Bulge in the scar
A soft lump in the scar or nearby, which becomes larger when standing, coughing, or straining, and decreases when you lie down.
CONDITION / TORSO AND ABDOMEN
Postoperative abdominal hernia.
Postoperative hernia — a bulge in the area of a scar after abdominal surgery: a portion of the intestine or fat protrudes through a weak spot in the abdominal wall. If the hernia interferes with life, it is electively closed — guidelines recommend a mesh behind the muscles.
CONCEPTUAL VISUALIZATION- What it is
- Hernia in the area of the scar after abdominal surgery — open or laparoscopic.
- How common
- According to a meta-analysis of 14,618 patients, about 2 years after a midline incision — in 12.8%.
- Incarceration
- Rare, if the hernia can be reduced, but this is an emergency — 103.
- Which helps
- Elective repair: mesh behind the muscles and closed defect above it.
01 / WHAT IS ITWhat is
What is
Postoperative hernia.
Postoperative hernia — a protrusion in the area of the scar left after abdominal surgery. Due to a weak spot in the abdominal wall, part of the intestine or fat protrudes outward. The hernia can appear after open surgery or at the site of a puncture after laparoscopy — more often where the puncture was 10 mm or larger or near the navel.
This is a common complication of abdominal surgeries: according to a meta-analysis of 56 publications (14,618 patients), approximately 2 years after a midline incision, hernia occurred in 12.8%, and surgical repair, according to the authors’ estimates, was required in 5.2% of those operated on.
If the hernia is reducible, the risk of strangulation is low: according to European guidelines — 1% in the first year and 2.5% over 5 years. But emergency hernia operations cause significantly more complications and deaths than planned ones. Therefore, the main question is how much the hernia interferes with daily life. This is what determines whether surgery is needed.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow
How
Postoperative hernia presents.
The main sign is a bulge in the scar or near it. It is also important to know the signs of strangulation: in that case, help is needed immediately.
Skin is stretched
The skin over the hernia may appear tight and stretched.
Interferes with life
The hernia may pull, cause pain or discomfort, and interfere with everyday activities. The impact on quality of life is the main factor considered when deciding about surgery.
Large — not always painful
A large hernia may not hurt: the weak spot is stretched, and the contents freely move out and back. Pain usually occurs with smaller ones.
Pain in the hernia
Pain in the hernia or around it may be a sign of strangulation. See a doctor the same day, and if the pain is severe and doesn't go away — call 103.
Incarceration
The hernia has become hard, painful, cannot be pushed back, the skin over it has changed color, you feel nauseous or are vomiting, gas is not passing — this is a reason to call 103.
03 / REASONSWhy does it occur?
Why does it occur?
Hernia in a scar.
European guidelines list factors related to the person themselves and to the surgery. Some of them can be changed even before the next operation.
Wound infection
It seems to have the greatest impact: in the combined data of 4,933 patients, hernia occurred in 19.4% of those whose wound after surgery got infected, versus 6.9% without infection.
Excessive weight
Excess weight increases the risk of hernia after abdominal surgery.
Smoking
In the combined data from 4 cohort studies, hernia occurred in 18% of smokers compared to 7.7% of those who do not smoke or quit; the quality of evidence is very low.
Diabetes and medications
In pooled data from 7 cohort studies, hernia occurred in 14.6% of people with diabetes versus 8.7% without it. The risk is also increased by medications that suppress the immune system.
Midline incision
A midline abdominal incision more often leads to hernia than a transverse or lateral one: in pooled data from randomized trials — 10% versus 5.2%. Hernia is also more frequent in older people and in those who have previously undergone abdominal surgery.
Laparoscopy punctures
Hernia more often appears at puncture sites of 10 mm or more, near the navel, and after single-incision laparoscopy.
