Incisional Hernia Repair in Western Australia

An incisional hernia is a hernia that develops through the scar of a previous abdominal operation. Whenever the muscle layer of the abdominal wall is cut to access organs inside, the healed scar tissue is weaker than the surrounding muscle. In around one in ten patients who have had open abdominal surgery, that scar tissue gradually stretches and the underlying muscle layer separates, allowing fat or bowel to push through and create a bulge under the old scar.

Incisional hernias can appear within months of the original operation or many years later. They can develop after appendix surgery, gallbladder surgery (especially older open gallbladder operations), bowel resection, hysterectomy, caesarean section, kidney surgery, aortic surgery, and following emergency abdominal operations of any kind. They can also occur at the small port sites used in laparoscopic surgery, although less commonly than after open operations.

Incisional hernias range from small and minimally symptomatic to very large, complex defects that distort the shape of the abdomen and significantly affect daily life. Some patients have a single defect along a scar; others have several smaller defects along the same scar — sometimes called a "Swiss cheese" pattern.

Like other hernias, incisional hernias do not heal on their own. They tend to enlarge over time and carry an ongoing risk of bowel becoming trapped. Repair is generally recommended, but the surgical planning is more complex than for first-time hernias — Dr Watson will discuss the realistic options for your specific situation in detail at consultation.

Incisional hernia is a complication of previous abdominal surgery. The risk factors include emergency surgery (where the abdominal wall is closed under difficult conditions), wound infection after the original operation, return to heavy lifting before the original repair fully healed, obesity, smoking, diabetes, chronic cough, malnutrition, long-term steroid use, and multiple previous operations through the same scar.

The single biggest modifiable risk factor is smoking. Smoking impairs wound healing, increases the risk of wound infection, and significantly raises the risk of an incisional hernia recurring after repair. Where possible, patients are strongly encouraged to stop smoking before incisional hernia surgery.

Incisional hernia repair is more technically demanding than first-time hernia repair, and surgical planning is highly individualised. The aims are the same — to reduce the contents back into the abdomen and to reinforce the abdominal wall — but the approach varies with the size of the defect, the quality of the surrounding tissue, and your overall health.

Open repair

Most large incisional hernias are repaired open, through an incision overlying the previous scar. The hernia sac is freed up, the contents reduced, and a piece of mesh is placed in one of several positions relative to the muscle layers to reinforce the repair. For very large defects, techniques to allow the abdominal wall muscles to be reapposed (such as component separation) may be required.

Laparoscopic and robotic repair

Selected incisional hernias can be repaired laparoscopically or robotically through small incisions away from the original scar. Mesh is placed inside the abdomen against the muscle wall. These approaches are generally suitable for moderate-sized defects without extensive previous abdominal adhesions, and offer faster recovery in suitable patients.

Mesh choice

Almost all incisional hernia repairs use mesh, because non-mesh repairs of incisional defects carry very high recurrence rates. Mesh type, size, and position are selected based on the specifics of your case.

Dr Watson will set out the realistic options, expected recovery, and risks specific to your hernia at consultation.

Recovery from incisional hernia repair varies more than for first-time hernia repair because the operations themselves vary so widely. After a small repair, most patients return to desk-based work within one to two weeks and to manual work after three to six weeks, similar to umbilical hernia recovery. After a large or complex reconstruction, recovery is significantly longer — typically four to six weeks before returning to even sedentary work, and three months or more before unrestricted heavy lifting. These are general guidelines, not guarantees.

Most patients are encouraged to walk from day one and to gradually rebuild abdominal strength under guidance. Wearing an abdominal binder for several weeks is sometimes recommended. Dr Watson reviews you in person or by telehealth several times in the months after surgery.