What is an incisional hernia?

An incisional hernia occurs when tissue pushes through a weak area in the abdominal wall at the site of a former surgical incision, usually through a scar from earlier surgery. This incision may have been made to access an internal organ, such as during an appendectomy or a caesarean section.

An incisional hernia is different from a recurrent hernia. After the original operation, the surgeon closes the layers of the abdominal wall with stitches. In some cases, this closure does not heal properly, weakens over time, or comes apart, allowing a hernia to develop.

Symptoms of an incisional hernia

Incisional hernia symptoms typically include a noticeable bulge or swelling near a previous surgical scar, which may become more obvious when standing, coughing, or straining and often reduces when lying down. Many people also experience a dull ache, pulling sensation, or discomfort around the area, along with a feeling of heaviness in the abdomen, particularly during physical activity or prolonged standing.

In some cases, there may be associated digestive symptoms such as bloating, constipation, or nausea if bowel tissue is involved. Symptoms can gradually worsen over time, and urgent medical attention is needed if the bulge becomes painful, hard, irreducible, or is accompanied by vomiting, as this may indicate a complication.

How common are incisional hernias?

Remarkably common, really. It is estimated that at least 12-15% of abdominal surgery / operations lead to an incisional hernia.

Historically, and even today, the success rate for repairing them is quite poor with a high incidence of complications and failure. In some reports from other surgeons 50-60% of incisional repairs have failed within 2 years.

Are incisional hernias dangerous?

As with all hernias, a strangulated hernia happens when the hernia contents, such as part of the intestine, become trapped and lose their blood supply, a serious and potentially life-threatening condition.

Do I need treatment or can I leave it?

If you do, it will almost certainly enlarge. It will just get bigger and probably become more and more unsightly and uncomfortable.

Do I have any non-surgical options?

You can try wearing a corset or a belt. Not ideal, as it can cause additional problems and it is difficult to find a good one.

What is the best incisional hernia repair method?

That is one of the really important questions. We have extensive experience in incisional hernia repair and today most hernia surgeons agree:

a) using mesh gives the best results.

b) both open and keyhole (laparoscopic) hernia repairs are effective when performed by experienced specialists. The choice of technique depends on factors such as the type of hernia, the presence of additional gaps in the abdominal muscles (a common finding), the condition of the surrounding muscles and the degree of muscle separation. The repair should always be tailored to the individual patient by a skilled surgeon.

c) the layer of the abdominal wall in which the mesh is placed is a really important factor. A sub-lay mesh technique where a mesh is placed between the abdominal muscle layers is considered to be superior to an on-lay mesh technique where the mesh over the muscles (and under the skin) after they have been stitched together. A sub-lay technique is associated with greater success in terms of longer term durability of the repair and lower risk of infection

Is mesh always used in incisional hernia surgery?

It should be. Sutured repairs have a really high failure rate

Biological meshes are unproven, and there are few long-term results available. So far in the majority of cases, when the mesh dissolves, the hernia returns.

Is the old cut reopened in incisional hernia repair surgery?

For open repairs, yes it is. If done well it’s an excellent operation. Some claim that the risk or incidence of infection is high. We think that this a reflection of poorly performed surgery. Often incisional hernias could be associated with ugly scars from the previous surgery and the open operation is also an opportunity to refashion the scar.

How good is keyhole repair?

Outcomes depend on the type of repair and the experience of the surgeon. In a traditional minimally invasive (keyhole) repair, mesh is placed on the inside of the abdominal wall to cover the hernia defect, but the edges of the gap are not brought together. If the defect is large, this can leave a noticeable bulge.

In these cases, more advanced minimally invasive techniques can be used to stitch the muscles back together, restoring the abdominal wall more effectively. When performed by an experienced specialist, minimally invasive hernia repair is often associated with less pain, smaller scars, and a faster recovery.

Complex incisional hernias

Incisional hernias can become particularly complex when they have previously been repaired and then recur, or when there is significant separation of the abdominal muscles. In these situations, simply closing the defect is often not enough. To achieve a strong repair with the muscles brought back together and adequate mesh coverage, comprehensive reconstruction of the abdominal wall (AWR) may be required.

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The choice between open and keyhole (laparoscopic) surgery, as well as the need for reconstruction of the abdominal wall, depends on several factors. These include the size and location of the hernia, the extent of the defect, the presence of additional nearby defects, the degree of muscle separation, and the overall quality of the abdominal wall tissue. Careful pre-operative planning, often using CT imaging, allows for a tailored surgical approach designed specifically for each patient.

The British Hernia Centre - How can we help?

At the British Hernia Centre, we treat the full spectrum of incisional hernias, from small, straightforward cases arising from previous keyhole procedures (commonly following prostate or gallbladder surgery), to large, complex hernias that have recurred after prior repair. We regularly manage cases that have been declined elsewhere due to their complexity, offering advanced surgical expertise and individualised treatment plans.

As the UK’s first and only dedicated specialist hernia centre, we have over 30 years of experience and now perform more hernia operations than any other surgical unit worldwide.

‍Contact the team at The British Hernia Centre for more information or to book a consultation.