Dr A K Bansal provides specialist surgical care for incisional and complex ventral hernias at Dr Bansal Gastro & Liver Centre, Gomti Nagar Extension and Myra City Hospital, Lucknow. The service covers retro-rectus (Rives-Stoppa / sublay) mesh repair, laparoscopic intra-peritoneal onlay (IPOM) and extended-TEP (eTEP) repair, and component-separation techniques (TAR) for large defects with loss of domain. Practice follows the European Hernia Society and Americas Hernia Society Quality Collaborative (AHSQC) standards.
An incisional hernia is a protrusion of abdominal contents through a fascial defect at the site of a previous surgical incision. It develops because the fascia at the operation site has failed to heal or has weakened over the years following the index surgery. International surgical literature reports incidence rates of 10–20% after midline laparotomy, with substantially higher rates in obese, diabetic, smoker, ascitic and previously infected wounds.
Incisional hernia is one of the most challenging conditions in abdominal wall surgery. Defects can range from a small symptomatic bulge to a giant hernia containing most of the small bowel with loss of domain — a state in which abdominal contents have lived outside the abdominal cavity for so long that the cavity itself has remodelled and cannot easily reaccommodate the contents without specialised techniques. Modern incisional hernia repair therefore requires careful pre-operative planning, anatomical imaging, technical familiarity with multiple mesh-plane options, and a multidisciplinary perioperative pathway.
Dr A K Bansal offers the full range of repair techniques for primary and recurrent incisional hernia. Care follows the European Hernia Society (EHS) classification and guidelines for incisional ventral hernia, the Americas Hernia Society Quality Collaborative (AHSQC) recommendations on pre-operative optimisation and outcome reporting, and the International Endo Hernia Society (IEHS) consensus on laparoscopic ventral hernia repair.
Incisional hernia is multifactorial. Risk factors fall into three groups:
Surgical/technical factors
Patient factors
Behavioural factors
The hallmark presentation is a soft bulge along the line of a previous abdominal scar. Symptoms vary with hernia size, contents and degree of compromise:
Seek urgent surgical care for: sudden severe pain at the hernia, a bulge that becomes hard and irreducible, persistent vomiting, abdominal distension, or fever. These suggest incarceration or strangulation, which is a surgical emergency.
Diagnosis is usually clinical, but CT scan of the abdomen is the standard pre-operative imaging for moderate or large incisional hernia. CT defines defect size, contents, presence of multiple ("Swiss cheese") defects, status of the rectus muscles, and any loss of domain. It is essential for surgical planning, particularly when component separation may be required.
EHS and AHSQC guidance supports elective repair for:
For very high-risk patients (severe cardiopulmonary disease, decompensated cirrhosis, prohibitive obesity), a period of pre-operative optimisation — weight reduction, smoking cessation, glycaemic control, treatment of comorbidities — may precede repair and substantially improves outcomes. In selected cases, watchful waiting with abdominal binder support is reasonable.
Pre-operative preparation for incisional hernia repair extends well beyond standard surgical work-up. Modifiable risk factors directly affect mesh integration, wound healing and recurrence:
Imaging review with the patient is essential — Dr Bansal personally walks through the CT scan with each patient to explain defect anatomy, mesh strategy and expected post-operative course.
The Rives-Stoppa retro-rectus repair is the open gold-standard for midline incisional hernia and is endorsed across modern hernia guidelines. The mesh is placed behind the rectus muscle but in front of the posterior rectus sheath — a vascularised, biologically favourable plane that promotes mesh ingrowth and avoids contact with bowel.
Key technical steps include:
Laparoscopic incisional hernia repair is offered for selected primary defects, especially in patients in whom open repair carries higher wound complication risk (obesity, prior wound infection). Recognised techniques:
Very large incisional hernias — particularly those with loss of domain or defect width above ~10 cm — cannot be closed safely at the midline without releasing tension on the abdominal wall. Component separation techniques achieve this by mobilising one of the lateral muscle layers:
TAR is technically demanding and is reserved for surgeons with specialist hernia training. It is increasingly the procedure of choice for giant incisional hernia, parastomal hernia, recurrent hernia after failed retro-rectus repair, and complex multi-defect ventral hernia.
Recovery varies with hernia size and technique. Typical pathways:
Patients are advised to wear an abdominal binder for the first 4–6 weeks (longer for complex repairs), avoid heavy lifting, and continue breathing exercises. Wound checks and suture/staple removal are typically scheduled at 10–14 days.
Recognised complications of incisional hernia repair include:
Dr A K Bansal trained in surgical gastroenterology at SGPGI Lucknow with All India Rank 1 in the M.Ch entrance examination. He is Ex Senior Consultant in the Department of Gastrosciences at Medanta Hospital and currently heads GI Surgery at Myra City Hospital. With 15+ years of surgical experience and 5000+ procedures, his ventral hernia practice includes open Rives-Stoppa repair, laparoscopic IPOM and eTEP, and component-separation techniques for complex disease.
Please bring your CT scan and the operative notes of your previous surgery if available.
Book AppointmentA protrusion of abdominal contents through a fascial defect at the site of a previous surgical incision. It develops because the fascia at the operation site has not fully healed.
Surgical-site infection, midline incisions, suboptimal closure, obesity, smoking, diabetes, malnutrition, chronic cough/constipation, ascites, and physical strain during healing all contribute.
Most do. EHS and AHSQC recommend elective repair for symptomatic and most asymptomatic incisional hernias in fit patients. Watchful waiting is occasionally appropriate in very high-risk patients after pre-operative optimisation.
Modern repair uses mesh in a planned plane — most often retro-rectus (Rives-Stoppa) open, or laparoscopic IPOM/eTEP. Very large defects may need component separation or TAR.
Techniques to mobilise the lateral abdominal wall and bring the rectus muscles back to the midline in large hernias. TAR (Transversus Abdominis Release) is the current technique of choice for many complex cases.
Small repairs: 1 night. Moderate retro-rectus repair: 2–4 nights. Complex repairs with TAR: 4–7 nights, plus 6–8 weeks of structured recovery.
5–15% for retro-rectus mesh repair in expert hands, lower in well-selected patients. Substantially higher with suture-only repair, obesity, smoking and poorly controlled diabetes.