The short version
- An forms at the site of a prior surgical incision, where the muscle layer never fully healed or has pulled apart.
- It will not heal on its own, and most grow over time. Repair is usually recommended once a hernia causes symptoms, keeps growing, or gets in the way of daily life.
- rebuilds the midline muscle layer and reinforces it with . It can be done robotically () or through an open incision.
- A bulge that is suddenly stuck out, firm, and painful is an emergency. Go to the ER.
A quick summary. The full details are below, and none of it replaces an exam.
What is an incisional (ventral) hernia?
An incisional hernia happens when tissue from inside the abdomen pushes through a weak spot at the site of a prior surgical incision. The skin healed, but the muscle layer underneath either never fully came back together or pulled apart over time. That gap lets intestine or fat bulge through, which can cause a visible lump, discomfort, or pain, especially with lifting, coughing, or straining.
These hernias range from small and simple to large and complex. Some patients have a single small defect. Others have a wide gap running much of the length of the old scar, sometimes with more than one defect along the way.
When should it be repaired?
An incisional hernia will not heal on its own, and most get larger over time. Repair is usually recommended when the hernia causes symptoms, keeps growing, or interferes with work and daily activity. Repairing a hernia while it is smaller is generally a simpler operation with an easier recovery than waiting until it becomes large or complex.
Some situations need urgent attention. If the bulge is suddenly stuck out, firm, and painful, or if you have nausea and vomiting with it, the tissue may be trapped and losing its blood supply. That is an emergency. Go to the nearest ER.
What is abdominal wall reconstruction?
For larger or more complex hernias, the operation is more than patching a hole. Abdominal wall reconstruction rebuilds the midline of the abdomen: the muscle edges are brought back together where they belong, and the repair is reinforced with mesh placed in a protected layer behind the muscles, away from the intestines. This restores the way the abdominal wall works, not just the way it looks.
When the muscle edges cannot meet without tension, a technique called TAR (transversus abdominis release) gives the extra give needed to rebuild the midline. Whether TAR is needed is planned ahead of time using your CT scan.
Two ways this is repaired
Dr. Rodriguez rebuilds the abdominal wall either robotically, using the eTEP approach, or through a traditional open incision. eTEP stands for "extended total extraperitoneal" repair. It works from a protected space behind the abdominal muscles through small ports, without entering the main abdominal cavity. Open reconstruction works through a single incision, usually along your prior scar, and remains the standard for the largest and most complex cases.
Dr. Rodriguez typically recommends the open approach when a hernia involves loss of domain (so much tissue has lived outside the abdominal wall for so long that the abdomen has lost room for it), when the hernia is complicated by a fistula or an ostomy, or when a skin graft lies directly over the bowel. Your anatomy, prior operations, and CT scan guide the choice.
Robotic eTEP vs. open reconstruction, side by side
| Robotic eTEP | Open Reconstruction | |
|---|---|---|
| Incisions | Several small port incisions, placed using ultrasound and your CT scan | One incision, usually along your prior scar |
| Best suited for | Small to mid-size defects and many complex repairs, when the anatomy allows | The largest and most complex hernias, including loss of domain, hernias complicated by a fistula or ostomy, and skin graft overlying bowel |
| Anesthesia | General anesthesia | General anesthesia |
| Mesh position | Behind the muscles, outside the abdominal cavity, away from the intestines | Behind the muscles, outside the abdominal cavity, away from the intestines |
| Hospital stay | Most patients stay one night | Often several days, depending on the size and complexity of the repair |
| Getting moving | Walking is encouraged starting the day of surgery | Out of bed the day after surgery, walking in the hallway, with physical and occupational therapy support |
| Drains | Sometimes placed; removed once drainage is low | Sometimes placed; removed once drainage is low |
| Lifting limit after surgery | Nothing over 10 pounds until your first follow-up visit | Nothing over 10 pounds until your first follow-up visit |
Details for each approach, including step-by-step walkthroughs, are on the pages below.
Robotic eTEP Reconstruction
Rebuilds the abdominal wall through small ports from a protected space behind the muscles, without entering the abdominal cavity. Most patients stay one night.
Read more →Open Reconstruction
Rebuilds the wall through a single incision, usually along your prior scar. The standard approach for the largest, most complex hernias.
Read more →