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Conditions · ii.

Ventral & Incisional Hernia

A bulge in the abdomen — most often at the site of a previous surgery. Sometimes small and easily ignored. Sometimes large enough to alter posture, breathing, and quality of life. Always best treated by a centre that does these every week.

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15–20%
of abdominal surgeries develop a hernia at the scar
eTEP · TAR
our preferred modern techniques
2–4hrs
typical surgical duration
1–3 days
hospital stay (varies by complexity)
What it is

A defect in the abdominal wall.

A ventral hernia is any hernia through the front (ventral) wall of the abdomen. When the defect appears at the site of a previous surgical scar, it is called an incisional hernia. They are common: roughly one in five abdominal operations develops a hernia at the scar within five years.

The size of the defect matters enormously. A small umbilical or epigastric hernia may be a simple half-hour repair. A large incisional hernia after a previous open surgery — particularly one that has recurred, or one in which a significant portion of the abdominal contents now sits outside the original muscular wall (loss-of-domain) — is among the most demanding operations in general surgery, and is best performed at centres that handle them regularly.

Like inguinal hernias, ventral and incisional hernias do not heal on their own. They tend to enlarge progressively, particularly with weight gain, pregnancy, repeat surgery, or chronic cough. Larger hernias are technically harder, biologically more complex, and carry a longer recovery — which is why earlier referral matters.

The bottom lineVentral and incisional hernias are best repaired when they are still small and uncomplicated. Modern minimally-invasive techniques mean even moderately large defects can be repaired through tiny incisions — but the larger the defect, the more demanding the operation.
Symptoms

What to look out for.

Ventral and incisional hernias tend to be more visible than inguinal hernias — but smaller ones can be subtle for years before becoming symptomatic.

A bulge at or near a scar

Most commonly along the midline, around the umbilicus, or at a previous open-surgery scar. May be present for years before becoming noticeable, particularly in overweight patients.

Progressive enlargement

A defect that has grown over months or years. Often correlates with weight gain, pregnancy, chronic cough, or repeat abdominal surgery.

Posture & breathing changes

Large hernias can pull the abdominal wall forward, alter posture, restrict diaphragm movement and worsen back pain. These changes reverse after repair.

Emergency — Go to Hospital
If your hernia becomes painful, hard, red, or accompanied by vomiting or fever, do not wait. Call our helpline +91 94561-88888 or go to the nearest emergency department immediately. A strangulated hernia is a surgical emergency.
Diagnosis

Examination plus a CT scan.

Unlike inguinal hernias, ventral and incisional hernias almost always need cross-sectional imaging — usually a contrast-enhanced CT scan of the abdomen — before surgery is planned. The CT shows the defect size, the contents of the hernia, the condition of the surrounding muscle, and whether there is loss-of-domain.

At The Hernia Institute, we use the CT not just to confirm the diagnosis but to measure the defect precisely. Our AI-assisted measurement tool (SurgiMeasure) calculates defect width, transverse diameter, and loss-of-domain ratio directly from the imaging — and feeds these into our pre-operative planning.

For very large or complex hernias, additional measures may be needed before surgery — including pre-operative weight loss, smoking cessation, optimisation of diabetes, or in selected cases progressive pneumoperitoneum or botulinum toxin injections to expand the abdominal cavity before repair. All of this is discussed at consultation with a written plan.

Treatment Options

Four techniques. One plan.

Ventral hernia repair has been transformed in the last decade. Three modern minimally-invasive techniques (eTEP, IPOM-Plus, robotic / lap. TAR) now cover the great majority of cases. Open component separation remains the right answer for the largest and most complex defects. The choice is made by the surgeon — and explained to you — at consultation.

— Option 01 —

Laparoscopic eTEP

Enhanced-view totally extraperitoneal repair. The mesh is placed between the layers of the abdominal wall (retromuscular) through 4–5 small incisions, without entering the abdominal cavity. The strongest mesh position with the smallest scars.

  • Best for: small-to-medium midline defects (under 8–10cm wide), recurrent hernias after open repair, patients who want to avoid an abdominal incision
  • Recovery: 1–2 day hospital stay, return to desk work in 10–14 days
  • Scars: 4–5 tiny laparoscopic ports
— Option 02 —

Laparoscopic IPOM-Plus

Intraperitoneal Onlay Mesh with primary defect closure. A specialised composite mesh is placed inside the abdomen against the defect, and the defect itself is also closed with sutures (the "Plus" component) for a stronger, more durable repair.

  • Best for: medium-sized ventral defects, multiple defects (Swiss-cheese hernias), select recurrent cases
  • Recovery: 1–2 day hospital stay, return to desk work in 10–14 days
  • Scars: 3–4 small laparoscopic ports
— Option 03 —

Laparoscopic TAR

Transversus Abdominis Release. A muscle-splitting technique that creates a large retromuscular pocket for mesh placement — used for larger, more complex defects where eTEP or IPOM are insufficient.

