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Abdominal Wall Hernias
Ventral & Incisional Hernia Repair in Katy & Sugar Land, TX
Abdominal Wall Hernia Surgery: Open, Laparoscopic & Robotic
A ventral hernia is a bulge where fat or intestine pushes through a gap in the front wall of the abdomen. When the gap forms in the scar of an earlier operation, it is called an incisional hernia. Both usually stand out more when you stand, cough, or lift, and both tend to grow over time.
At Surgical Associates of Southern Texas, board-certified surgeon Dr. Murtaza Shakir maps each abdominal wall hernia with a careful exam and, when needed, CT imaging. He then repairs it with an open, laparoscopic, or robotic technique matched to its size, location, and history, from a small defect closed in under an hour to a planned reconstruction of a wide separation. He sees patients in Katy and Sugar Land. For every hernia type we treat, see the main hernia repair page.
Meet the Surgeon
Dr. Murtaza Shakir, MD, general surgeon and abdominal wall hernia specialist in Katy and Sugar Land, TX
- Dual board certified in General Surgery and Complex General Surgical Oncology
- Named a Houstonia Top Doctor in General Surgery, 2026 (see listing)
- Highly reviewed: rated 4.9 stars on Google
- Specialized in open, laparoscopic, and robotic ventral and incisional hernia repair, abdominal wall reconstruction for large defects, and recurrent hernia repair
Patient Reviews
Patient Experiences With Dr. Shakir
Rated 4.9 stars on Google. Real experiences from patients treated in Katy and Sugar Land.
Jump to a section
- At a glance
- What is a ventral hernia?
- Primary vs. incisional hernias
- Causes and risk factors
- Symptoms and urgent signs
- Ventral hernia or diastasis?
- Exam and CT imaging
- Does it need surgery?
- Meet your surgeon
- How the repair is chosen
- Open vs. laparoscopic vs. robotic
- Where the mesh goes
- Large defects and reconstruction
- Recovery
- Risks and recurrence
- Patient reviews
- Why choose us
- Insurance
- Locations
- FAQs
- Schedule a consultation
At a Glance
Ventral & Incisional Hernia Repair at a Glance
- What it is
- Surgery to close a gap in the front abdominal wall and reinforce it, usually with mesh. A ventral hernia can form on its own; an incisional hernia forms in an old surgical scar.
- Who treats it
- A general surgeon. Dr. Shakir is board certified in General Surgery and Complex General Surgical Oncology.
- How it is assessed
- A standing and lying exam, plus a CT scan for most incisional hernias and for large, recurrent, or hard-to-feel hernias.
- Repair options
- Robotic, laparoscopic, or open repair with mesh. Very wide defects may need open abdominal wall reconstruction with component separation.
- Hospital stay
- Same day or one night for most small to medium minimally invasive repairs; about two to five days after a large open reconstruction.
- Typical recovery
- Desk work in one to two weeks after a minimally invasive repair; lifting limited for four to six weeks, and six to eight weeks or more after a reconstruction.
- Urgent warning signs
- Sudden severe pain, a hard, red, or purple bulge that will not go back in, vomiting, or no gas or stool. Call 911 or go to the nearest emergency department.
- Where
- Offices in Katy and Sugar Land, TX. Call 713-955-9191.
Abdominal Wall Basics
What Is a Ventral or Incisional Hernia?
A ventral hernia is any hernia through the front of the abdominal wall other than the groin. Fat or a loop of intestine, wrapped in a thin sac of abdominal lining, pushes through a gap in the strong fibrous layer that holds the wall together. An incisional hernia is the same problem at the site of a previous operation, and it is among the most common ventral hernias that surgeons repair.
How the Abdominal Wall Is Built
Think of the abdominal wall as layered fabric. Down the front run the two rectus muscles (the “six-pack”), joined in the middle by a tough seam called the linea alba. On each side, three flat muscles, the external oblique, internal oblique, and transversus abdominis, wrap around toward the back. Their tendon-like sheets, called fascia, form sleeves around the rectus muscles. Underneath everything lies the peritoneum, a thin lining that covers the intestines.
Strength comes mainly from the fascia, not the muscle. A hernia is a hole or tear in that fascia, which is why exercise cannot close it.
Why the Midline and Old Scars Give Way
The linea alba has no muscle of its own, so it is a natural weak point; many epigastric and umbilical hernias start there. Any operation that cuts through the fascia leaves a scar that never regains its full original strength. Roughly one in ten to one in five abdominal incisions eventually develops a hernia, sometimes years after the original surgery.
Learn more about incisional hernias after surgery and ventral hernia causes and repair options.
Hernia Types
Primary Ventral Hernias vs. Incisional Hernias
Ventral hernias fall into two groups: primary hernias, which form without any previous surgery, and incisional hernias, which form in a surgical scar. The difference matters because incisional hernias are more often large, can involve several holes along one scar, and sit in scar tissue that makes repair more involved.
