A hernia through an old surgical scar starts small and enlarges over years. Once the gap is wide, pulling the edges together under tension fails, and the abdominal wall has to be rebuilt rather than patched.
Incisional hernia reconstruction repairs a hernia through a previous surgical scar where the defect is too large for a straightforward mesh repair. The muscle layers are released in a controlled way, a technique called component separation, so the midline can be closed without tension, and mesh reinforces the repair. Where skin is also deficient or infected, flap reconstruction is added.
A small incisional hernia can be closed and reinforced with mesh, and that works well. As the defect widens, the muscles on each side retract sideways and shorten, and simply pulling them back to the midline puts the repair under tension. Tension is what makes repairs fail, and the recurrence rate for a large hernia closed that way is high.
It also causes a physiological problem. Forcing a large volume of bowel back into an abdomen that has adapted to living without it raises the pressure inside, which pushes the diaphragm up and can compromise breathing and kidney function in the first days. That is a genuine risk in very large hernias and shapes the planning.
Component separation addresses both. By dividing one muscle layer along its length on each side, the abdominal wall is allowed to slide inward. Each side can often be advanced several centimetres, so the midline meets without tension while the muscles remain innervated and functional. Mesh is then placed, usually behind the muscle rather than directly under the skin, to reinforce the repair.
Where the overlying skin is thin, ulcerated, or where mesh has become infected from a previous attempt, soft tissue reconstruction is needed as well. That is the point at which this stops being purely a hernia operation and becomes a reconstruction of the abdominal wall.
Optimising the patient before surgery changes the outcome here more than in almost any other elective operation.
A CT scan measures the defect and shows how much bowel lies outside the abdomen, which determines whether the abdomen can safely accept it back.
Smoking cessation, weight optimisation and diabetic control before the date. In very large hernias, techniques to prepare the abdomen may be used beforehand.
The previous scar and any thin or unstable skin is excised, and the hernia sac opened and dealt with.
A muscle layer is released along its length on each side, allowing the abdominal wall to slide inward so the midline meets without tension.
Mesh is placed behind the muscle layer, where it is protected from the skin and incorporates well.
Excess skin is removed, flap cover is used if the skin is deficient, and drains are placed to prevent fluid collecting.
Pain relief, breathing exercises and early mobilisation. Breathing can feel restricted at first as the abdomen adjusts to a higher pressure.
Drains removed as output falls. Wound monitored closely; fluid collections are the commonest early problem. Abdominal binder worn.
Gradual return to light activity. Binder continues. Still no lifting, straining or abdominal exercises.
Normal activity resumes progressively. Core strengthening under guidance. Scar matures over the year.
A successful reconstruction restores a flat, functional abdominal wall and relieves the dragging discomfort. Recurrence remains possible, particularly in smokers, in obesity and in diabetes, which is why preparation beforehand matters so much. The scar is long, and a degree of bulging or asymmetry is common even after a technically good repair. Recovery is slower than patients expect: six to twelve weeks before normal activity, and no heavy lifting for three months.
This is major abdominal wall surgery, frequently in patients who have had complications before.
Protecting the repair for three months is what stops it failing.
Mesh reinforces a repair; it does not overcome tension. A large defect pulled together under tension fails whether or not mesh is used, which is why the muscle layers are released first.
Where the mesh sits matters more than how big it is. Mesh placed behind the muscle incorporates better and is far less prone to infection than mesh sitting just under the skin.
Not with a large reconstruction. Three months without lifting or abdominal exercise is the usual advice, and returning early is a frequent cause of recurrence.
Obesity substantially increases wound breakdown, infection and recurrence. Weight optimisation before surgery genuinely changes the chance of the repair lasting.
Large hernia repair fails for predictable reasons: tension, infection and an unfit patient. Planning the release properly, reconstructing the skin when it is inadequate, and insisting on smoking cessation and weight optimisation beforehand are what change the recurrence rate.
Repair of a symptomatic incisional hernia is commonly covered by health insurance and by government schemes. Cost depends on the size of the defect, the mesh used, whether flap reconstruction is needed and the length of stay. A written estimate follows assessment and imaging.
Most come from people whose previous repair has failed.
Ask your question →Most often because the defect was closed under tension, or because mesh was placed just under the skin where it is vulnerable to infection. Smoking, obesity and diabetes all add to the risk. Addressing those, and releasing the muscle layers so the closure is tension free, is what changes the odds.
Three months for anything heavy, and that is not a cautious estimate. The repair is at its most vulnerable during this period, and returning to lifting early is one of the commonest reasons reconstructions fail.
Because both substantially increase the chance of the wound breaking down, the mesh becoming infected and the hernia coming back. Preparing properly turns a likely failure into a durable repair, and it is worth the delay.
Flatter, and functional. Some bulging or asymmetry is common even after a technically sound repair, particularly with very large hernias, and the scar is long. This is reconstruction of a damaged abdominal wall rather than a cosmetic operation.
Returning a large volume of bowel into an abdomen that had adapted to living without it raises the pressure inside and pushes up the diaphragm. It usually settles over days, and it is one reason very large hernias are planned carefully and sometimes prepared beforehand.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
