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Health condition · Clinically reviewed

Incisional hernia, from a bulge at an old scar to a durable, mesh-based repair.

A common late complication of abdominal surgery - and a solvable one. The right assessment, the right team and the right operation matter far more than the size of the lump.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against the British Hernia Society, EHS and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including laparoscopic and robotic mesh repair, TAR and component separation.

Key facts

Incisional hernia at a glance.

The essentials, in plain English - what it is, who gets one and how UK surgeons put things back together.

  • What it is

    A bulge of abdominal contents through a defect in a previous surgical scar - the layers that held the wound together have given way.

  • How common

    One of the most common late complications of abdominal surgery - up to 10 to 30 per cent of midline laparotomies eventually develop one.

  • Who is at risk

    Obesity, smoking, diabetes, wound infection, emergency surgery and connective tissue disease all increase the chance.

  • What it feels like

    A swelling at or near an old scar - often reducible early on, sometimes painful and, occasionally, an emergency.

  • Imaging

    Ultrasound for small defects; CT of the abdomen for anything larger or complex - it maps the defect, contents and loss of domain.

  • Definitive fix

    Mesh repair - open, laparoscopic, robotic or with a transversus abdominis release for larger defects.

Why this guide matters

The right team matters as much as the right operation.

Incisional hernias can range from a small lump easily fixed in a day case to a full abdominal wall reconstruction. Three ideas frame the rest of this page.

  • Mesh reduces recurrence

    Aside from very small defects, a properly placed mesh is the reference standard - halving the risk of the hernia coming back.

  • Optimise the patient first

    Weight, smoking, diabetes, chest and constipation - fixing what you can before surgery is the single strongest predictor of a durable repair.

  • Complex hernias deserve an MDT

    Recurrent, large or contaminated hernias belong at a specialist commissioned complex abdominal wall unit - not a general list.

How the diagnosis is made

From a lump at the scar to a repair plan.

The steps a UK GP or surgeon will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Surgical history

    Which operation, which incision, how it healed - wound infection, dehiscence or an emergency laparotomy all raise the risk.

  2. 02

    Assessing

    Risk-factor review

    Weight, smoking, diabetes, steroid use, chronic cough, constipation, ascites and connective tissue disorders such as Ehlers-Danlos.

  3. 03

    Assessing

    Focused examination

    Standing and lying, cough impulse, defect size, reducibility and the state of the overlying skin.

  4. 04

    Confirming

    Ultrasound for small defects

    Quick, radiation-free confirmation for small or uncertain lumps - and helpful in slim patients.

  5. 05

    Confirming

    CT abdomen for anything larger

    Maps the true size of the defect, the contents, any loss of domain and the state of the muscle layers.

  6. 06

    Preparing

    Complex hernia MDT

    Large, recurrent or contaminated hernias are discussed at a specialist abdominal wall reconstruction unit before surgery is planned.

  7. 07

    Preparing

    Pre-operative optimisation

    Weight loss, smoking cessation, diabetes control and, sometimes, botox or progressive pneumoperitoneum before a large repair.

Typical pathway: a first visit to a settled plan over weeks, with a proper CT and specialist opinion for anything complex.

Symptoms

What an incisional hernia looks and feels like.

The typical picture - a bulge that grows, sometimes aches, sometimes catches - and the features that mean it needs urgent surgical care.

  • Swelling at the scar

    A soft bulge along or beside an old surgical incision - often more obvious on standing, coughing or straining.

  • Increasing size over time

    Most incisional hernias slowly enlarge - a lump that was easy to push back can become fixed.

  • Discomfort and dragging pain

    A pulling ache that worsens by the end of the day or with lifting - not usually severe unless something is trapped.

  • Reducible early on

    In the early stages the bulge can be pushed back into the abdomen while lying flat - a reassuring but not permanent finding.

  • Irreducible or incarcerated

    A hernia that will no longer reduce - uncomfortable, at higher risk of obstruction and a reason to seek surgical review soon.

  • Skin changes and ulceration

    Large, chronic hernias can thin and ulcerate the overlying skin - a sign the defect is no longer safe to observe.

  • Loss of domain

    When so much of the bowel lives outside the abdominal cavity that closing it will need specialist reconstruction.

  • Red flag - strangulation

    Sudden pain, tenderness, redness, vomiting or a hernia that will not reduce - a surgical emergency needing hospital assessment now.

Treatment

How incisional hernias are treated in the UK.

A ladder that runs from careful observation through minimally invasive mesh repair to full abdominal wall reconstruction at a specialist centre - see our page on incisional hernia repair for the operation itself.

  • Watchful waiting

    Small, asymptomatic hernias in high-risk patients can be safely observed - with a clear plan for what should trigger surgery.

  • Lifestyle optimisation

    Weight loss, stopping smoking, treating a chronic cough or constipation - every one reduces the risk of recurrence after repair.

  • Truss or support garment

    Occasionally used to control symptoms when surgery is delayed or declined - not a substitute for repair.

  • Primary suture repair

    Suitable only for very small defects (usually under 1 to 2 cm) - higher recurrence than mesh.

