Incisional Hernia

An incisional hernia develops through a weakened area of the abdominal wall at or near the site of a previous surgical incision. It can occur when fat, intestine, or other abdominal tissue pushes through the weakened area and creates a bulge near the surgical scar.

Some incisional hernias are small and cause few symptoms. Others may enlarge over time or cause pain, pressure, and difficulty with everyday activities. Treatment depends on the size and location of the hernia, symptoms, previous surgeries, and the patient's overall health.

What Is an Incisional Hernia?

Abdominal surgery requires an incision through layers of the abdominal wall. As the incision heals, scar tissue forms and restores strength to the area.

An incisional hernia can develop when the surgical site remains weaker than the surrounding abdominal wall, allowing tissue from inside the abdomen to push outward.

The hernia may develop directly beneath the scar or close to it. It may appear relatively soon after surgery or become noticeable months or years later.

Incisional hernias are considered a type of ventral hernia, meaning they occur through the front abdominal wall.

What Does an Incisional Hernia Look or Feel Like?

A common sign is a lump or bulge at or near a previous surgical scar.

Symptoms may include:

• A bulge near an abdominal incision
• A bulge that becomes more noticeable while standing, coughing, lifting, or straining
• Aching or pressure near the scar
• Sharp or dull abdominal pain
• Tenderness around the hernia
• Discomfort during lifting, bending, or physical activity

Small incisional hernias may cause no symptoms, while larger hernias are more likely to cause discomfort.

What Causes an Incisional Hernia?

An incisional hernia occurs when an area of the abdominal wall does not regain enough strength after surgery to withstand pressure from inside the abdomen.

Several factors can affect healing or increase pressure on the surgical site.

These may include:

• Surgical-site infection
• Obesity
• Smoking
• Diabetes or other conditions that can affect wound healing
• Chronic coughing
• Chronic constipation and repeated straining
• Pregnancy
• Increased abdominal pressure
• Certain previous abdominal surgeries

Physical strain during recovery may also place additional stress on a healing incision, which is why patients should follow their surgeon's postoperative lifting and activity restrictions.

Can an Incisional Hernia Develop Years After Surgery?

Yes. An incisional hernia does not necessarily appear immediately after surgery.

Some become noticeable during the first several months of healing, while others may develop or become apparent much later.

This means that a new lump or bulge near an old surgical scar can still be an incisional hernia even if the original operation occurred years earlier.

How Is an Incisional Hernia Diagnosed?

Diagnosis usually begins with a review of the patient's surgical history and a physical examination.

A healthcare provider may examine the abdominal wall while the patient is standing or lying down and may ask the patient to cough or strain to make the hernia easier to identify.

Imaging may be recommended when the hernia is difficult to examine or when more information is needed about its size, location, or contents.

Possible imaging tests include:

• Ultrasound
• CT scan
• MRI in selected cases

CT imaging can be particularly useful when evaluating larger or more complex abdominal wall hernias and planning treatment.

Does an Incisional Hernia Need Surgery?

Not every incisional hernia requires immediate surgery.

A small hernia that causes few or no symptoms may sometimes be monitored. The American College of Surgeons identifies watchful waiting as an option for some ventral hernias that are not causing symptoms.

However, an incisional hernia will not repair the abdominal wall defect on its own. Surgery is the treatment used to physically repair the hernia.

Repair may be considered when:

• The hernia causes pain or discomfort
• The bulge is increasing in size
• Symptoms interfere with daily activities
• The hernia becomes difficult to reduce
• There is concern about trapped bowel or other tissue
• The hernia has previously been repaired and returned
• The patient prefers repair after discussing treatment options

The decision should account for the benefits of repair as well as the patient's individual surgical risks.

How Is an Incisional Hernia Repaired?

Incisional hernias can vary significantly in size and complexity, so there is no single surgical technique that is appropriate for every patient.

Treatment may involve open, laparoscopic, or robotic-assisted repair.

Open Incisional Hernia Repair

During open surgery, the surgeon makes an incision to access the hernia and returns the protruding tissue to the abdominal cavity.

The abdominal wall defect is then repaired. Surgical mesh may be used to reinforce the repair depending on the size and characteristics of the hernia.

Laparoscopic Incisional Hernia Repair

Laparoscopic hernia surgery uses several small incisions and a camera to access the abdominal wall.

