Incisional Hernia After Abdominal Surgery: What to Do and When to Operate
An incisional hernia is a bulge that appears at a previous abdominal scar, caused by a weakness in the wall. It rarely resolves on its own and usually needs surgical repair with a mesh. Timing depends on symptoms, hernia size and your general health, rather than on urgency alone.
What is an incisional hernia?
Why does it happen?
- Wound infection after the original surgery
- Obesity and a large abdominal circumference
- Smoking, which impairs tissue healing
- Diabetes and poorly controlled blood sugar
- Chronic cough or straining, for example from prostate or bowel problems
- Repeated operations through the same incision
- Certain connective tissue and nutritional conditions
How do I recognise it?
Is an incisional hernia dangerous?
When should an incisional hernia be operated on?
- The hernia causes pain, discomfort or limits your daily activities
- It is enlarging progressively over time
- There have been episodes of the content becoming temporarily trapped
- The bulge is cosmetically or functionally troublesome
- Your general health allows a planned procedure with acceptable risk
Preparing before surgery
How is an incisional hernia repaired?
Open repair
Laparoscopic and endoscopic repair
What is recovery like?
Key points to remember
- An incisional hernia will not heal without surgery
- Most cases are not urgent, but a suddenly hard and painful bulge needs emergency care
- Repair almost always uses a mesh to reduce recurrence
- The technique is chosen for your anatomy, not the other way round
- Optimising health before surgery improves the outcome
Frequently asked questions
Can an incisional hernia go away on its own?
No. Once the abdominal wall has a defect at a scar, it does not close spontaneously in adults. Muscles and fascia cannot rejoin on their own across the gap. The hernia may stay stable for a time, but it tends to enlarge gradually. Surgical repair, usually with a mesh, is the only definitive way to correct it.
How long can I safely wait before operating?
If the hernia is small and completely symptom-free, watchful waiting can be reasonable, particularly when surgical risk is high. There is no fixed deadline. However, you should seek urgent care if the bulge becomes suddenly hard, painful and impossible to push back, or if you develop vomiting or a blocked bowel, as these suggest a trapped hernia.
Is a mesh always necessary?
In almost all adult incisional hernias I use a mesh, because closing the defect by suture alone leads to a high rate of recurrence. The mesh reinforces the wall and distributes tension across a wider area. Only in very specific small cases might repair without mesh be considered, and this is decided individually after examining the tissues.
Will the hernia come back after surgery?
Recurrence is possible even after a correct repair, though a mesh reduces the risk considerably. The likelihood is higher when risk factors persist, such as smoking, obesity, poorly controlled diabetes or chronic straining. Addressing these before and after surgery protects the result. Following the advised recovery restrictions during healing also matters for long-term stability.
What is the TESAR technique?
TESAR stands for Totally Endoscopic Sublay Anterior Repair, a minimally invasive approach I developed. It places the reinforcing mesh in the sublay plane, behind the muscle, through an entirely endoscopic route using small incisions. It is one option among several and suits particular anatomies. I only propose it when it is genuinely appropriate for a given patient's hernia.