  • Open mesh repair

    Sublay, onlay or underlay techniques - the workhorse for most incisional hernias and the reference standard.

  • Laparoscopic and robotic repair

    Minimally invasive IPOM, eTEP and robotic techniques reduce wound complications and speed recovery in selected patients.

  • Component separation / TAR

    Transversus abdominis release and anterior component separation restore the midline for large or complex defects in specialist centres.

  • Adjuncts - botox and PPP

    Pre-operative botox to the lateral wall or progressive pneumoperitoneum can rescue hernias with significant loss of domain.

What this guide is based on

The sources behind every claim on this page.

UK and European surgical society guidance and NHS commissioning documents, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or surgeon knows your history and can tell you which parts apply to you. If a hernia is painful, suddenly larger or will not go back in, get seen the same day.

  • British Hernia Society (BHS). Groin and ventral hernia guidelines.

  • European Hernia Society (EHS). Guidelines on the treatment of incisional abdominal wall hernias.

  • NHS England. Service specification for complex abdominal wall reconstruction (specialist commissioned).

  • Royal College of Surgeons of England. Commissioning guide - hernia surgery.

Red flags

When a hernia needs urgent attention.

Most incisional hernias are safely managed on an elective list. These are the features that change the picture and where a specialist opinion is needed now.

  • Strangulation

    A tender, irreducible, red or discoloured hernia with vomiting or systemic upset - go to A&E. Bowel viability is time-critical.

  • Small bowel obstruction

    Cramping pain, distension, vomiting and absolute constipation with a known hernia - needs urgent hospital assessment.

  • Skin breakdown over the hernia

    Thinning, weeping or ulcerated skin over a large hernia is a strong signal that observation is no longer safe.

  • Rapidly enlarging hernia

    A hernia that has grown quickly or become suddenly painful deserves a same-week surgical opinion.

  • Mesh infection after previous repair

    Redness, discharge or a chronic sinus after mesh surgery - a specialist problem, often needing mesh removal.

  • Loss of domain

    When most of the abdominal contents live outside the wall - specialist reconstruction and, sometimes, pre-operative botox is required.

  • Emergency laparotomy history

    Hernias after emergency surgery, contaminated wounds or dehiscence carry higher recurrence risk and often need specialist input.

  • Recurrent hernias

    Second and third-time hernias should be referred to a complex hernia MDT before any further repair is planned.

  • Ascites or advanced liver disease

    Repair in this setting is complex and higher risk - joint hepatology and hernia review is safer than an isolated approach.

Living with it

A treatable problem, with a clear plan.

Four ideas that make the biggest difference day to day - preparation, sensible support, patient recovery and knowing the signs that must not be ignored.

A quiet reminder

Recurrence is a team sport.

Surgeon, patient and habits all decide whether a repair lasts - the operation is only one part.

  1. 01 Prepare

    Optimise before surgery

    Weight, smoking, diabetes and nutrition - the best predictors of a durable repair are set weeks before the operation.

  2. 02 Support

    Belts help symptoms, not cure

    A well-fitted abdominal binder can settle daily discomfort while you wait for surgery - it is not a substitute for a repair.

  3. 03 Recovery

    Respect the recovery

    Most repairs need six to twelve weeks of graded activity - lifting too soon is one of the commonest reasons a hernia comes back.

  4. 04 Watch

    Know the emergency signs

    Sudden pain, a hernia that will not go back in, vomiting or a change in colour of the lump - do not wait, get seen.

Frequently asked

Everything we get asked about incisional hernias.

Quick answers on why they happen, when they need surgery and what specialist repair involves.

  • What is an incisional hernia?

    It is a hernia that develops through the scar of a previous abdominal or pelvic operation. The muscle layers that were closed at the end of surgery have failed, allowing fat or bowel to bulge through the weakness beneath the skin.

  • How common are they after abdominal surgery?

    Very common - depending on the type of incision, technique and patient risk factors, up to 10 to 30 per cent of midline laparotomies eventually develop an incisional hernia. Rates are lower for transverse and laparoscopic incisions and lower again when patient risk is optimised.

  • Do all incisional hernias need surgery?

    No. Small, asymptomatic hernias in patients at high surgical risk can be safely watched, with clear advice about the red flags. Symptomatic, enlarging, painful or complex hernias should be repaired, ideally after weight, smoking and diabetes have been optimised.

  • What surgical options are there?

    The main options are open mesh repair (sublay, onlay or underlay), laparoscopic and robotic mesh techniques such as IPOM and eTEP, and for large or complex defects a transversus abdominis release or component separation. See our page on incisional hernia repair for a fuller walk-through.

  • When would I be referred to a specialist centre?

    Large hernias, hernias with loss of domain, recurrent hernias, contaminated fields, previous mesh infection and complex reconstructions are all discussed at specialist commissioned complex hernia units - such as King’s, Guy’s, the Royal Free and Manchester - before surgery is planned.

  • What is loss of domain and why does it matter?

    When a hernia has been present for a long time, so much of the abdominal contents can live outside the abdominal cavity that closing it becomes dangerous. Specialist reconstruction, pre-operative botox to relax the lateral wall and progressive pneumoperitoneum can all help make a safe repair possible.

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