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Umbilical, ventral and incisional hernia repair: an OR 101 guide

Umbilical, ventral and incisional hernia repair: an OR 101 guide

RODNIE ORO
Surgery

Reviewed by Rodnie Oro, cath lab charge nurse · Last reviewed: October 2026 · Education only, not medical advice

Abdominal wall hernia repair in one minute

What it is: surgery to repair a hernia in the front of the abdomen: at the belly button (umbilical), the abdominal wall (ventral) or an old scar (incisional).

Who it is for: people with a painful or growing hernia, or one that has become stuck.

Main risks: wound infection, fluid collection (seroma), the hernia coming back, mesh problems.

Usually: under general anaesthetic, 1–3 hours, home the same day to a few days.

On this page: What is abdominal wall hernia repair? · Who is it for? · When is it done? · Step by step · Recovery · Risks · Kit list · First time in theatre? · FAQ

Cross-section diagram of skin, muscle wall and abdomen with a hernia sac pushing out through a gap in the front abdominal wall

What is abdominal wall hernia repair?

A hernia in the front of the abdomen is a bulge where fat or bowel pushes through a gap in the muscle wall:

  • Umbilical: at or near the belly button
  • Ventral (epigastric): in the midline above the belly button
  • Incisional: through the scar of a previous operation

Small hernias may be closed with stitches. Larger ones are usually reinforced with a mesh, placed by open or keyhole surgery, per surgeon. Big incisional hernias may need a more complex wall reconstruction.

New to the acronyms? See the Cath Lab Abbreviations A–Z.

Who is it for?

It may be considered for people with:

  • a hernia causing pain or discomfort
  • a hernia that is getting bigger
  • a stuck or strangulated hernia, as an emergency

The decision is made by your surgical team, who will talk through the reasons, the alternatives and the risks with you.

When is it done?

Most operations are planned; some are urgent. Before it, you usually have:

  • an examination and often a scan
  • blood tests and, for bigger operations, an ECG
  • a review of your medicines, especially blood thinners and diabetes medicines, as per centre protocol
  • fasting instructions
  • a chance to ask questions and give consent
Timeline of the usual steps before abdominal wall hernia repair: Clinic: Assessment and consent, Pre-assessment: Bloods, medicines, On the day: Checks, WHO sign in, In theatre: About 1–3 hours

Step by step

1. Getting ready

Team brief and WHO checklist first. The anaesthetic team and ODP give the anaesthetic (general, regional or local, as per centre protocol); antibiotics and blood-clot prevention are given as per centre protocol. The circulating practitioner checks positioning, pressure areas, the diathermy plate and warming. The scrub practitioner sets up the instrument trolley and does the first count. For keyhole repair the laparoscopic stack is also checked.

2. Access

For open repair, a cut is made over the hernia. For keyhole repair, ports are placed to the side of the abdomen, away from the hernia, sizes per device and operator.

Front view of a patient showing an incision over a belly button hernia and keyhole ports on the side of the abdomen

3. Repairing the hernia

  • A. Sac freed. The hernia sac is found and freed from the edges of the gap.
  • B. Contents back. The contents are pushed back, freeing any stuck bowel carefully.
  • C. Gap closed or meshed. The gap is closed with sutures and, for most, reinforced with a mesh, size per device and operator.
  • D. Closure. The wound is closed in layers; a drain may be left, per surgeon.
Four-panel schematic of abdominal wall hernia repair: sac freed, contents back, gap closed or meshed, closure

4. Finishing

Local anaesthetic is injected and the skin closed with sutures, clips or glue. A binder may be advised. Final counts are confirmed before closure, specimens labelled and checked, and the patient goes to recovery with a full handover.

Recovery and aftercare

  • First hours: in recovery, then a ward or day unit; pain relief and anti-sickness medicine as needed.
  • Going home: same day for small repairs; a few days for larger ones.
  • Activity: walking early; avoid heavy lifting for about 4–6 weeks, per surgeon; ask your team.
  • Wounds: keep them clean and dry as advised; sutures or clips may need removing.
  • Follow-up: clinic review or a phone call, as per centre protocol.

Call 999 if you have severe pain, heavy bleeding, breathlessness or collapse. Contact your team or GP if you have a fever, worsening tummy pain or swelling, vomiting, or a wound that becomes red, hot or leaky.

Risks and complications

Your team will explain the risks that apply to you. Possible problems include:

  • wound infection
  • fluid collection under the wound (seroma)
  • the hernia coming back
  • mesh infection or problems needing further surgery (uncommon)
  • injury to the bowel (rare)
  • blood clots in the legs or lungs

Theatre kit list (printable)

Example kit list

Every theatre has its own protocol, and sizes and doses vary.

  • general instrument set
  • mesh, size and type per device and operator
  • mesh fixation (sutures or tacks), per surgeon
  • laparoscopic stack and ports for keyhole repair
  • strong closure sutures
  • drain, per surgeon
  • local anaesthetic, as per centre protocol; dressings and binder
Generic drawings of the main kit: mesh (generic), strong closure suture, port, wound drain

Procedural steps

  • Team brief, WHO sign in; anaesthesia; antibiotics as per centre protocol
  • Supine position; prep and drape; count
  • Incision or ports
  • Sac freed; contents reduced; gap measured
  • Closure of gap; mesh placed and fixed
  • Drain if used; closure; counts; sign out and handover
Recovery timeline after abdominal wall hernia repair: Day 0: Recovery, pain relief, Days 0–3: Home for most, 4–6 weeks: No heavy lifting, Weeks: Clinic if needed

First time in theatre?

đź’ˇ First-time tip

  • Know your role. Scrub, circulating, anaesthetic and ODP each have their own checks; ask at the team brief.
  • Counts matter. Swabs, needles and instruments are counted before, during and at closure; speak up if one is missing.
  • Mesh check. Read back the mesh type and size before opening, and log it.
  • Stuck bowel. If bowel is stuck, the team may need extra instruments; know where the bowel set is.
  • Warmth. Keep warming devices running.

FAQ

Why do hernias form in scars?

The scar is weaker than normal muscle wall, especially after infection or with extra weight.

Will I have mesh?

Most adults with anything more than a small hernia do.

Can I reduce the risk of it coming back?

Not smoking, a healthy weight and avoiding heavy lifting while healing help.

Sources

All checked on 14 October 2026. Each page's own date is shown where it gives one.

Disclaimer

Education only. This page is for general education for healthcare students, theatre staff and curious readers. It isn't medical advice and doesn't replace advice from your own doctor, surgical team or local unit protocols. Equipment and medicines are described generically. No product or manufacturer is recommended. If you think someone is having a medical emergency, call 999.

Disclosure: I work in the medical device industry. This page is independent education and isn't sponsored or reviewed by any company.

All diagrams on this page are original illustrations created for rodnieoro.com.

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