile drapes are placed.
3. The surgeon makes the planned incisions — either one larger incision (open) or several small ones (laparoscopic or robotic).
4. The hernia is identified, and any tissue that has protruded is gently returned into the abdomen.
5. The defect in the fascia is measured and, where possible, closed with strong sutures.
6. Mesh is placed in the chosen plane and fixed in position with sutures, tacks, or surgical glue, depending on the technique.
7. Any internal layers are closed, drains are placed if needed, and the skin is closed.

For larger hernias, particularly those with a wide defect or loss of abdominal wall domain, the surgeon may use a technique called component separation, which involves carefully releasing certain muscle layers to allow the abdominal wall to be brought back together. This is a more extensive operation and is performed by surgeons with specific training in complex abdominal wall reconstruction.

Recovery and Healing

In hospital

The length of hospital stay depends on the approach and the size of the hernia. Laparoscopic and robotic repairs of small-to-medium hernias often allow discharge after one to two days. Open repairs of larger hernias may need three to five days, or sometimes longer for complex reconstructions.

While in hospital you can expect:

• Pain control with a combination of medications, often including paracetamol, anti-inflammatory drugs where safe, and short-term stronger pain relief
• Encouragement to start walking on the day of surgery or the morning after
• Gradual reintroduction of fluids and food as bowel function returns
• Care of the surgical wound and any drains
• Breathing exercises to reduce the risk of chest infection

The first weeks at home

Most people feel sore for the first one to two weeks and notice steady improvement after that. Typical advice in this phase includes:

• Take pain medication as prescribed; the need for strong painkillers usually drops quickly
• Walk regularly — gentle, frequent walking supports recovery and reduces the risk of blood clots
• Avoid heavy lifting, straining, and abdominal exercises
• Wear an abdominal binder if your surgeon has recommended one
• Keep the incision clean and dry; follow your team’s instructions on showering and dressings
• Watch for signs of infection (increasing redness, warmth, swelling, discharge, or fever) and contact the team if these appear

Return to activity

The timeline varies with the size of the hernia and the type of repair, but commonly:

• Light desk work and driving: usually around two to three weeks, when off strong pain medication and able to perform an emergency stop comfortably
• Light household activities: three to four weeks
• Heavier physical work, sports, and lifting: typically six to twelve weeks, sometimes longer for large repairs

Your surgeon will give you a specific plan for return to activity. The principle is that the mesh integrates into the abdominal wall over weeks to months, and during that time straining and heavy lifting are avoided so the repair is not stressed.

Longer-term healing

The abdominal wall continues to remodel for several months. Many people describe a gradual fading of the firmness around the repair and a return of normal sensation. Mild numbness around the incision is common and usually improves over time. Core-strengthening exercises can be reintroduced under guidance once the surgeon confirms it is safe.

Risks and Complications

Incisional hernia repair is generally safe, especially for elective procedures in optimised patients. As with any surgery, there are risks. Understanding them helps you recognise problems early.

Early complications

• Wound infection — redness, warmth, swelling, discharge, or fever in the days after surgery
• Bleeding or bruising at the wound site
• Seroma — a collection of clear fluid under the skin near the repair, which is common after larger repairs and usually settles on its own
• Hematoma — a collection of blood under the skin
• Urinary retention — difficulty passing urine after surgery, usually temporary
• Ileus — a temporary slowing of the bowel after surgery
• Anaesthetic complications — uncommon but possible, particularly in people with other health problems
• Blood clots in the legs or lungs — the risk is reduced by early walking and, in some cases, blood-thinning injections during the hospital stay

Later complications

• Chronic pain — a small number of people develop ongoing discomfort at the repair site
• Mesh-related issues — rarely, mesh can become infected, shift, or cause irritation. Modern meshes designed for abdominal wall use are well tolerated in the great majority of cases.
• Recurrence — the hernia returning at the same site. Recurrence is the most studied long-term outcome of hernia surgery. It is more likely after suture-only repair than after mesh-reinforced repair, and more likely after repair of very large hernias or in people with risk factors such as ongoing smoking, obesity, or poorly controlled diabetes.
• Adhesions — internal scar tissue that can occasionally cause bowel problems

Choosing a surgeon and centre with experience in abdominal wall surgery, along with good pre-operative preparation and adherence to post-operative instructions, can reduce these risks.

Life After Incisional Hernia Repair

For most people, life after recovery from incisional hernia repair feels like a return to normal — often a substantial improvement on the months or years leading up to surgery. Daily comfort, posture, exercise tolerance, and confidence with clothing and movement typically improve once the repair has healed.

