Incisional Hernia

Understanding Incisional Hernia

When the abdomen is opened for surgery, the muscle layers are stitched back together and normally heal into a strong scar. Sometimes that healing is incomplete — because of infection, tension on the wound, or factors such as obesity or diabetes — leaving a gap in the wall beneath the skin scar. Abdominal contents can then push through this gap, forming a bulge known as an incisional hernia.

The bulge often appears when you stand, cough or strain and may flatten when you lie down. Over time the defect can widen and the hernia can grow, which is why an incisional hernia does not resolve on its own and generally becomes harder to repair the longer it is left.

Symptoms

• A bulge or swelling at or near a previous surgical scar
• A lump that grows on standing, coughing or straining and eases on lying flat
• Aching, pulling or dragging discomfort around the scar
• A feeling of pressure or heaviness in the abdomen
• Skin changes or tenderness over a large hernia
• Sudden severe pain, a firm irreducible lump, nausea or vomiting (a warning of strangulation)

Causes & risk factors

• A previous abdominal operation, especially through a large incision
• Wound infection or poor healing after the original surgery
• Being overweight or obese
• Diabetes, smoking or poor nutrition, which slow healing
• Straining early after surgery, chronic cough or constipation
• Multiple operations through the same incision

Possible complications

• Incarceration — the contents become trapped and cannot be reduced
• Strangulation — the blood supply to trapped bowel is cut off, a surgical emergency
• Bowel obstruction with pain, vomiting and abdominal distension
• Progressive enlargement, sometimes leaving a very large defect that is harder to repair

How it is diagnosed

An incisional hernia is often clear on examination — the surgeon feels the bulge along the old scar while you cough or lift your head to tense the abdomen. Because these hernias can be large or have several defects, a CT scan is frequently used to map the size of the gap and the muscles involved, which is important for planning the safest and most durable repair.

Treatment options

An incisional hernia will not heal without surgery. Small hernias with few symptoms may occasionally be monitored, but most are repaired to relieve symptoms and prevent the contents becoming trapped. Before surgery, factors that impair healing — such as high blood sugar, smoking and excess weight — are addressed where possible to give the repair the best chance of lasting.

Surgical treatment

Repair involves closing the defect and reinforcing the abdominal wall with a soft mesh, which markedly reduces the risk of the hernia returning. Dr. Sujan Shrestha performs both open and keyhole (laparoscopic) incisional hernia repairs, selecting the technique that best fits the size and complexity of the defect.

Smaller hernias can often be repaired using a laparoscopic approach through a few small cuts, meaning less wound-related pain and a quicker recovery. Larger or complex hernias may need an open reconstruction of the abdominal wall to restore strong, tension-free support. The right approach is always matched to the individual hernia.

Recovery & aftercare

Recovery depends on the size of the hernia and the type of repair. Small keyhole repairs may allow a return to light activity within days, while larger reconstructions need a longer, more gradual recovery. Heavy lifting and strenuous activity are avoided for several weeks. Reaching a healthy weight and controlling cough or constipation protect the repair over the long term.

When to see a doctor

See a doctor if a bulge or ache develops at an old surgical scar, so it can be assessed and repaired before it enlarges. Seek emergency care immediately if the lump becomes hard, very painful or cannot be pushed back, especially with nausea, vomiting or discolouration of the overlying skin — signs of strangulation.