Open incisional hernia repair

An incisional hernia is a weakness in your abdominal wall which happens at the site of a cut (incision) made during a previous operation.

Any operation on your abdomen needs a cut that is closed with stitches. Sometimes your wound does not heal properly and a weakness happens in the muscle layer. This results in the contents of your abdomen, along with the inner layer, pushing through your abdominal muscles. This produces a lump under your skin called a hernia.

You should no longer have the hernia. Surgery should prevent serious complications and allow you to return to normal activities.

You can sometimes control the hernia with supportive clothing or simply leave it alone. It will not get better without surgery.

Occasionally, the hernia can get larger with time. It can also be dangerous because your intestines or other structures within your abdomen can get trapped and have their blood supply cut off (strangulated hernia). The symptoms that may suggest a strangulated hernia are:

• severe pain
• a hernia that will not disappear when you lie down
• vomiting

If you have any of these symptoms you must call your healthcare team immediately as you may need an urgent operation.

If you are female and are planning to become pregnant, it is usually better to wait until after your pregnancy before having the operation. Pregnancy increases the size of your abdomen and may undo the hernia repair. Your surgeon will tell you the risks of delaying having the operation.

Various anaesthetic techniques are possible.

The operation can take between 90 minutes and 3 hours, sometimes longer in more complicated cases. Your surgeon will make a cut through your old scar. They will repair the weak tissue either with stitches only or using a synthetic mesh, which they will stitch to the muscles under your skin.

Your surgeon will close your skin over the repair. They may need to form a flap of skin over the repair so that your skin closes properly.

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Do not do exercises that involve heavy lifting or make your hernia painful.

Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

The healthcare team will try to reduce the risk of complications.

Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, you are a smoker or have other health problems. These health problems include diabetes, heart disease or lung disease.

Some complications can be serious and may even cause death.

General complications of any operation

• Infection of the surgical site (wound).
• Allergic reaction to the equipment, materials or medication.
• Bleeding during or after the operation.
• Blood clot in your leg (deep-vein thrombosis - DVT).
• Blood clot in your lung (pulmonary embolus), if a blood clot moves through your bloodstream to your lungs.
• Chest infection — your risk will be lower if you have stopped smoking and you are free of Covid-19 (coronavirus) symptoms for at least 7 weeks before the operation.

Specific complications of this operation

• Developing a collection of blood (haematoma) or fluid (seroma) under your wound.
• Difficulty passing urine. You may need a catheter (tube) in your bladder for 1 to 2 days.
• Skin necrosis, where some of the skin flap dies.
• Injury to your bowel.
• Damage to nerves that supply your skin around the cut made by your surgeon, leading to a numb patch or continued discomfort.
• Removing your belly button, leaving a scar instead.
• The problem coming back. You may need another procedure to fix it.

Consequences of this procedure

• pain
• unsightly scarring of your skin

You may be able to go home the same day or your doctor may recommend that you stay in hospital for one or more days.

Increase how much you walk around over the first few days.

Your doctor will tell you when you can return to work.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Most people make a full recovery and can return to normal activities. However, the hernia can come back.

An incisional hernia is a weakness in your abdominal wall which happens when previous wounds do not heal properly. If left untreated, an incisional hernia can cause serious complications.