Long-term outlook

Once the mesh is well integrated and the abdominal wall has remodelled, the repair is intended to be permanent. Most people do not need ongoing specialist follow-up beyond the early months, unless the original repair was complex.

Preventing recurrence

The same factors that contributed to the original hernia — or to its recurrence risk — remain important after surgery. Helpful long-term habits include:

• Maintaining a healthy body weight
• Not smoking
• Managing chronic cough or constipation promptly
• Using safe lifting techniques, particularly bending at the knees and avoiding twisting under load
• Building and maintaining core strength gradually, ideally with guidance from a physiotherapist familiar with post-hernia recovery
• Treating other medical conditions, particularly diabetes, well

Diet and nutrition

A balanced diet supports healing in the months after surgery and helps prevent constipation. Generally helpful elements include:

• Adequate protein to support tissue healing
• Plenty of fluids
• Fibre-rich foods such as fruits, vegetables, and whole grains to prevent straining
• Smaller, more frequent meals in the early weeks if larger meals feel uncomfortable

When to contact your surgical team after recovery

Get in touch with your surgeon if, weeks or months after surgery, you notice:

• A new bulge near the repair site
• Increasing pain at the site
• Persistent fluid collection, redness, or discharge
• Any of the urgent symptoms described earlier, in which case seek emergency care

Frequently Asked Questions

Can an incisional hernia heal on its own?

No. The gap in the fascia does not close by itself. Without surgery, an incisional hernia tends to slowly enlarge over time.

Is surgery always needed?

Surgery is the only definitive treatment, but not every hernia is repaired immediately. Very small, painless hernias in people at high anaesthetic risk are sometimes watched. For most people with symptoms or an enlarging hernia, repair is recommended by their surgeon.

Is mesh safe?

Surgical mesh designed for abdominal wall repair has been used widely for decades. Major hernia societies favour mesh reinforcement for incisional hernia repair because suture-only repairs have substantially higher recurrence rates. Complications related to mesh are uncommon when modern meshes are used appropriately by experienced surgeons. Your surgeon can explain which mesh is planned for your repair and why.

How do open, laparoscopic, and robotic repairs compare?

Open repair allows the most direct access for large or complex hernias. Laparoscopic and robotic repairs use smaller incisions, are generally associated with less wound pain and faster early recovery, and may be preferred for small to medium hernias. The choice depends on the hernia and the surgeon’s experience with each technique.

How long until I can return to work?

Most people doing desk-based work return in around two to three weeks. Jobs involving heavy lifting, prolonged standing, or manual labour usually require six to twelve weeks, sometimes longer after a large repair. Your surgeon will tailor advice to your specific job.

Can the hernia come back after repair?

Recurrence is possible, particularly after large or complex repairs or in people with ongoing risk factors. Modern mesh-reinforced repairs have lower recurrence rates than older suture-only techniques. Maintaining a healthy weight, not smoking, and avoiding heavy strain in the months after surgery all help reduce risk.

Will I have a visible scar?

Open repair generally leaves a scar along the line of your previous incision. Laparoscopic and robotic repairs leave several small scars from the port sites. All scars fade over months but never disappear entirely.

Will I need to wear an abdominal binder forever?

No. Binders are used short term during recovery if your surgeon recommends one. They are not needed long term once the repair has healed.

Can I exercise after the repair?

Yes — in fact, regular activity is encouraged. Walking starts immediately. Heavier exercise, lifting, and abdominal strengthening are gradually reintroduced, usually after six to twelve weeks, on your surgeon’s advice. Working with a physiotherapist can help you rebuild core strength safely.

What kind of doctor performs incisional hernia repair?

Incisional hernia repair is performed by general surgeons. For larger or more complex cases, surgeons with additional experience in abdominal wall reconstruction or minimally invasive hernia surgery are often involved.

Conclusion

An incisional hernia is a common consequence of abdominal surgery, but it is also a well-understood and treatable problem. Modern techniques — particularly mesh reinforcement and minimally invasive approaches — have improved both the recovery experience and the durability of the repair.

The decision to proceed with repair, and the choice of approach, are shaped by the size and location of the hernia, your overall health, and the surgeon’s assessment. Preparing well before surgery, following post-operative instructions during recovery, and maintaining healthy habits long term all support a good result. With careful planning and experienced care, most people who undergo incisional hernia repair return to comfortable, normal daily life.