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?

An incisional hernia, or laparocele, is a defect in the abdominal wall that develops along the scar of a previous operation. The layers of muscle and fascia that were sutured fail to hold, and the contents of the abdomen push through the weak point.

You usually notice it as a bulge under the skin near the old scar. It may be more visible when you stand, cough or strain, and it often flattens or disappears when you lie down.

It is a common problem. Any abdominal incision can develop one, and the risk persists for years after the original surgery, not only in the first months.

Why does it happen?

Wound healing is a biological process, and several factors can interfere with it. When the repaired wall does not regain its strength, a hernia can form even after a technically correct operation.

The most relevant risk factors include:

Understanding your own risk factors matters, because some can be improved before any repair and this influences the long-term result.

How do I recognise it?

The typical sign is a soft swelling along or near a surgical scar. In the early stages it may be small and only noticeable on exertion.

Over time the bulge often grows and may become permanent. Some people feel a dragging discomfort, a sense of heaviness or occasional pain, particularly at the end of the day or after physical effort.

A clinical examination is usually enough for the diagnosis. When the hernia is large, recurrent or difficult to assess, I request a CT scan of the abdominal wall to map the defect and plan the repair.

Is an incisional hernia dangerous?

Most incisional hernias are not an emergency. They tend to enlarge slowly and cause discomfort rather than acute danger.

The concern is that a loop of bowel or other content can become trapped in the defect. If this content cannot slide back, the hernia becomes incarcerated, and if its blood supply is compromised it becomes strangulated.

Strangulation is a surgical emergency. Signs include a bulge that suddenly becomes hard and painful, cannot be pushed back, and is accompanied by vomiting or a blocked bowel. In that situation you should go to an emergency department immediately.

When should an incisional hernia be operated on?

An incisional hernia does not heal by itself, so surgery is the only way to correct it definitively. However, an operation is not always urgent, and the decision is shared.

I generally consider repair when one or more of these apply:

In selected cases, particularly a small and completely symptom-free hernia in a person with high surgical risk, a period of watchful waiting is reasonable. This is a considered choice, not neglect, and I discuss it openly.

Preparing before surgery

For elective repair, the weeks before the operation matter. Stopping smoking, improving blood sugar control and losing weight where relevant all reduce the risk of complications and recurrence.

For very large hernias, sometimes described as a loss of abdominal domain, specific preparation may be required so that the abdomen can tolerate the return of its contents. This is planned individually.

How is an incisional hernia repaired?

Repairing the defect by suture alone carries a high rate of recurrence. For this reason, in almost all adult cases I reinforce the wall with a surgical mesh, which distributes tension and supports healing.

There are several ways to place the mesh and to access the wall. The right approach depends on the size and position of the defect, the quality of the tissues and your previous surgery.

Open repair

In open surgery the wall is exposed through an incision, the defect is closed and the mesh is positioned, often behind the muscle in the so-called sublay plane. This approach is well suited to larger or complex hernias and to abdominal wall reconstruction.

Laparoscopic and endoscopic repair

Minimally invasive techniques use small incisions and a camera. They can reduce wound-related problems and shorten recovery for suitable hernias.

I developed the TESAR technique (Totally Endoscopic Sublay Anterior Repair), which places the mesh in the sublay plane through an entirely endoscopic route. It is one option among several, and I only propose it when a patient's anatomy makes it genuinely appropriate.

What is recovery like?

Recovery depends on the size of the hernia and the technique used. Many patients go home within a few days, and some minimally invasive repairs allow an earlier discharge.

Some discomfort, swelling and bruising around the site are normal in the first weeks. I advise avoiding heavy lifting and intense straining for a defined period, which I tailor to each operation.

Recurrence remains possible even after a well-performed repair, especially when risk factors persist. Managing weight, avoiding smoking and treating chronic cough or constipation all help protect the result over the long term.

Key points to remember

If you have noticed a bulge near an old abdominal scar, I would encourage you to have it assessed rather than to wait until it becomes troublesome. A clinical evaluation lets us understand your particular situation, weigh the benefits and risks, and decide together whether and when repair makes sense. I am glad to discuss this with you in consultation.

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.

Published on: 2026-08-10 · Content by Dr. Federico Fiori

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