Incisional Hernias
What is an incisional hernia?
An incisional hernia develops at or near a previous surgical incision where the abdominal wall has weakened. A wound infection or problems with healing can also contribute. Fat or organs can push through this weakened area and create a bulge.
What causes an incisional hernia?
Incisional hernias can often occur without any events, as an incision in your connective tissue weakens the natural defenses for hernia prevention. Having said that, there are several risk factors for developing a hernia after a previous surgery:
Some of the common risk factors of developing an incisional hernia are believed to include:
Chronic cough
Chronic constipation
Wound infection
Diabetes
Connective Tissue Disorder
Complications from surgery
How do I know if I have an incisional hernia?
You may notice a bulge near your previous incisions which can be soft and may be reducible. You may also have associated symptoms such as:
Pain or soreness near your incision
Bulging near your incision
Discomfort while straining or lifting
Burning or gurgling sensation near the incision
When Should I be Concerned?
If you are having severe pain by your incision or bulge, redness, or signs of a bowel obstruction such as inability to have a bowel movement associated with nausea or vomiting, you may need surgical evaluation immediately, as the contents of the hernia may be stuck.
How is an incisional hernia diagnosed?
The most common way incisional hernias are diagnosed is through a physical exam during a visit with a physician. You may not even have any symptoms but may have an obvious bulge. Sometimes if your hernia is large or more complex, you may need medical images to see it better such as a CT scan or ultrasound.
What are my options for repair?
The decision to repair an incisional hernia depends on your symptoms, the hernia’s size and complexity, your overall health, and your goals. Your surgeon will discuss the benefits and risks of surgery, as well as whether observation is appropriate.
Reasons to consider elective repair include:
Relieving symptoms caused by the hernia.
Addressing a hernia that is becoming larger or more difficult to treat.
Reducing the risk of the intestines becoming trapped in the hernia and requiring emergency treatment.
Repair returns the hernia contents to the abdomen and closes or reinforces the opening. Options include an open operation through the previous scar or a laparoscopic or robotic repair through several small incisions. Your surgeon will recommend an approach based on your individual case.
How does an open incisional hernia repair work?
An open repair usually involves an incision at the previous scar. The surgeon restores the abdominal wall muscles toward their normal position and reinforces the repair with mesh when appropriate. Excess skin may also be removed if needed. The details depend on the size and complexity of the hernia and your surgical plan.
How does a laparoscopic or robotic incisional hernia repair work?
Small incisions are made in the abdomen, and carbon dioxide gas creates space for the surgeon to work. Depending on the technique, a flap or space within the abdominal wall is created for mesh placement. The hernia is reconstructed, the mesh is secured, and the tissue layers are closed as appropriate. The gas is released at the end of the procedure.
Minimally invasive approaches may offer benefits for pain, incision size, and recovery in selected patients. These operations require specialized expertise. An open approach may be more appropriate for some larger or more complex hernias; your surgeon will explain the options and tradeoffs.
What is abdominal wall reconstruction surgery?
Abdominal wall reconstruction is the practice of taking a dysfunctional abdominal wall due to hernia disease and putting it back together using advanced surgical techniques. Abdominal wall reconstruction is reserved for large, more complex, or recurrent hernias.
Recovery after complex incisional hernia repair
Your recovery plan depends on the repair, your health, and the complexity of your case. Your surgeon’s discharge instructions take priority over general guidance on this page.
Immediately after surgery
You will recover in the Post-Anesthesia Care Unit (PACU), where the team monitors you as the anesthesia wears off. Some patients go home after recovery; others need a hospital stay, particularly after complex abdominal wall reconstruction. Your team will decide when discharge is appropriate.
Temporary shoulder or upper abdominal discomfort can occur after laparoscopic or robotic surgery because of the gas used during the procedure. A sore throat can follow a breathing tube or gastric tube. Tell your team about persistent or worsening symptoms, including difficulty swallowing.
Chest pain, shortness of breath, fainting, or sudden weakness require immediate medical attention. Alert hospital staff immediately; if you are at home, call 911.
During a hospital stay
Your team will help you begin walking and moving safely. Follow their instructions for how often to get up and whether you need assistance.
You may receive an incentive spirometer, a handheld device for deep-breathing exercises. Use it as instructed.
Your pain-management plan may include nonopioid medicines, opioid medicines when needed, or patient-controlled analgesia (PCA), which allows you to press a button for a controlled dose. Medicines may be given through an IV and later by mouth.
Your team may provide medicine to prevent blood clots, such as heparin or enoxaparin (Lovenox), and medicine for nausea. They will also review which home medicines to resume.
Preparing to go home
You will receive prescriptions, follow-up arrangements, and instructions for wound care, diet, medicines, and activity. Arrange a ride home and help during recovery. Remove loose rugs and cords that could cause a fall.
Ask your team before combining pain medicines with sleep aids, sedating antihistamines, anxiety medicines, or muscle relaxants. These include diphenhydramine (Benadryl), clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium), cyclobenzaprine (Flexeril), and carisoprodol (Soma).
Recovering at home
Follow your team’s instructions for fluids, food, walking, and bowel care. Your needs may differ depending on other health conditions and the operation. Contact your team about fever or chills, persistent nausea or vomiting, difficulty passing stool, or symptoms that are getting worse.
Return to work, lifting, exercise, driving, and travel should follow your surgeon’s guidance. Increase activity gradually within those instructions. A larger, recurrent, or more complex repair may require a longer recovery.
Follow-up
Attend follow-up as directed so your surgeon can assess healing and adjust your activity plan. Recovery continues after you begin feeling better. If activity causes renewed discomfort, reduce the activity and contact your team if symptoms persist or worsen.
Complications and when to seek help
Possible complications include fluid collections (seromas), wound infection or separation, abscess, bleeding, persistent pain, and hernia recurrence. Your surgeon will discuss your individual risks.
A seroma can feel like a lump where the hernia used to be, particularly after a larger repair. Some resolve without treatment, but your team should assess a new or concerning swelling. Some bruising around the incisions or groin can occur after surgery.
When to call your surgical team
Follow the contact instructions in your discharge paperwork. Call for:
Fever of 100.4°F or higher, or fever as defined in your discharge instructions.
Increasing redness, wound opening, or drainage from an incision.
Bleeding that does not stop with pressure as instructed.
Persistent nausea or vomiting.
Difficulty or inability to urinate after surgery.
Severe or increasing abdominal pain, including pain not relieved by prescribed medication.
Extensive or increasing bruising, swelling, or discoloration.
Symptoms that are getting worse rather than improving, or any concern about your recovery.
When to seek emergency care
Call 911 for chest pain, fainting, shortness of breath or difficulty breathing, trouble speaking, new weakness, or sudden vision changes. Notify your surgeon after emergency care has been arranged.
Next Steps
If you’re dealing with an incisional hernia, the Hernia Experts are here for you.
Our team is highly experienced in all the most advanced treatment options.
After your procedure, our surgeons and office staff will be with you every step of the way.
To set up a consultation, please call us at (212) 305-5947 or use our online appointment request form. We look forward to answering your questions and meeting your hernia care needs.