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Open Incisional Hernioplasty Repair
Open Incisional Hernioplasty Repair corrects a hernia through a previous abdominal scar using direct surgical access and durable mesh reinforcement — providing reliable long-term results for this challenging and commonly encountered type of hernia.
Overview
Open Incisional Hernioplasty treats hernias that develop through the scar of a previous abdominal operation — one of the most common complications of abdominal surgery. The procedure requires careful dissection of the hernia sac from surrounding scar tissue, complete mobilisation of the fascial defect edges, reduction of all hernia contents, and closure of the defect reinforced with a well-positioned mesh to distribute tension evenly and prevent recurrence. Open repair provides direct surgical access that is particularly valuable for large, complex, or recurrent incisional hernias where laparoscopic repair is not feasible.
Types of Incisional Hernia Repair
Incisional hernias range from small single-defect hernias to large complex defects requiring advanced reconstructive techniques. The repair technique is individualised to defect characteristics and patient health.
- Open Primary Suture Repair (for very small defects with adequate tissue quality)
- Open Onlay Mesh Repair (mesh placed over the closed fascial repair)
- Open Sublay Mesh Repair (mesh in retro-muscular space — lowest recurrence)
- Component Separation with Mesh Repair (releasing abdominal wall muscles to close large defects)
- Biologic Mesh Repair (for contaminated fields or active infection)
Risk Factors of Incisional Hernia
Incisional hernia formation is influenced by both surgical and patient-related factors. Understanding these risks helps prevent hernia formation and identify patients needing close monitoring.
- Wound infection after the original abdominal surgery — the strongest risk factor
- Obesity increasing abdominal wall tension and impairing wound healing
- Smoking significantly impairing collagen synthesis and fascial healing
- Emergency abdominal surgery associated with higher hernia rates than elective procedures
- Chronic corticosteroid or immunosuppressive medication use
- Malnutrition and low serum albumin impairing fascial repair strength
Incisional Hernia Symptoms
Incisional hernias typically develop months to years after the original surgery and produce a characteristic pattern of symptoms reflecting abdominal wall disruption.
- Visible bulge along or near the previous surgical scar
- Aching or dragging discomfort worsened by physical activity
- Progressively enlarging hernia over months to years
- Difficulty with core physical activities or exercise
- Skin changes over a large hernia — thinning, excoriation, or ulceration
- Sudden severe pain from incarceration or strangulation
- Bowel obstruction symptoms — vomiting and distension from bowel incarceration
- Psychological distress and body image concerns from visible abdominal deformity
Key Benefits
Discover the advantages of choosing our open incisional hernioplasty repair services.
Comprehensive repair of complex incisional hernia with the lowest achievable recurrence rate
Sublay mesh position utilises the abdominal pressure to hold mesh in the optimal position
Resolves the pain, discomfort, and cosmetic deformity caused by large incisional hernias
Prevents incarceration and strangulation in hernias with narrow-necked defects
Component separation allows primary fascial closure even in very large or complex defects
Clinical Features
The technology, techniques and clinical approach behind our open incisional hernioplasty repair.
Pre-operative CT mapping identifies all fascial defects for comprehensive repair planning
Sublay mesh placement provides the strongest mechanical reinforcement with lowest recurrence
Component separation technique available for very large midline defects
Pre-operative nutritional and risk factor optimisation improves mesh integration outcomes
Drain placement minimises post-operative seroma formation under large mesh repairs
Preparation Instructions
- Complete pre-operative CT of the abdomen to map the fascial defect size and muscle quality
- Provide blood results including CBC, coagulation, blood group, kidney and liver function
- Achieve the best possible nutritional status before surgery — malnutrition significantly impairs healing
- Stop smoking at least 4 weeks before surgery
- Stop anticoagulants 5 to 7 days before surgery under supervision
- Optimise diabetes and blood pressure control
- Arrange home support for 3 to 5 weeks post-discharge
- Fast for 8 to 10 hours before the procedure
The Procedure
Step-by-step guide to what you can expect during your open incisional hernioplasty repair procedure.
CT-Guided Hernia Mapping
Your surgeon reviews your CT scan to precisely map the number, size, and position of all fascial defects in the incisional scar, assess the quality of the abdominal wall muscles, and plan the mesh position and component separation requirements needed to achieve the most durable repair without excessive tension.
Nutritional and Risk Factor Optimisation
Your surgeon may recommend a period of pre-operative optimisation — including nutritional support, smoking cessation, and weight reduction — before scheduling surgery for large incisional hernias, as these factors significantly influence wound healing, mesh integration, and long-term recurrence rates.
General Anaesthesia and Abdominal Access
General anaesthesia is administered and the abdomen is accessed through an incision over or within the previous surgical scar. Dense adhesions from the prior operation are divided carefully, the entire hernia defect is exposed, and all hernia contents are reduced back into the abdominal cavity.
Fascial Defect Preparation and Closure
The fascial edges of the defect are carefully dissected and mobilised to allow tension-free approximation. For large defects where direct closure is not possible without unacceptable tension, component separation — releasing the external oblique fascia — allows the defect to be closed primarily.
Sublay Mesh Placement
A large surgical mesh is positioned in the sublay (retro-muscular) plane — behind the muscles and in front of the peritoneum — where it is held in the optimal mechanical position by the pressure of the abdominal contents. The mesh is secured with permanent sutures to the posterior fascial layer on all sides.
Layered Closure and Drain Placement
The anterior fascia and muscle layers are closed over the mesh, and a drain may be placed in the subcutaneous space to prevent seroma formation. The skin is closed with interrupted absorbable sutures and a compression dressing is applied to support the abdominal wall during the early healing period.
What to Expect
Open Incisional Hernioplasty is performed under general anaesthesia and takes 90 to 150 minutes depending on defect size. The surgeon carefully repairs the fascial defect with mesh secured in the optimal anatomical plane for maximum durability. Hospital stay is typically 3 to 5 days with active physiotherapy from day one. Core strength returns over 4 to 6 weeks as the mesh integrates.
Recovery
Avoid lifting more than 5 kilograms for 6 weeks while the mesh integrates. Attend wound review at 2 weeks and activity clearance at 6 weeks. Maintain a healthy weight and address modifiable risk factors — smoking cessation and weight management — to protect the repair long-term. Contact your surgeon immediately for hernia recurrence, wound complications, fever, or severe abdominal pain.
Frequently Asked Questions
Common questions about open incisional hernioplasty repair.
Related Services
Explore other services in our General Surgery department.
Complex Laparoscopic Hernia Surgery
Complex Open Hernia Surgery
Amputation Major
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