Depending on the size of the hernial orifice and the swelling of the hernia, incisional hernias can take on a range of different appearances. Small defects are often not even noticeable. Depending on how much organ material from the abdominal cavity has moved into the hernial sac, an incisional hernia can become fairly sizeable.
As well as being cosmetically noticeable due to their swelling, incisional hernias can also lead to serious complications if loops of bowel get trapped, affecting intestinal transit and causing intestinal blockage. If this happens, emergency surgery is essential.

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An incisional hernia can usually be diagnosed simply by clinical examination, i.e. following inspection and palpation of the hernial swelling under the scar. The hernial swelling can often be reduced easily on lying down and the hernial orifice can be felt. We subsequently carry out an ultrasound examination of the anterior abdominal wall. This not only provides an accurate picture of the size of the hernial orifice and what the hernial swelling contains, but it also allows us to rule out any other defects in the area of the old incision.

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The aim of surgical treatment is to return the "contents of the hernia" back to the abdominal cavity and to achieve permanent closure of the hernial orifice. Conventional suturing methods are nowadays only used in exceptional circumstances to treat incisional hernias. Long-term studies have shown a recurrence rate of incisional hernias following suturing of > 50%. Reinforcement of the abdominal wall using non-absorbable synthetic meshes has therefore become established as the standard. A wide range of different anatomical mesh positions, however, along with surgical approaches, are used.

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