Incisional hernias arise after abdominal surgery and are common after caesarean sections and gynaecological operations. They can be difficult to treat because of adhesions of abdominal viscera to the sac and because the size of the fascial defect may be so large that mesh is required for the repair. All but small incisional hernias should therefore be referred for treatment by a surgeon. Suprapubic incisional hernias are particularly complicated and require a surgical specialist to repair.

In the rare event of strangulation of an incisional hernia, operate to save the patient’s life by dividing the fascia and relieving the obstruction. Make your incision through the previous scar. Close the fascia with interrupted monofilament nylon. If this is not possible, close the skin and refer for mesh closure.