Umbilical hernia
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
A postoperative hernia that remains soft and reducible does not require emergency care. But if it becomes strangulated, the intestine may lose its blood supply. Call 103 if even one of the following occurs — with a hernia or after its repair:
103 immediately if:
- The hernia or abdomen suddenly hurts severely and the pain does not stop;
- The hernia has become hard or painful to the touch and cannot be pushed back in;
- The skin over the hernia has changed color;
- Nausea, vomiting, or inability to keep food down;
- Gas or stool does not pass;
- The abdomen hurts when touched;
- Breathing has become very rapid after surgery;
- Confusion or slurred speech has appeared after surgery;
- The skin has become bluish, pale, or mottled after surgery;
- After surgery — very high or very low temperature, severe chills;
- a rash appeared after surgery that does not fade when pressed;
- suddenly having difficulty breathing after surgery;
- pain appeared in the chest or upper back after surgery;
- the heart beats very rapidly after surgery;
- the person fainted;
- bleeding from the wound does not stop.
Do not delay a visit to the doctor:
Do not drive yourself — have someone take you or call 103. Do not forcefully push in a painful hernia. Immediately - to the surgeon who operated, and if it does not work - to the reception department: after plastic surgery, pain or swelling in the surgical area increases. On the same day: the hernia started to hurt but remains soft and reducible; the abdomen has bloated; mild fever; after plastic surgery the wound became red or is oozing pus; after surgery there is a cough with blood or pain and swelling of a leg (usually calf) or arm — these may be signs of a clot. Planned: you noticed a bulge in the scar; the hernia is getting bigger, pulls or interferes with usual activities; the hernia returned after previous surgery — make an appointment for a consultation.
05 / DIAGNOSTICSAs defined,
As defined,
what this hernia is and what type it is.
- Conversation
What abdominal surgeries were performed and when; whether the wound got infected; whether the hernia has already been operated on; smoking, weight, diabetes, and medications.
- Review
The doctor examines the abdomen standing and lying down, asks to cough or strain; evaluates the size of the hernia and whether it is reducible.
- Ultrasound, CT or MRI
If the examination does not give a definite answer. The most sensitive — CT; ultrasound or MRI with straining — when cost or avoiding radiation is important.
- CT or MRI before surgery
If surgery is planned, instructions recommend CT or MRI to plan it.
06 / TREATMENTHow we treat
How we treat
postoperative hernia.
The main goal of treatment is quality of life. Not every hernia needs to be operated on immediately; if surgery is needed, it is prepared for, and plastic repair is performed with a mesh. There is little evidence for guidelines, so the decision is made individually.
01
Follow-up
If the hernia can be pushed back in and does not cause problems.
- Risk of strangulation
- In an observation of 23,022 people who were not operated on, the risk of an acute complication — strangulation or intestinal obstruction — was 1.24% per year and 2.59% over 5 years.
- What happens later
- In a Danish study of 569 patients with postoperative hernia, among those observed without surgery, the likelihood of surgery over 5 years was 19%, and emergency surgery — 4%.
- When to operate
- Guidelines recommend surgery if the hernia worsens quality of life and the person can tolerate it — after a detailed discussion about the risks of surgery and observation.
02
Preparation
What to change before planned surgery.
- What the guidelines advise
- Lose weight if overweight, control diabetes well by glycated hemoglobin, quit smoking, improve respiratory endurance.
- What this gives
- According to a systematic review by the European Hernia Society, quitting smoking and losing weight in people with obesity reduced the risk of complications, although there are few studies.
- If losing weight does not succeed
- If after a weight loss program it was not possible to reduce weight, the risks of postponement — deterioration in quality of life and increase of the defect — may outweigh the benefits of further weight loss. This is discussed with the surgeon.
03
Mesh repair
Mesh behind the muscles, defect closed.
- Mesh, not just sutures
- In five randomized studies (934 patients), hernia recurred in 11.8% after mesh repair compared to 30.4% after suturing. In a study of 181 patients over 10 years — 32% versus 63%.
- Behind the muscles
- Guidelines recommend placing the mesh behind the rectus muscles. According to a meta-analysis of 10 mostly retrospective studies (1,948 patients), the wound was less likely to become infected than with mesh over the muscles.