The surgeon repairs the hernia from inside the abdomen, often using mesh to reinforce the weakened area.

Robotic-Assisted Incisional Hernia Repair

Some incisional hernias may also be repaired using robotic-assisted surgery.

Like laparoscopic surgery, robotic-assisted repair uses small incisions and specialized instruments. Whether it is appropriate depends on the hernia's size and location, previous operations, anatomy, and the surgeon's treatment plan.

What About Large or Complex Incisional Hernias?

Some incisional hernias involve a larger section of the abdominal wall or develop after several previous abdominal operations.

These cases may require more extensive abdominal wall reconstruction rather than a straightforward hernia repair.

Treatment planning may take into account:

• Size of the abdominal wall defect
• Number of previous hernia repairs
• Location of existing surgical mesh
• Previous abdominal operations
• Scar tissue
• Condition of the surrounding abdominal muscles
• Overall health and surgical risk

This is one reason an evaluation by a surgeon familiar with abdominal wall hernias can be important for recurrent or complex cases.

Can an Incisional Hernia Come Back After Repair?

Yes. Hernia recurrence is a recognized potential complication after incisional hernia repair.

Recurrence risk depends on several factors, including the size and complexity of the hernia, surgical technique, wound healing, previous repairs, and individual health factors.

Patients can support healing by following postoperative instructions and addressing modifiable factors when appropriate.

Can an Incisional Hernia Become an Emergency?

Most incisional hernias are not emergencies, but abdominal tissue or intestine can sometimes become trapped.

An incarcerated hernia occurs when herniated tissue becomes stuck and cannot return to the abdomen. Severe pain, nausea, and vomiting may occur.

If trapped intestinal tissue loses its blood supply, the hernia becomes strangulated and requires urgent medical treatment.

When Should You Seek Immediate Medical Care?

Seek prompt medical attention if an incisional hernia is accompanied by:

• Sudden or severe abdominal pain
• A painful or increasingly tender bulge
• Persistent nausea or vomiting
• A bulge that suddenly becomes firm or cannot move back into the abdomen
• Rapidly increasing swelling
• Redness or darkening of the skin over the hernia
• Rapidly worsening symptoms

Sudden sharp abdominal pain with vomiting can indicate incarceration or bowel obstruction and requires medical evaluation.

What Is Recovery Like After Incisional Hernia Surgery?

Recovery varies considerably because incisional hernias range from small defects to complex abdominal wall repairs.

Factors that can affect recovery include:

• Size of the hernia
• Surgical approach
• Complexity of the abdominal wall reconstruction
• Previous abdominal surgeries
• Overall health
• Type of work and normal physical activity

After surgery, patients may receive instructions about:

• Walking and light activity
• Incision care
• Pain management
• Lifting restrictions
• Returning to work
• Driving
• Resuming exercise
• Follow-up appointments

Your surgeon will provide individualized recommendations based on the specific repair.

Incisional Hernia Surgery in the East Bay

Hernia Innovations provides evaluation and surgical treatment for incisional, recurrent, and other abdominal wall hernias throughout the East Bay.

Our board-certified surgeons evaluate the patient's previous surgeries, symptoms, hernia anatomy, imaging, and overall health to determine an appropriate treatment plan.

When surgery is recommended, treatment may include open, laparoscopic, or robotic-assisted hernia repair based on the individual hernia and patient.

Call (925) 940-1025 or request an appointment online.

Frequently Asked Questions About Incisional Hernias

Can an incisional hernia go away on its own?

No. The abdominal wall defect associated with an incisional hernia does not typically close on its own. Some small hernias that cause no symptoms may be monitored, while surgery is required to physically repair the defect.

What does an incisional hernia look like?

An incisional hernia often appears as a lump or bulge at or near a previous surgical scar. The bulge may become more noticeable during coughing, lifting, standing, or straining.

Can an incisional hernia develop years after surgery?

Yes. Although many incisional hernias become apparent during the months following surgery, they can develop or become noticeable later.

Is an incisional hernia serious?

Many incisional hernias are not immediately dangerous. However, complications can occur if intestine or other tissue becomes trapped. Sudden severe pain, vomiting, or a painful non-reducible bulge requires prompt evaluation.

Do all incisional hernias need surgery?

No. Some small, asymptomatic incisional hernias may be monitored. Surgery may be recommended when the hernia causes symptoms, enlarges, becomes difficult to reduce, or presents concern for complications.