Incisional Hernia

An incisional hernia is a bulge that forms along or near the scar from a previous abdominal operation. When the abdominal wall is cut during surgery and stitched back together, the repaired muscle and connective tissue can be weaker than the surrounding wall. Over months or years, this weakness may stretch, allowing fat or bowel from inside the abdomen to push through.

Factors that increase the risk include wound infection after the original surgery, being overweight, smoking, diabetes, chronic coughing, heavy lifting soon after surgery, and previous emergency operations. Symptoms range from a painless bulge that is more obvious when standing or straining, to aching, a sense of pressure, or discomfort with activity. Incisional hernias vary greatly in size, from a small defect to a large bulge involving much of the previous scar.

Incisional hernias tend to enlarge over time, and larger hernias are more difficult to repair. Surgery is recommended when the hernia is causing pain or discomfort, is affecting your work, posture or daily activities, is increasing in size, or when the skin over it is becoming thin. Repair is also advised to prevent bowel becoming trapped or strangulated within the hernia, which requires emergency surgery.

Not every incisional hernia needs an operation straight away. Small, painless hernias in people with significant medical problems may be monitored. Before planned repair, your surgeon may recommend steps that improve the chance of a lasting result, such as stopping smoking, optimising diabetes control and losing weight. A CT scan is often arranged to measure the size of the defect and plan the repair.

Incisional hernia repair is performed under general anaesthesia. The hernia contents are returned to the abdomen, the edges of the defect are brought together where possible, and the area is reinforced with a synthetic mesh, which substantially lowers the risk of the hernia recurring compared with stitches alone.

• Open repair - the old scar is reopened, the hernia repaired and the mesh placed within the layers of the abdominal wall. This is often used for larger hernias or where excess skin needs to be removed
• Laparoscopic (keyhole) repair - small incisions are made away from the scar and the mesh is placed on the inside of the abdominal wall

Large or complex hernias may require more extensive abdominal wall reconstruction. Your surgeon will explain which approach is recommended and why.

Recovery depends on the size of the hernia and the type of repair. Small hernias repaired by keyhole surgery are often day surgery or a single night in hospital, while larger open repairs may involve a stay of several days. Pain is managed with regular pain relief, and you will be encouraged to walk early. An abdominal binder may be recommended for support in the first weeks.

Return to desk-based work is usually possible within two to three weeks, while heavy lifting and manual work should generally wait six weeks or longer, according to the advice of your surgeon.

We welcome patients whose incisional hernia is a workers compensation matter. Please bring your claim number and insurer details to your appointment so that the necessary approvals can be arranged promptly.

Bowel or fat can become trapped (incarcerated) or lose its blood supply (strangulated) within an incisional hernia. This is an emergency.

Go to your nearest emergency department or call 000 if:

• The hernia becomes suddenly painful, hard or tender and cannot be pushed back in
• The skin over the hernia becomes red, purple or discoloured
• You develop vomiting, bloating or severe abdominal pain
• You are unable to pass wind or open your bowels

After surgery, contact the practice or seek medical attention if you develop a fever, increasing redness, discharge or pain at the wound, a rapidly enlarging swelling under the scar, or a new bulge at the site of the repair.