An incisional hernia appears at a previous surgical incision. Repair almost always involves mesh reinforcement (preferably retromuscular), open or laparoscopic/robotic; for large defects a component separation is used.
What is the operation?
It is the repair of a hernia arising at a previous surgical incision. It almost always requires mesh reinforcement and, for large defects, reconstruction of the wall for a functional, durable repair.
Correct mesh placement and restoration of the rectus midline are decisive in reducing recurrence.
When is it needed?
It is indicated for a symptomatic or enlarging hernia, functional/cosmetic burden and to avoid strangulation. Planning is individualised to the size, site and composition of the defect.
Preparation
For large/complex defects a CT scan is done for planning. Crucial is pre-operative optimisation: weight control, smoking cessation, glycaemic control — substantially lowering complications and recurrence.
How it's done
The contents are reduced and the wall reinforced with mesh, preferably in a retromuscular (sublay) position — the most durable placement. Depending on size, the approach is open or laparoscopic/robotic.
For large defects, an abdominal-wall component-separation technique allows tension-free midline closure and restores wall function.
Retromuscular mesh
Placing mesh behind the muscles (sublay) — a durable repair with low recurrence.
Lap./Robotic
Repair through small incisions for selected defects — fewer wound problems.
Component separation
Wall reconstruction for large defects — tension-free closure.
Recovery
The timeline depends on size. An abdominal binder and gradual return are advised; lifting is avoided for several weeks, with individualised guidance.
Risks & outcomes
Recurrence is higher than for primary hernias, so technique and preparation are crucial. Possible complications: seroma, infection, wound-healing problems. Retromuscular mesh and proper preparation minimise recurrence.
Frequently asked questions
Why did a hernia appear in my scar?
An incisional hernia results from weakening of the old incision. Factors such as wound infection, coughing, obesity or smoking increase the risk.
Is mesh always needed?
Almost always, yes — mesh substantially reduces recurrence compared with simple suture.
What is component separation?
It is a technique for reconstructing the abdominal wall that allows tension-free closure of large defects.
How is recurrence reduced?
With correct technique (retromuscular mesh) and pre-operative optimisation: weight control, smoking cessation, glycaemic control.