Incisional Hernia

What is an incisional hernia?

These occur through the site of a previous surgical scar. They can vary in size and the symptoms they cause. Some are straightforward to repair and some can be very complex requiring complete abdominal wall reconstruction.

Surgical repair

Repair can be with strong sutures alone or with a synthetic mesh to reinforce the tissues. This can be done with either open or keyhole surgery depending on the size, type and location of the defect. Patients with large hernias and redundant skin are often better served with an open repair when the excess tissue can be removed and a mesh placed within the abdominal wall to avoid contact with the bowel. Keyhole repair is often more suitable for smaller hernias or hernia off the midline.

Open hernia repair – This technique is most common and often used in either small uncomplicated hernias or in large defects when redundant tissue needs to be excised. The incision is usually at the site of the previous scar and gives an opportunity to make this neater. Occasionally drains are used to remove any fluid (seroma) from the operation site especially in the larger repairs. Recovery time will depend on the size of the hernia. Dissolvable sutures are used and a waterproof dressing placed over the wound. A pressure dressing is often used to minimise bruising and the space available for fluid to collect at the hernia repair site.

Laparoscopic (keyhole) repair – Small cuts are made in the abdominal wall to allow the passage of the instruments. The hernia is repaired using synthetic mesh and keyhole fixation devices. The cuts are repaired with dissolvable sutures and a local anaesthetic is given. A waterproof dressing is placed over the sites so you can shower straight away. These should be left for 5 days. On removal if the wound is not dry another dressing should be applied for a few more days.

More information on Laparoscopic Surgery

What happens prior to surgery?

The secretary and hospital will organise a day for the procedure and give you the admission details. Routine blood tests and a heart tracing (ECG), maybe required before admission. You will be asked not have anything to eat up to six hours prior to surgery. Water can be taken up to 2 hours prior to the surgery. The surgeon will go through the procedure again with you on the day and take your consent. The anaesthetist will also visit to discuss the general anaesthetic and your post-surgery pain relief. It is also not uncommon for patients to require anti-sickness medications after a general anaesthetic.

How long will it take for me to recover from surgery?

Straightforward hernia repair is usually performed as a day-case procedure. If the procedure is carried out later in the day or if there are any other medical concerns then an overnight stay maybe required. More complex hernia repair can require 2-3 days in hospital before patients feel confident mobilising and they may need the help of an abdominal support binder.

You will be discharged once you are fully mobile and comfortable. Most patients require 2-3 days of simple pain medication but should be fully functional during this period. Some patients return to work after this, but it will depend on the type of repair and your occupation.

Which medications will I require after surgery?

You will be discharged from hospital with a supply of simple painkillers with instructions on how to use them. Regular paracetamol is particularly effective and can be combined with an anti-inflammatory (ibuprofen) or codeine-based drug (dihydrocodeine). Anti-inflammatories are not suitable for all patients and should be taken with food. The codeine-based drugs can cause constipation and should be taken with plenty of fluids. Most patients do not require regular painkillers after 5 days.

When can I return to work?

Generally, it is recommended to take two weeks off after surgery. Your ability to return to work will depend on your job and varies between individuals. Patients can often return to work a week after surgery if required. We would not recommend flying immediately after surgery. This should be discussed on a case-by-case basis with the consultant.

When can I return to normal activities?

This will depend on the size of the hernia repair. Day to day activities including light lifting can begin immediately after surgery provided you are comfortable. Strenuous activities (heavy lifting, weights in the gym, HIIT training, contact sports) should be avoided for 6 weeks and reintroduced in a stepwise manner. There are usually no restrictions on lifestyle or activities after a hernia has been repaired once recovery is complete (beyond 6 weeks).

When can I drive?

Driving should be avoided in the first week after surgery. Once you can perform an emergency stop in a stationary vehicle and turn to view your blind spot then driving should be safe. It is preferable to contact your insurance company to check for any specific instructions they may have.

What are the risks?

Straightforward repair carries a low risk of the hernia returning (2-5%). Large hernia repairs can collect fluid around the surgical site after the operation. This is called a seroma and is often the result of a reaction to the mesh used to reinforce the area and the space available for fluid to collect. If it is sterile and not causing discomfort it is better left, as it will resolve with time. Infective complications are uncommon and usually treated with a course of antibiotics. Very occasionally a mesh may need to be removed if infected.

Who do I contact if there are concerns?

The group practice telephone is answered in working hours and messages can be left out of hours. Any concerns will be relayed directly to the consultant surgeon on receipt. The hospital ward also provides a 24/7 means of contact. They will contact the consultant about any concerns and are able to give advice if required.