  • Best for: larger defects (10–20cm wide), complex recurrent hernias, hernias with loss-of-domain after preparation
  • Recovery: 2–4 day hospital stay, return to desk work in 3–4 weeks
  • Scars: 4–6 laparoscopic ports
— Option 04 —

Open Component Separation

The right answer for the largest, most complex abdominal wall reconstructions — typically those with very wide defects, significant loss-of-domain, infected or extruded mesh from a previous repair, or where minimally-invasive access is impossible.

  • Best for: very large or recurrent defects, infected mesh, loss-of-domain reconstructions
  • Recovery: 4–7 day hospital stay, return to desk work in 4–6 weeks
  • Scars: one midline incision, typically along the previous scar

Mesh selection — lightweight, composite, biologic — is made case by case based on the defect, the surgical field, and the patient's risk profile.

Your Journey

From first call to full recovery.

Ventral and incisional hernias typically need 2–4 weeks from consultation to surgery — to allow time for imaging, optimisation, and pre-habilitation. Complex and loss-of-domain cases may need longer preparation.

i

Consultation & CT

30–45 minute appointment. Examination, CT imaging review, SurgiMeasure analysis, written treatment plan.

ii

Optimisation

Where needed: weight loss, smoking cessation, diabetes control. For complex cases, pre-operative bowel preparation or botulinum toxin.

iii

Surgery & Recovery

2–4 day hospital stay for most cases. Specialised post-op pain control, early mobilisation, abdominal binder fitting.

iv

Follow-Up

48-hour, 2-week, 6-week, and 6-month reviews. Hernia recovery physiotherapy support throughout.

Recovery

What to expect after surgery.

Why The Hernia Institute

A centre built around one specialty.

Specialists, not generalists

Every operation at THI is performed by a surgeon whose primary clinical focus is hernia and abdominal wall surgery — not a general surgeon who also does hernias.

Evidence-based, tailored

The recommended technique is grounded in current international guidelines and then adapted to your anatomy, lifestyle, and risk profile. Documented and shared with you before the day of surgery.

Modern operating theatre

4K laparoscopy, premium energy platforms (Sonicision, LigaSure), a curated mesh library, and a nursing team trained specifically in abdominal wall recovery.

Common Questions

Things patients often ask.

My hernia is small — do I really need surgery?

Ventral hernias rarely shrink and almost always grow. The single most important predictor of a difficult repair is the size of the defect at the time of surgery — small hernias are simple operations with quick recoveries, large ones are major reconstructions.

If your hernia is small now, fixing it now is almost always easier, safer, and shorter to recover from than waiting until it is large.

Which mesh will be used? Is it safe?

The mesh used depends on the technique and your individual anatomy. For retromuscular placements (eTEP, TAR), a lightweight macroporous polypropylene mesh is standard. For intraperitoneal placement (IPOM-Plus), a composite mesh with an anti-adhesion coating is used. For contaminated or infected fields, biologic or biosynthetic meshes are considered.

All meshes used at THI are CE/FDA-approved, from established manufacturers, with long-term published safety data.

How long will I be off work?

For desk-based work: 2–4 weeks depending on technique. For physically demanding work involving heavy lifting: 6–12 weeks. Large or complex reconstructions may need longer. A written, signed return-to-work certificate is provided after surgery so you can plan accordingly.

What does it cost?

Costs vary by technique (open vs laparoscopic), the type of mesh used, your room category, and your insurance. We provide a transparent itemised estimate during your consultation — and we work with most major health insurers in India. For outstation or international patients, we offer a fixed-price package on request.

I had a hernia repair years ago and it has come back. Can you help?

Yes — recurrent hernia work is one of the highest-volume referral categories at THI. Re-operative surgery is technically more demanding and is best performed at centres that see it regularly. We routinely take on recurrent hernias from across Punjab, neighbouring states, and outside India.

I have had multiple previous abdominal surgeries — am I a candidate for laparoscopic repair?

In most cases, yes. Even with multiple previous open surgeries, modern minimally-invasive techniques (particularly eTEP and laparoscopic TAR) can often be used. The decision is made after reviewing your CT scan and discussing the trade-offs at consultation.

For the small subset of patients where minimally-invasive access is genuinely impossible or risky, open component separation remains an excellent technique.

A ventral or incisional hernia? Start here.

Whether your defect is small or large, primary or recurrent — most consultations result in a clear, written plan and a CT review within 30–45 minutes. Outstation patients can begin with a teleconsultation.

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Related Conditions
Condition

Inguinal Hernia

The most common hernia in adults — a bulge in the groin that needs prompt evaluation.

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Recurrent Hernia

Hernias that have come back after surgery elsewhere. Re-operative work is one of our highest-volume referrals.

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Paediatric Hernia

Children's hernias are not small adult hernias — they need a different team and a different recovery pathway.

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