- The defect is closed
- The edges of the muscles are brought together over the mesh, rather than just covering the gap with the mesh. Mesh in contact with the intestines is used with caution.
- What is taken into account
- With mesh, seroma — fluid accumulation in the wound — occurs more often: in three studies 19% versus 6.7%; no difference was found in the frequency of infection.
04
Open or minimally invasive
Depends on the hernia and the surgeon's experience.
- Choice of access
- Guidelines consider open, laparoscopic, and robotic surgery acceptable — depending on the patient, the hernia, and the surgeon's experience.
- Laparoscopy
- According to a review of 10 randomized studies (880 patients), after laparoscopy, the wound was less often infected, and there was no difference in recurrence rate; in half of the studies, follow-up was less than 2 years.
- eTEP and IPOM
- In a meta-analysis of 12 studies (868 patients, mostly with primary hernias), after IPOM, pain was stronger after a week, and hospital stay was longer; no differences were found in complications or hernia recurrence.
- Large hernia
- If the edges of the defect cannot be approximated without additional tissue release, more complex reconstruction is required.
05
After surgery
Recovery and possible complications.
- Movement and Load
- It is recommended to move immediately, as much as your condition allows; heavy lifting and straining exercises should be avoided for 4 weeks. You can take a shower from the first day, and swim once the wound has healed, approximately after 2 weeks.
- Bandage
- A brace or compression clothing can be worn for comfort during the first 6 weeks.
- Mesh Infection
- An infected mesh does not always need to be removed: in a review of 10 studies (265 patients), wound vacuum therapy preserved it in 76.2% of cases, and for mesh placed behind the muscles — in 98.5%.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Postoperative hernias at the Dr. Valikhnovskyi Institute of Surgery are treated under the 'Flat Stomach' approach. The method is chosen based on the size of the hernia, previous surgeries, and the condition of the abdominal wall.
CLINIC SERVICE
Slender belly
Abdominal wall with umbilical, postoperative and large hernias and diastasis — mostly minimally invasive.
View service
What we do for this condition
- Mesh behind the rectus muscles — the mesh is placed between the layers of the abdominal wall: it is held by pressure in the abdomen, grows into its own tissues, and does not touch the intestines.
- eTEP — endoscopically, in the layers of the abdominal wall behind the rectus muscles, without entering the abdominal cavity; this allows placing a large mesh.
- TARM (TARUP) — the mesh is inserted through the abdominal cavity and positioned behind the rectus muscles.
- Robotic reconstruction — 3D imaging with magnification and instruments that bend in multiple planes — for suturing muscles and fixing the mesh in hard-to-reach areas.
- Component separation (TAR) and botulinum toxin — for large hernias: freeing the muscles to bring the edges of the defect together, and a few weeks before surgery — relaxing the lateral muscles with botulinum toxin.
- Treatment of complications — if the hernia has recurred or the mesh is infected — repeat reconstruction; infection is often treated while preserving the mesh.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- CT scan and photo onlineSend a CT or ultrasound, discharge summaries of previous surgeries, and photos of the abdomen standing — the doctor will preliminarily assess the situation.
- ConsultationExamination standing and lying down, discussion about previous surgeries, chronic diseases, and medications; if necessary — CT for planning.
- Plan and preparationMethod and mesh; before a planned operation — stop smoking, control weight and blood sugar.
- SurgeryHernia repair with mesh behind the muscles — open, laparoscopic, or robotic.
- RecoveryWalking starts on the day of the operation or the next day; heavy lifting — not earlier than 4 weeks and after surgeon's approval.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Can a postoperative hernia go away on its own?
It is not worth counting on this. Among the risks of delaying surgery, guidelines cite an increase in the defect and deterioration in quality of life.
Is it necessary to operate?
No, if the hernia is reducible and does not interfere: the risk of incarceration is small — about 1% in the first year and 2.5% over 5 years. Surgery is recommended when the hernia worsens quality of life.
Why use a mesh if it can be stitched?
After stitching, the hernia recurs more often: in a study of 181 patients over 10 years — in 63% versus 32% after mesh repair.
