A ventral hernia is a gap in the front wall of the abdomen through which fat or bowel pushes out, forming a bulge under the skin. When that gap appears through the scar of a previous operation — where the closed muscle has gradually given way — it is called an incisional hernia. They are two names for the same problem in different settings, and they are repaired on the same principles.
Incisional hernias are common after abdominal surgery. The larger the original wound, and the more it was challenged by infection, obesity or heavy lifting during healing, the more likely the muscle layer is to separate over the months and years that follow.
Signs and symptoms
- A bulge in the abdominal wall, often near or along an old scar, more obvious on standing or straining.
- Aching or dragging discomfort, particularly after activity or at the end of the day.
- A bulge that grows over time, or that becomes harder to push back in.
- Skin changes or a sense of the contents being "stuck" in larger hernias.
When to seek care the same day. If the bulge becomes firm, painful and irreducible, especially with nausea or vomiting, the contents may be obstructed or strangulated. Go to an emergency department.
When surgery is the right call
A small, symptom-free ventral hernia can sometimes be watched. More often, repair is advised — these hernias enlarge over time, and a smaller defect is a simpler, safer operation than the same hernia left to widen for several more years. Pain, growth, difficulty reducing the bulge, or interference with daily life all tip the balance toward repair.
For larger or recurrent hernias, timing also allows preparation: weight loss, stopping smoking and good diabetic control all measurably improve the result, and are planned for as part of the operation rather than as an afterthought.
The repair — matched to the defect
The aim of a good repair is to bring the muscle layers back to the midline and reinforce them with mesh in a durable plane — not simply to patch the hole. How that is achieved depends on the size and shape of the defect.
Laparoscopic and robotic mesh repair
For small and moderate defects, keyhole repair places mesh inside or behind the muscle wall through a few small incisions, avoiding a long cut. Recovery is quicker and wound problems are fewer. This can be done laparoscopically or with a robotic platform, whose dexterity makes a keyhole retromuscular repair achievable in cases that would otherwise need an open incision.
Open retromuscular repair (Rives–Stoppa)
For midline ventral and incisional hernias of any real size, mesh is placed behind the rectus muscles, in front of the deep layer — the retromuscular plane. This is the workhorse of abdominal wall repair: the mesh is held by the body's own pressure and the muscle is closed over it, restoring the natural line of the abdomen. More on the Rives–Stoppa repair →
When the defect is wide
If the gap is too wide to close without tension, the muscle layers themselves are released — component separation or transversus abdominis release (TAR) — so the wall can be reconstructed properly. That is covered in the complex abdominal wall reconstruction guide.
The principle behind all of it. A hernia that comes back is almost always one repaired under tension, or with mesh too small or in the wrong plane. The repair is planned around restoring the anatomy, not closing the skin.
Recovery
Recovery depends on the size of the repair. A small keyhole repair is often day surgery or a single overnight stay, with a return to desk work in one to two weeks. A larger open retromuscular repair usually means a few days in hospital and a more gradual return over four to six weeks, avoiding heavy lifting while the wall consolidates. You will be given clear, specific limits for your repair.
Risks, honestly
The common issues are bruising, seroma (a fluid collection under the wound) and wound healing problems, which are more likely in larger repairs and in smokers or patients with diabetes or obesity — which is why preparation matters. Recurrence is uncommon after a properly planned repair but is never zero. All of this is discussed fully before any decision is made.
Request an appointment →