Epigastric Hernia
A small gap in the midline between the breastbone and the belly button. It usually contains a pea- or grape-sized knob of fat and can be surprisingly tender for its size. More than one may be present, and they often appear alongside a widened midline (diastasis).
Umbilical and Paraumbilical Hernia
A gap at or just beside the belly button, the most familiar ventral hernia in adults. Pregnancy, weight gain, and fluid in the abdomen are common triggers. These have their own page: umbilical hernia repair.
Spigelian Hernia
A less common hernia along the outer edge of the rectus muscle, usually in the lower abdomen. It often slips beneath an intact outer muscle layer, so there may be pain without an obvious bulge. Its narrow opening can trap tissue, and imaging is often needed to confirm it.
Incisional Hernia
A hernia in the scar of an earlier abdominal operation, whether open, laparoscopic, or robotic. It can be a small gap at a port site or a long, wide defect along a midline incision. When it returns after a previous hernia repair, it is a recurrent hernia; see recurrent hernia repair.
Risk Factors
What Causes a Ventral or Incisional Hernia?
A ventral or incisional hernia develops when steady pressure inside the abdomen meets a weak spot in the fascia. Some weak spots are natural, some are left by surgery, and many risk factors make a weak spot more likely to open:
- A previous incision that healed with a weak scar
- A wound infection after the original operation
- Obesity, which loads the wall with constant pressure
- Smoking, which weakens tissue and slows healing
- Diabetes, steroid use, or poor nutrition
- A chronic cough, constipation, or regular heavy lifting
- Several operations through the same area
- Emergency surgery, where the wall may have been closed under difficult conditions
Risk Factors You Can Change
Weight, smoking, blood sugar, and nutrition are the factors that most affect whether a repair heals well and holds. They cannot close a hernia, but improving them before an elective repair lowers the chance of wound problems and recurrence. Dr. Shakir discusses which apply to you at the first visit.
Recognizing the Signs
Symptoms of a Ventral or Incisional Hernia
The most common sign is a bulge on the abdomen or along a surgical scar that gets bigger when you stand or strain and flattens when you lie down. Symptoms depend on the size of the gap and what is passing through it. A large hernia can be nearly painless, while a small one with a tight opening can ache a great deal.
- A bulge on the abdomen or along a scar
- A bulge that enlarges when standing, coughing, or straining
- Pulling, pressure, or aching at the site
- Pain with lifting, bending, or getting out of bed
- A bulge that has grown over months or years
- Thin or shiny skin over the bulge
- Bloating or changes in bowel habit
- Difficulty pushing the bulge back in
Large abdominal wall hernias can also affect posture, core strength, and breathing, and can make work and exercise harder. Adult ventral hernias do not close on their own, and symptoms usually progress. See ventral hernia pain and symptoms.
When to See a Surgeon
Schedule a consultation if you notice a new bulge near an old incision, a bulge that is growing or aching, pain that limits lifting or exercise, or a hernia that is getting harder to push back in. Early evaluation usually means a simpler repair.
When an Abdominal Wall Hernia Needs Emergency Care
Seek immediate care for sudden, severe pain at the hernia, a firm, tender, red or purple bulge, a hernia that no longer goes back in, or nausea, vomiting, bloating, fever or trouble passing gas or stool. These can signal trapped intestine. For a medical emergency, call 911 or go to the nearest emergency department.
Diastasis Recti
Is It a Ventral Hernia or Diastasis Recti?
Diastasis recti is a widening and thinning of the midline seam between the rectus muscles, not a hole, so it is not a hernia. It causes a long ridge or dome down the middle of the abdomen when you sit up, while a hernia usually forms a rounder, more defined bulge. The two often occur together, especially after pregnancy or major weight change.
Diastasis Alone
Because there is no opening, diastasis does not trap intestine. It is often managed with core-strengthening exercise, and surgery is generally not performed for the separation by itself.
Hernia Within a Diastasis
When an epigastric or umbilical hernia sits inside a wide diastasis, repairing only the small hole can leave the surrounding midline weak. Dr. Shakir notes any diastasis at the exam and explains whether addressing it at the same operation makes sense for you.
A Careful Evaluation
How Dr. Shakir Evaluates and Maps the Hernia
Ventral and incisional hernias are measured and mapped before surgery, because the size, number, and location of the gaps decide the approach, the mesh, and the recovery. Evaluation has three parts.
Examination
Dr. Shakir examines you standing and lying down, often while you cough or strain. He checks the length of the old scar, how many gaps can be felt, the quality of the surrounding muscle, and the condition of the skin, and notes any diastasis or previous mesh.
CT Imaging
A CT scan is recommended for most incisional hernias and for any ventral hernia that is large, recurrent, or hard to feel, such as in a heavier abdomen or with a suspected Spigelian hernia. CT measures the width of the gap, finds hidden second defects along the scar, shows the position of any old mesh, and helps judge whether the muscles can be brought back together. Already had a scan? Read A CT scan showed a hernia. Do I need surgery?
