Incisional hernia

The main symptom of an incisional hernia is a bulge around your incision site. It may be more noticeable when you stand, cough, sneeze, or lift a heavy object.

Other incisional hernia symptoms may include:

• Nausea
• Vomiting
• Pain, aching, burning or discomfort around the hernia
• Fever (a temperature above 38C)
• Increased heart rate
• Diarrhoea or constipation
• Bloating
• Thin, narrow stools (poo)

Incisional hernias occur when your muscles don't heal properly after abdominal surgery resulting in a weakness in the abdominal wall. Sometimes, they develop for no apparent reason, but they are often caused by:

• Too much pressure on the abdominal wall
• Exercising too soon after abdominal surgery
• Getting pregnant too soon after abdominal surgery
• Emergency abdominal surgery or surgery that requires a large incision
• Poor alignment of the wound edges during surgery
• The stitching technique used during surgery

You may have a higher risk of developing an incisional hernia if you:

• Are overweight or obese
• Smoke
• Develop a wound infection along the incision site
• Have another medical condition such as diabetes, kidney, or lung disease
• Take certain medications like chemotherapy, immunosuppressants or steroids

At your first appointment, you will be seen by a consultant surgeon who specialises in hernia repair. This will typically be a general surgeon, though many surgeons will specialise in a subspecialty of general surgery, for example gastroenterology or upper GI surgery.

Your consultant will ask you about your symptoms, general health, and medical history. They will perform a physical examination of your abdomen and incisional hernia. Your first consultation is also where we get to know you, discuss your expectations for treatment and encourage you to ask any questions you may have.

If your consultant suspects that your hernia may have developed complications, they may order blood tests, or imaging scans such as a CT scan, MRI, or ultrasound to check for infection and blockages.

After making a diagnosis, your consultant will discuss possible treatment options with you and decide on the best option based on your symptoms and diagnosis.

Although you won't always have to have surgery because you have an incisional hernia, surgery is the only option to repair the hernia. Incisional hernia repair surgery involves pushing the protruding tissue and organs back inside the abdomen. We then strengthen the abdominal wall using mesh in order to prevent your hernia from protruding again.

Hernia repair surgery can either be performed as open surgery, where a large incision is made in the abdomen, or as laparoscopic (keyhole) surgery, which is a minimally invasive technique done using very small incisions.

Laparoscopic surgery involves making several small incisions in the abdomen and using a camera called a laparoscope and small surgical instruments to perform the surgery using images on a screen.

Laparoscopic surgery is often chosen over open surgery as it is less invasive and has a faster recovery time and fewer complications than open surgery. However, in some instances open surgery will be the better or safer choice. For example, if there is a lot of scar tissue around your hernia, open surgery could be necessary.

Your consultant will tell you everything you need to do to prepare for your surgery. If there's anything you're not sure about, or if you have any questions about how to prepare for your surgery, speak to your consultant or call the hospital for advice. Being well-prepared for your surgery will help to ease any anxiety you may have as well as allow your surgery and recovery to go more smoothly.

Before your surgery, tell your consultant about any medical conditions or allergies you have and any medication you are taking, including over-the-counter medicines. Your consultant may tell you to stop taking some medications like blood thinners before your operation. This is to reduce the risk of bleeding during and after your surgery.

You will not be able to eat or drink anything from midnight on the day of your operation.

What lifestyle changes can I make before my surgery?

Being in optimal health before your surgery can reduce the risk of complications and speed up your recovery.

To make sure you are as healthy as possible before your surgery:

• Eat a healthy, balanced diet with plenty of fruit, vegetables, lean proteins, and whole grains
• If you smoke, try to stop at least eight weeks before your surgery
• Avoid alcohol for a few days before and after your surgery. Alcohol thins the blood and can increase the risk of bleeding
• Take regular exercise

Hernia repair is normally carried out under general anaesthetic, which means you'll be asleep for the procedure.

Open incisional hernia repair

During open hernia surgery, your surgeon will make an incision into your abdomen over the site of your hernia. They will push the protruding organs and tissues back into place and typically they will then secure them there using surgical mesh.

Laparoscopic incisional hernia repair

A laparoscopy is a type of keyhole surgery. Your surgeon will begin by making a few very small incisions into your abdomen around the site of your hernia. Through these, they will insert a laparoscope - which is a thin flexible tube with a light and camera attached to it - as well as specially made surgical tools. The laparoscope allows them to see what is happening inside your abdomen without 'opening you up'.

The herniated tissue or bowel is pushed back inside your abdomen and the layers of muscle are stitched together, or a mesh may be placed in the abdominal wall to strengthen it. The incision is closed using dissolvable stitches.

