Incisional hernia repair: choices, risks and recovery

After an abdominal operation the muscle and tissue layers knit back together, but occasionally the repair stretches or gives way. Through the gap, fat or bowel can bulge under the scar. The bulge may be tiny and painless or a sizeable swelling that changes shape with posture and coughing.

Several things make a gap more likely: infection of the original wound, a very large or emergency operation, weight, smoking, diabetes and medicines that slow healing. A hernia can appear months or years after the first surgery. This is why the NHS hernia overview, which names hiatus, umbilical, inguinal, femoral, lumbar and stoma hernias, is only a partial guide to this particular type.

InformedHealth.org explains that when an incisional hernia causes no symptoms and the risk of complications is low, surgery may not be needed at first, though the hernia often becomes larger with time. Larger openings are harder to repair and carry more risk of complications, which is one argument for acting before a hernia becomes very large.

Wearing an abdominal support belt can make a hernia more comfortable but does not repair it. If you are considering a pregnancy, tell your surgeon, since the same source notes that mesh is less elastic than natural muscle and that this can matter in pregnancy.

Planning often matters more here than for simple hernias. Your surgeon may ask about the original operation, any infection afterwards and previous attempts at repair, and may request a scan to map the defect. Many units want blood sugar well controlled and smoking stopped, and the Guy's and St Thomas' hernia guidance suggests no smoking for at least 4 weeks before a hernia repair.

Losing weight beforehand can reduce strain on the repair, although it is not always realistic and should not be pursued through crash dieting. Ask whether a physiotherapist or dietitian can help.

• Tell the team about blood thinners, diabetes treatment and steroid or immune-suppressing medicines.

• Ask whether you are likely to stay overnight; small repairs often are day-case, larger ones usually need a stay.

• Plan help at home, because lifting and housework will be limited.

The surgeon returns the bulging contents to the abdomen, closes or bridges the defect and, most often, reinforces it with a synthetic mesh. InformedHealth.org describes open surgery through a larger cut and keyhole surgery through several small cuts of about 5 to 10 mm. It reports that keyhole repair is less likely to lead to wound infection and can shorten the hospital stay, but needs surgeons with the right experience.

Open repair remains common for larger or complicated hernias. General anaesthetic is normally used. For a small defect, a day-case approach similar to other abdominal wall hernias is possible, as the Hull leaflet on abdominal wall hernia repair describes.

The Hull leaflet lists bleeding, wound infection, recurrence, scarring and seroma, a fluid collection under the scar, as common problems of hernia repair, with bowel injury rare. With mesh, there is also a small chance of mesh infection or chronic discomfort, which can need further treatment.

Recurrence is a real possibility, and it is higher where the hernia is large or where the patient smokes or has diabetes. Neither source used here gave figures that can be relied on for your situation, so ask your surgeon for numbers based on their own results.

Walking starts early, and pain is controlled with regular painkillers. Timelines vary with the size of repair: a Plymouth hospital leaflet on hernia repair gives heavy lifting at 6 weeks and driving at 7 to 10 days for its own repairs, and larger reconstructions generally take longer. Your discharge sheet is the rule.

Contact your hospital or NHS 111 for a wound that is red, hot, draining or opening, fever, increasing swelling or pain, or vomiting. Call 999 for severe abdominal pain with vomiting and a hard, tender bulge, or for breathlessness and chest pain.

Complex or recurrent hernias may be referred to a surgeon with a particular interest in abdominal wall repair. On the NHS that can affect the route and wait; privately, ask who will actually operate and what is covered if you need a return to theatre.

• How big is my defect, and is mesh needed?

• Is keyhole repair suitable for me, and how often do you do it?

• What do you recommend I change before surgery?

• How will my repair be protected during healing?