Incisional Hernia After Surgery: Causes, Symptoms, Complications & Treatment

Surgery is often a path to healing, but sometimes, unexpected issues can arise during recovery. One such complication is an incisional hernia after surgery, a condition where tissues or organs protrude through a weakened surgical site. In this guide, Chennai Hernia Care helps you understand how incisional hernia can occur postoperatively, what symptoms to watch for, what complications may develop, and how to treat or prevent them.

What Is an Incisional Hernia After Surgery?

An incisional hernia is a type of hernia that occurs at or near the site of a previous surgical incision, especially in the abdominal wall. Unlike spontaneous hernias, this is directly linked to prior surgeries, where the healing process fails to fully restore structural integrity in the incision area.

In your daily life, if you notice a bulge or swelling around a surgical scar sometime after your operation, that could be a red flag for an incisional hernia.

Key Facts:

• Incisional hernias are relatively common: 9%–20% incidence at 1 year after abdominal surgery.
• In fact, a Medscape review notes that about 50% of incisional hernias become evident within 2 years, and nearly 74% manifest by 3 years after surgery.
• These hernias may begin small, but can enlarge over time if untreated, leading to functional and safety issues.

Causes & Risk Factors for Incisional Hernia After Surgery

To prevent or manage a hernia complication, you first need to know why it happens. Below is your existing list, refined and supplemented with data from recent studies:

• Obesity/Overweight: Excess weight strains the abdominal wall and suture lines.
• Age & Tissue Weakness: Older patients (>60) have reduced tissue elasticity.
• Post-operative infection: Post-surgical infections can significantly delay healing, making the incision site more susceptible to herniation.
• Early physical strain: Lifting heavy loads or sudden strain too soon can disrupt the healing site.
• Smoking: Tobacco use impairs wound healing and increases the risk of incisional hernias. It reduces blood flow and oxygen supply to tissues, hindering the healing process.
• Diabetes / Poor glycemic control: Poorly controlled diabetes can affect the healing process, increasing the risk of complications, including incisional hernias.
• Malnutrition: Poor nutrition can slow down recovery and impair wound healing, making hernia formation more likely.
• Multiple surgeries in the same region: Having multiple surgeries in the same area increases the risk of developing an incisional hernia.
• Chronic cough / raised intra-abdominal pressure: Conditions like COPD or constipation add stress to the incision barrier.

In modern studies, hernia size is itself a predictor of complications after repair. Larger defects carry a higher risk of wound events, mesh bulging, or recurrence.

Understanding these factors helps both patients and surgeons plan for safer recoveries and better outcomes.

Symptoms & Diagnosis of Incisional Hernia After Surgery

Early recognition is critical. Here are the indicating signs and standard diagnostic approaches:

Common Symptoms

• A visible bulge or lump near or at your surgical scar, especially when standing, coughing, or straining.
• Pain or discomfort, particularly during movement, coughing, or heavy activity.
• A feeling of heaviness or pressure in the abdomen.
• In advanced or complicated cases, symptoms may include nausea, vomiting, or changes in bowel habits.

Diagnostic Methods

At Chennai Hernia Care, we rely on a combination of clinical judgement and imaging:

• Physical examination + patient history (accounts for ~70% of diagnoses)
• CT scan: Improves diagnostic accuracy (~95%), especially in subtle or internal defects.
• Ultrasound: Useful, non-invasive, and good for visualising wall defects
• MRI: Reserved for complex or ambiguous cases, offering high-definition soft-tissue views.

Early diagnosis is crucial for preventing complications and ensuring the best possible outcomes for our patients.

Complications of Incisional Hernia After Surgery

Now we come to a critical section: “What can go wrong if this hernia is left untreated?” This is where complications from incisional hernia, post-incisional hernia repair, and laparoscopic incisional hernia repair arise.

Minor & Early Complications
These often occur in the weeks to months after repair or hernia onset:

1. Seroma/Fluid Collections
   After dissection and mesh placement, fluid can collect in the space around the repair. Most resolve on their own, but if persistent or symptomatic, aspiration or drainage may be needed.
2. Hematoma/Bleeding
   Minor bleeding into the surgical site or soft tissues may cause swelling, bruising, or discomfort. Careful hemostasis during hernia surgery helps reduce this.
3. Wound infection/surgical site infection (SSI)
   Infection around the incision is a common complication. Superficial infections may be managed with antibiotics and wound care; deeper infections involving mesh may require mesh removal.
4. Pain/Chronic pain/Neuralgia
   Persistent pain beyond 6–8 weeks can reflect nerve irritation, mesh fixation tension, or nerve entrapment.