Laparoscopic or open?
Both approaches, as well as robotic, are acceptable — the choice depends on the hernia and the surgeon’s experience. After laparoscopy, the wound is less likely to become infected, and no difference was found in hernia recurrence.
Do I need to lose weight and quit smoking before surgery?
Yes, the guidelines recommend this: excess weight, poorly controlled diabetes, and smoking are important modifiable factors. If weight loss is not successful, the decision is made together with the surgeon.
When can I lift heavy objects?
Heavy lifting and straining exercises—no earlier than 4 weeks: this is how long it takes for the mesh to integrate. You can move within your comfort limits immediately.
Can a hernia come back after repair?
Yes. According to various studies, after post-operative hernia repair, the hernia recurs in 23–50% of cases. The risk is higher in smokers, in diabetes, after wound infection and other complications, and also after repair without mesh.
Sources
18 sources · European Hernia Society guidelines, meta-analyses, randomized studies, and NHSshowCollapse
- Midline incisional hernia guidelines: the European Hernia SocietyBritish Journal of Surgery, 2023doi:10.1093/bjs/znad284 ↗
- Updated guideline for closure of abdominal wall incisions from the European and American Hernia SocietiesBritish Journal of Surgery, 2022doi:10.1093/bjs/znac302 ↗
- EHS Guidelines on the Management of Primary Ventral and Incisional Hernias Under Emergency ConditionsJournal of Abdominal Wall Surgery, 2026doi:10.3389/jaws.2026.16228 ↗
- Systematic Review and Meta-Regression of Factors Affecting Midline Incisional Hernia Rates: Analysis of 14,618 PatientsPLoS One, 2015doi:10.1371/journal.pone.0138745 ↗
- Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional herniaAnnals of Surgery, 2004doi:10.1097/01.sla.0000141193.08524.e7 ↗
- Laparoscopic versus open surgical techniques for ventral or incisional hernia repairCochrane Database of Systematic Reviews, 2011doi:10.1002/14651858.CD007781.pub2 ↗
- Meta-analysis of sublay versus onlay mesh repair in incisional hernia surgeryAmerican Journal of Surgery, 2014doi:10.1016/j.amjsurg.2013.08.030 ↗
- Identifying predictors of ventral hernia recurrence: systematic review and meta-analysisBJS Open, 2021doi:10.1093/bjsopen/zraa071 ↗
- IPOM versus eTEP as minimally invasive approaches for ventral/incisional hernias: a systematic review and meta-analysisHernia, 2025doi:10.1007/s10029-025-03319-6 ↗
- Comparison of Robot-assisted Enhanced-view Totally Extraperitoneal (eTEP) and Transabdominal Retromuscular (TARM aka TARUP) Ventral Hernia Mesh Repair: A Systematic Review and Meta-AnalysisJournal of Abdominal Wall Surgery, 2025doi:10.3389/jaws.2025.14723 ↗
- The European Hernia Society Prehabilitation Project: a systematic review of patient prehabilitation prior to ventral hernia surgeryHernia, 2022doi:10.1007/s10029-022-02573-2 ↗
- Watchful waiting as a treatment strategy for patients with a ventral hernia appears to be safeHernia, 2016doi:10.1007/s10029-016-1464-z ↗
- The salvage of mesh infection after hernia repair with the use of negative pressure wound therapy (NPWT), a systematic reviewANZ Journal of Surgery, 2022doi:10.1111/ans.18040 ↗
- HerniaNHS, 2026nhs.uk/conditions/hernia ↗
- Stomach acheNHS, 2023nhs.uk/symptoms/stomach-ache ↗
- SepsisNHS, 2026nhs.uk/conditions/sepsis ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
- Pulmonary embolismNHS, 2026nhs.uk/conditions/pulmonary-embolism ↗
The figures on the page are from these sources.
Bulge in the scar
after the operation?
Send a CT or ultrasound and records of previous surgeries. The doctor will say whether surgery is needed and how to prepare for it.