Hernia repair surgery normally takes around 45 minutes. Whether you have open or keyhole surgery, your consultant surgeon will clean and close the incisions and you will be taken to the recovery room, where you will be monitored closely until the effects of the anaesthetic have worn off.

Recovery from any type of surgery is different for everyone and depends on factors such as your age, general health and whether or not there were any complications during your surgery. Your consultant will be able to give you an estimated recovery timeline based on your individual circumstances.

You may experience some pain and discomfort after your surgery. Your healthcare team will give you painkillers to manage this, but please tell a member of the nursing staff if you have any pain or feel unwell after your operation.

How many nights will I need to stay in hospital?

Incisional hernia repair is normally done as a day case, meaning you'll be able to go home later the same day. In some cases, you may need to spend one night in the hospital after your surgery.

Will I be able to drive home?

You will not be able to drive yourself home from hospital after your hernia repair surgery. Please make arrangements for someone to come and collect you, or we can organise a taxi if you prefer.

How soon can I go back to work?

How soon you can go back to work after your hernia repair depends on how soon you recover from surgery, and the type of job you do. Most people are well enough to return to work around a week after surgery. If your job involves manual labour, you may need to take around two weeks off work after your hernia repair.

How soon can I drive?

You cannot drive for at least the first 24 hours after a general anaesthetic. The anaesthetic may still be in your system and can impair your concentration and reaction times. After this, you can drive when you can safely control your vehicle and perform an emergency stop without pain. Check with your consultant and inform your insurance company before driving after your hernia repair surgery.

When will I be back to normal?

Recovery from any type of surgery is a gradual process that is different for everyone. You can help your recovery to go more smoothly by being as prepared as possible for your operation and allowing yourself to recover at your own pace. Call the hospital if you have any questions or concerns.

You will probably have some swelling, bruising and tenderness around the site of your hernia after the surgery. Your healthcare team will advise you on caring for your surgical wound. The bruising and tenderness should settle down within a few days, but the area may be swollen for several weeks. Take over-the-counter painkillers like paracetamol or ibuprofen if you need to.

Avoid constipation by eating a high-fibre diet and drinking plenty of fluids after your surgery. Straining to have a bowel movement should be avoided as this can increase pressure and pain around the surgical wound.

Taking gentle exercise like walking is recommended after surgery but avoid strenuous exercise and heavy lifting for at least four to six weeks. Most people can resume normal activities within two weeks.

As with all types of surgery, hernia repair surgery carries a small risk of complications. Your consultant will explain all the possible risks and complications before your surgery and answer any questions you may have about your procedure. Being as well-informed as possible about what to expect from your surgery will help put your mind at rest and allow you to make an informed decision so please ask any questions you may have.

Possible complications of any surgery include:

• Bleeding
• Infection
• Blood clots
• Adverse reactions to the anaesthetic

Possible complications specific to hernia repair surgery include:

• Seroma - this is a collection of fluid that builds up under the wound and may need to be drained with a needle
• Damage to nearby organs
• Nerve damage
• Scarring
• Difficulty passing stools (poo) due to temporary weakness of the abdominal muscles
• Your hernia may come back

Call your doctor straight away if you:

• Have pain that is getting worse or not going away
• Are vomiting
• Have a fever (a temperature above 38C)
• Notice redness, swelling, or discharge from your surgical wound
• Have not opened your bowels for three days after your surgery

We answer some of your most commonly asked questions about incisional hernias.

What is an incisional hernia?

An incisional hernia occurs when organs or tissue bulge out at the site where a surgical incision was made during previous abdominal surgery.

Are incisional hernias dangerous?

Most incisional hernias are not dangerous, but they can become dangerous if complications occur. Complications include strangulation (where a section of organ or tissue becomes trapped, causing the blood supply to be cut off), and obstruction (where a piece of bowel becomes blocked). These are medical emergencies and need immediate surgery.

Are incisional hernias painful?

Incisional hernias can cause pain which may be mild or severe and may ache or burn. Pain may be worse when standing, coughing, sneezing, or lifting.

Can an incisional hernia heal itself?

An incisional hernia will not heal by itself and needs to be treated with surgery to repair the hernia and strengthen the abdominal wall.

At Circle Health Group we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about treatment for incisional hernias, book your appointment online today or call a member of our team directly.

Content reviewed by Circle in-house team in April 2023. Next review due April 2026.

1. Incisional hernia, John Hopkins
2. Hernia, NHS
3. Incisional hernia, The British Hernia Centre
4. Hernias: Incisional hernia repair, NIH