Major & Late Complications

These are more serious, rarer, but important to understand:

1. Recurrence of Hernia
   Even after repair, hernias may recur, especially if the mesh fails, fixation is inadequate, or patient factors persist. Recurrence rates in studies vary (14%–18% for some open vs laparoscopic)
2. Mesh Infection/Deep Prosthetic Infection
   Infections involving the mesh are serious; often require complete removal of the mesh and delayed re-repair.
3. Mesh Migration/Erosion
   The mesh may shift or erode into adjacent tissues or organs (bowel, tissues), leading to pain, bowel injury, or fistulas.
4. Adhesive Bowel Obstruction
   Adhesions (scar tissue) can form between organs and the mesh or the peritoneum, leading to bowel obstruction.
5. Enterocutaneous Fistula/Enteroprosthetic Fistula
   Although rare, an abnormal connection can form between the intestine and the skin or mesh, often requiring complex surgery.
6. Mesh Contraction/Shrinkage/Bulging
   Over time, mesh may contract, losing overlap, creating bulging or contour deformity even without full recurrence.

Treatment Options for Incisional Hernia After Surgery

Now that you understand what may go wrong, let’s look at how Chennai Hernia Care addresses this with tailored, evidence-based treatment strategies.

Non-Surgical/Conservative Approaches

For small, asymptomatic incisional hernias after surgery, or in patients not fit for surgery:

• Watchful waiting/monitoring
• Supportive garments/trusses (temporarily)
• Lifestyle changes: weight loss, good nutrition, and avoiding strain
• Smoking cessation, diabetes control, and cough management

These do not correct the defect but can slow progression and reduce symptoms.

Surgical Approaches

When repair is indicated (symptomatic, enlarging hernia, risk of complications), Chennai Hernia Care offers advanced surgical techniques:   

1. Open Hernia Repair
   • The traditional approach is often used for large, complex hernias.
   • Larger incision, direct exposure, and reinforcement
   • Recovery time: 4–6 weeks
   • More suitable when anatomy is challenging or prior revisions exist
2. Laparoscopic Hernia Repair
   • Minimally invasive with small incisions
   • Benefits: less pain, faster recovery, fewer wound infections 
   • However, laparoscopic repairs may carry a slightly higher risk of intraoperative serosal injury or enterotomy.
   • Operative time may be longer in complex cases.
3. Robotic-Assisted Surgery
   • Offers precision and reduced scarring
   • Utilises advanced technology for enhanced surgical control
   • Provides 3D visualisation for the surgeon
   • Often results in less post-operative pain and faster recovery
   • Particularly useful for complex cases or recurrent hernias

In all surgical options, mesh is often used to reinforce the defect, reducing tension and the risk of recurrence.

If you’re preparing for incisional hernia surgery, you may also find our detailed guide on the questions to ask before your hernia operation helpful for understanding what to expect and choosing the best approach.

Mesh & Fixation: Complications & Considerations

During incisional hernia repair, surgical mesh helps strengthen the abdominal wall and reduce the risk of recurrence. Polypropylene mesh is widely used, safe, and effective, though it may cause mild inflammation during tissue healing.

In rare cases, mesh complications like infection, shifting, or tightening can occur. Studies show that laparoscopic hybrid-mesh repairs have minimal complications when performed correctly.

At Chennai Hernia Care, our consultant specialists guide patients and coordinate with hospitals to ensure the right mesh choice, secure fixation, and sterile surgical practices — helping you achieve a safe and smooth recovery.

Here is a side-by-side comparison:

Treatment Type	Recovery Time	Advantages	Common Risks / Complications
Open Repair	4-6 weeks	Good for large or complex hernias	Wound infection, slower recovery, recurrence
Laparoscopic / Robotic	1-2 weeks	Less pain, quicker mobility, fewer wound complications	Serosal injury, mesh fixation pain, and longer operative time

Recovery & Rehabilitation

Your journey does not end with surgery; the recovery phase is important.

At Chennai Hernia Care, we offer:

• Personalised physical therapy to restore core strength without stressing the repair
• Dietary counselling to support healing and weight control
• Pain management strategies (medications, local modalities)
• Frequent assessments to detect early complications

Typical timeline (for uncomplicated repairs):

• Return to normal day-to-day activities: ~4–6 weeks
• Full recovery (heavy lifting, sports): up to 3 months

Patients with robotic or laparoscopic repair often recover faster and experience less postoperative discomfort than those with open surgery.

Conclusion

We serve as your trusted consultant and long-term partner in recover, not a surgical centre. Our specialists collaborate with leading hospitals across Chennai to ensure expert diagnosis, treatment guidance, and coordinated care.

If you’re experiencing an incisional hernia or are concerned about one after surgery, our consultants provide a comprehensive evaluation and recommend the most suitable surgical approach, advanced mesh options, and personalised follow-up care. This helps minimise complications during incisional hernia repair and ensures a lasting, confident recovery.

Frequently Asked Questions (FAQs)