What is an incisional (ventral) hernia?

After someone has surgery, the muscle being held together by sutures can weaken over time, resulting in a defect in the abdominal wall. This sometimes leads to tissue or internal organs pushing through the muscle into the abdomen.

When this happens, it is called an incisional hernia, which a type of ventral (or abdominal) hernia. Flank hernias, which occur on the side of your torso, are a type of incisional hernia and are treated like other incisional hernias.

illustration of an incisional hernia

What are the risk factors for incisional hernias?

The primary risk factor is weakness at the incisional site of a prior abdominal surgery. Other common causes include conditions, behaviors and activities that strain or weaken the abdominal wall, such as:

Being overweight
Smoking
Diabetes
Steroids, chemotherapy or other medications that weaken the immune system
Heavy lifting or other strenuous activities

What are the signs and symptoms of incisional hernias?

Signs and symptoms include:

A bulge in the affected area
Pain (ranging from a dull ache to severe pain), especially when coughing, sneezing or lifting heavy objects
Bloating or constipation

How are incisional hernias diagnosed?

Following a review of your medical and surgical history, your doctor will carefully examine your abdominal area. You may be asked to stand and cough so the doctor can see or feel a bulge that indicates a hernia.

If you have an incisional hernia, your doctor may order imaging tests such as:

Ultrasounds
Computed tomography (CT) scans
Magnetic resonance imaging (MRI) scans

These tests can help provide more details on the hernia's location and help determine the surgical strategy.

What are treatment options for incisional hernias?

Depending on the size and condition of your hernia, treatment options vary. They include:

Observation: In some milder cases, your doctor will recommend observing the hernia over time before taking more action.
Elective surgical repair: Some incisional hernias cause excessive pain or discomfort, which may lead your surgeon to recommend elective (non-emergency) surgical repair.
Emergency surgical repair: Urgent or emergent surgery may be needed in the rare cases in which an incisional hernia threatens to strangle a portion of the intestine.

Surgical repair of an incisional hernia involves closing the weakness in the abdominal wall and reinforcing it, often with synthetic mesh material. The specific method used depends on your hernia's size and location, your general health and your expected level of future physical activity.

What are the different types of incisional hernia surgery?

The surgeons at the Brigham and Women's Hospital Hernia Program are highly experienced in the full range of surgeries for incisional hernias, including:

Open hernia repair: This involves making an incision over the hernia site and pushing the bulging tissue or organ back in place. The surgeon then closes the hole with sutures or with a combination of sutures and plastic mesh.
Laparoscopic hernia repair: This is a minimally invasive procedure in which small incisions, a tiny video camera, special surgical tools and a piece of plastic mesh are used to repair the hernia.
Robotic hernia repair: This procedure is similar to laparoscopic repair. In this case, however, your surgeon uses robot-assisted technology to guide the movements of the surgical tools precisely.
Complex ventral hernia repair: This involves separating the different layers of the abdominal wall to create a more durable repair.

How do you make an appointment?

To learn more about the Hernia Program's multidisciplinary approach to patient care or to schedule an appointment with one of our specialists, please call 617-525-9726. Our providers see patients at the following locations: