Incisional Hernia and Abdominal Wall Repair

What an incisional hernia is

During abdominal surgery the muscle and fascial layers are divided and then brought back together with sutures, and that line regains its strength as it heals. If healing is incomplete for any reason, or if the repair line weakens over the years, pressure from inside the abdomen gradually pulls it apart. Tissue then bulges through the gap — an incisional hernia. It can appear at one point along an old scar or involve its whole length.

Most incisional hernias declare themselves within the first few years after the original operation, though some appear much later. They usually begin as a small bulge at one point on the scar and enlarge as the fascial defect widens. Some patients have several separate defects along the same scar, which changes the surgical plan considerably — one reason imaging before surgery is so useful.

Why it happens, and what raises the risk

An incisional hernia rarely has a single cause; it is the result of several factors acting on wound healing at once. Infection of the surgical wound after the original operation is among the most important. Smoking impairs blood supply to the tissues and the formation of collagen. Diabetes, kidney failure, steroid medication, poor nutrition and disorders of connective tissue all weaken healing in the same way.

Anything that keeps pressure inside the abdomen high puts mechanical strain on the closure: excess weight, chronic cough, constipation, straining to pass urine, and work that involves heavy lifting. Emergency operations and procedures requiring a long midline incision carry a higher risk as well. Because several of these factors can be improved before surgery, they are reviewed carefully when a repair is being planned.

• Previous wound infection
• Smoking
• Excess weight and increased intra-abdominal fat
• Diabetes and poorly controlled blood sugar
• Chronic cough, constipation and persistent straining

Symptoms, and why it will not resolve on its own

The usual sign is a bulge along the old scar that becomes obvious on standing or straining and flattens when you lie down. It is often accompanied by local tightness, dragging and discomfort that builds through the day. As the hernia enlarges, the abdominal wall loses part of its supporting function, and patients may notice back pain, altered posture, a sense of fullness in the abdomen and changes in bowel habit. Stretched skin over a large hernia can also become irritated.

An incisional hernia does not close spontaneously. The gap in the fascia is a soft-tissue defect, and everyday abdominal pressure widens it a little more over time. A support binder can ease symptoms but treats nothing. As the hernia grows, the eventual repair becomes more demanding and the risk of contents becoming trapped rises. The following may indicate strangulation and requires urgent assessment.

• The bulge becomes firm and will not reduce when lying flat
• Sudden, severe pain over the hernia
• Redness, bruising or warmth of the overlying skin
• Nausea, vomiting or generalised abdominal distension
• Inability to pass gas or stool, or fever

Why preparation before surgery matters

Repairing an incisional hernia means reconstructing the abdominal wall, and the preparation is genuinely part of the result. Unless the situation is urgent, some changes are recommended beforehand. Stopping smoking is one of the single most effective steps for tissue healing. Bringing blood sugar under control, losing weight, treating constipation and controlling a chronic cough all make both the operation and the recovery more straightforward.

A CT scan is requested for most patients before surgery. It shows the true size of the defect, how many defects there are, what the hernia sac contains and the condition of the abdominal wall muscles. Choosing a technique without that information is difficult. At İzmir Cerrahi Merkezi the surgical plan is drawn up individually for each patient once this assessment is complete.

How the repair is done, and why mesh is used

In an open repair, the surgeon works through the old scar, frees any adhesions, returns the hernia contents to the abdomen and closes the fascial defect with an appropriate technique. To make the repair durable, the closure is almost always reinforced with mesh, frequently placed between the muscle layers. For very wide defects, advanced techniques such as component separation may be needed — releasing the layers of the abdominal wall in a controlled way so that the midline can be brought together without tension.

In a laparoscopic repair, the defect is covered with mesh from inside the abdomen through several small ports. This suits selected patients, while extensive adhesions, very large defects or problems with the overlying skin usually favour an open approach. Repairs done without mesh leave the suture line under tension and are more prone to recurrence, which is why mesh is regarded as central to a durable result here. Over time the mesh becomes incorporated into your own tissue; it does not need routine removal and does not prevent MRI or CT scanning.

Recovery and getting assessed

Incisional hernia repair is a larger undertaking than groin or umbilical hernia surgery, and both the hospital stay and the recovery period vary considerably with the size of the defect and the technique used. In the early days, good pain control, breathing exercises and gradual mobilisation are the foundations of recovery. Swelling, bruising and a tight feeling across the abdomen are expected. The interval before heavy lifting and abdominal exercise is set individually by your surgeon.

In the longer term, keeping weight under control, not smoking, avoiding constipation and treating anything that causes chronic coughing all help protect the repair. If you have noticed a new bulge along an old surgical scar, a swelling that is enlarging, or increasing discomfort there, it is worth being assessed. For appointments and information call 0538 508 3872, or attend Güneşli Mah. 507 Sok. No: 3, Konak, İzmir. If signs of strangulation appear, go to an emergency department without delay.