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Allen KamravaMD · MBA · FACS · FASCRS

Colon and Rectum

Ventral / Incisional Hernia

A ventral or incisional hernia is a bulge of tissue that protrudes through a weak spot in the abdominal wall, often at the site of a previous surgical incision.

Reviewed by Allen Kamrava, MD, MBA, FACS, FASCRS · Last reviewed 2025-10-12

Overview

What is a ventral or incisional hernia?

A ventral hernia is a bulge of tissues, such as intestine or fat, that pushes through a weak spot in the muscles of the abdominal wall. An incisional hernia is a specific type of ventral hernia that occurs at or near the site of a previous surgical incision. The weakening of the abdominal wall can be a result of the surgical incision failing to heal properly, or from gradual stretching and thinning of the scar tissue over time. These hernias can range from small, asymptomatic bulges to very large, complex defects that can cause significant symptoms and complications. They are very common, occurring after up to 20% of abdominal surgeries.

Symptoms

What are the symptoms?

The most common sign is a visible bulge on the abdomen, especially when straining, coughing, or standing. Many hernias are asymptomatic, but as they enlarge, they can cause:

  • Aching or discomfort at the site of the hernia, which may worsen with activity.
  • A feeling of pressure or heaviness.
  • Nausea or vomiting if the intestine becomes trapped in the hernia.
  • Changes in the skin overlying the hernia, such as redness or thinning.

Causes & risk factors

What causes an incisional hernia?

An incisional hernia is caused by the failure of the abdominal wall to heal strongly after a surgical incision. Several factors increase the risk of developing an incisional hernia:

  • Wound Infection: A surgical site infection after the initial surgery is a major risk factor.
  • Obesity: Excess weight puts constant strain on the abdominal wall.
  • Smoking: Smoking impairs wound healing and weakens connective tissue.
  • Malnutrition and Steroid Use: These can also impair the healing process.
  • Chronic Straining: Conditions that increase intra-abdominal pressure, such as chronic coughing, constipation, or heavy lifting.
  • Surgical Technique: The way the initial incision was closed can play a role. Midline incisions have a higher risk of hernia formation than transverse or off-midline incisions.

When to see a doctor

When should I see a doctor?

You should see a doctor if you notice a bulge at a prior incision site or anywhere on your abdomen. While not always an emergency, hernias tend to enlarge over time and can lead to serious complications. A doctor can evaluate the hernia and discuss treatment options, which usually involve surgical repair.

Urgent — get care now

When is it an emergency?

A hernia becomes a surgical emergency if it becomes incarcerated or strangulated. Incarceration means that the contents of the hernia (like the intestine) are trapped and cannot be pushed back into the abdomen. If the blood supply to this trapped tissue is cut off, it is called strangulation, which can lead to tissue death (gangrene) and a life-threatening infection.

You should go to the emergency room immediately if you have a hernia and develop:

  • Sudden, severe pain at the hernia site.
  • Nausea and vomiting.
  • The inability to have a bowel movement or pass gas.
  • The bulge becomes firm, tender, and red or purple.

Diagnosis & tests

How is an incisional hernia diagnosed?

The diagnosis is usually made by a physical examination. The doctor will examine your abdomen while you are lying down and standing, and may ask you to cough or strain to make the hernia more apparent. For very large or complex hernias, or in obese patients where the examination is difficult, a CT scan of the abdomen is often used to confirm the diagnosis and to clearly define the size of the defect and its contents. This is crucial for surgical planning.

Treatment

How are incisional hernias treated?

Treatment for a symptomatic incisional hernia is surgical repair. The goal is to return the herniated contents to the abdominal cavity and to repair the defect in the abdominal wall. Due to high recurrence rates with simple suture repair, most ventral and incisional hernia repairs are now performed with a piece of surgical mesh to reinforce the abdominal wall.

  • Open Hernia Repair: The surgeon makes an incision over the hernia, reduces the contents, and repairs the defect. The mesh is most commonly placed in the retrorectus or sublay position, behind the abdominal muscles but in front of the peritoneum. This has been shown to have the lowest rates of recurrence and complications.
  • Laparoscopic or Robotic Repair: This is a minimally invasive approach where the surgeon makes several small incisions and uses a camera and specialized instruments to place a piece of mesh on the inside of the abdominal wall, covering the hernia defect from within (intraperitoneal onlay mesh or IPOM). This approach is often associated with a shorter recovery time and less pain.

The choice of surgical approach depends on the size and complexity of the hernia, the patient's anatomy, and the surgeon's expertise.

Self-care

Self-Care and Prevention

After hernia surgery, it is important to avoid heavy lifting and strenuous activity for 4-6 weeks to allow the repair to heal. To prevent a hernia from developing or recurring, it is important to:

  • Maintain a healthy weight.
  • Stop smoking.
  • Use proper lifting techniques.
  • Treat conditions that cause chronic coughing or straining.

Frequently asked questions

Can I just wear a binder for my hernia?
An abdominal binder or hernia belt can provide some external support and may help with discomfort, but it will not fix the hernia. It can be used as a temporary measure while awaiting surgery or for patients who are too frail to undergo a repair.

What are the risks of hernia surgery?
The main risks include recurrence of the hernia, surgical site infection, and complications related to the mesh, such as chronic pain or erosion into the bowel. The risk of these complications is minimized with proper surgical technique and patient optimization before surgery.

Does my hernia have to be repaired with mesh?
For most incisional hernias, repair with mesh provides a much more durable and long-lasting result than a suture-only repair. Recurrence rates for suture repair of incisional hernias can be over 50%, while mesh repair has recurrence rates in the range of 10-20%.

References

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