Previous Operative Reports
How the original incision was closed, whether mesh was used, and what was done at any earlier hernia repair directly change the plan. Please bring prior operative reports and imaging to your visit, or let the office know where they can be requested.
Conditions That Can Look Like a Hernia
A lipoma (a soft fatty lump), a fluid collection under an old scar, a diastasis, or a bulge from weakened muscle after a side incision can all mimic a hernia. The exam, and CT when needed, tells them apart.
Timing of Repair
Does a Ventral or Incisional Hernia Always Need Surgery?
Not always right away, but most are best repaired. A ventral hernia will not heal by itself, and incisional hernias in particular tend to widen over time, which makes the eventual repair larger. Repair is usually advised when the hernia hurts, is growing, limits work or exercise, is hard to push back in, or has ever become stuck.
Observation can be reasonable for a small, painless hernia in a patient whose surgical risk is high. In that case, Dr. Shakir explains the warning signs to watch for and how often to be rechecked. An abdominal binder may ease discomfort but does not fix the gap. Read more about when hernia surgery becomes necessary and whether hernias go away on their own.
Getting Ready for an Elective Repair
For a large or recurrent hernia, a short preparation period can make the repair safer and more durable. Dr. Shakir may recommend:
- Stopping smoking and nicotine, ideally at least four weeks before surgery
- Targeted weight loss when weight is significantly elevated
- Better blood sugar control for patients with diabetes
- Attention to nutrition, a chronic cough, or constipation
- Medical clearance and a review of blood thinners and other medications
Do not stop any prescription medication unless instructed by the appropriate healthcare professional. See our pre-operative care guide.
Your Surgeon
Meet Your Abdominal Wall Surgeon
Murtaza Shakir, MD
Board-Certified General Surgeon & Surgical Oncologist
Ventral and incisional hernia care at Surgical Associates of Southern Texas is led by Dr. Murtaza Shakir, who is board certified in General Surgery and Complex General Surgical Oncology.
Board certification
American Board of Surgery: General Surgery and Complex General Surgical Oncology
Medical degree
Aga Khan University
Residency
General Surgery, Riverside Methodist Hospital, Columbus, Ohio
Fellowship
Two-year Surgical Oncology fellowship, University of Pittsburgh Medical Center
Surgical practice includes
Named a Houstonia Top Doctor in General Surgery (2026). Learn more about our general surgery services.
Surgical Planning
How Your Ventral Hernia Repair Is Chosen
The repair is chosen from the map of your hernia and your overall health, and it is explained before you decide. These are the factors that weigh most.
Width and Number of Defects
Defects under about 4 cm are usually straightforward minimally invasive repairs. Wider gaps, several gaps along a long scar, or a hernia that holds much of the abdominal contents call for a reconstruction that restores the midline, not just a patch over the hole.
Previous Surgery and Mesh
Scar tissue inside the abdomen, old mesh, and the plane used for an earlier repair all influence which approach is safest. A hernia that came back after an open repair is often best reached from a fresh plane.
Skin and Wound Factors
Thin or damaged skin over the bulge, a history of wound infection, or infected old mesh may favor an open operation that can address those problems directly.
Your Health and Goals
Weight, smoking, diabetes, heart and lung health, and the work or activity you want to return to are weighed against the benefits of each approach.
Treatment Options
Open vs. Laparoscopic vs. Robotic Ventral Hernia Repair
All three approaches free the hernia, return its contents to the abdomen, and reinforce the wall. Mesh is used in nearly all adult ventral and incisional hernia repairs because it lowers the chance of the hernia returning. The approaches differ in where the surgeon works from and where the mesh can be placed.
| Feature | Robotic | Laparoscopic | Open |
|---|---|---|---|
| Incisions | A few small incisions away from the hernia | Three to five small incisions on the side | Over the hernia, often through the old scar |
| Mesh position | Within the wall, away from the intestine | Coated mesh against the inner abdominal wall | Between the layers of the wall |
| Often used for | Small to medium ventral and incisional hernias | Small and medium defects, little prior surgery | Very large defects, old mesh or excess skin |
| Key feature | Gap sewn closed from inside | Wide mesh overlap around the gap | Allows component separation reconstruction |
Typical patterns only. Dr. Shakir recommends an approach after your exam.
No approach is right for every hernia. For a broader comparison, read robotic vs. open hernia repair.
Mesh in Plain Language
Where the Mesh Goes: Onlay, Sublay, and Intraperitoneal
In abdominal wall repair, where the mesh sits matters as much as whether it is used. Picture the wall as layers from skin to intestines; the mesh can be placed at three main levels.
| Feature | Onlay | Sublay | Intraperitoneal |
|---|---|---|---|
| Location | On top of the muscle, under skin and fat | Within the wall, usually behind the rectus muscles | Inside the abdomen against the inner lining |
| Contact with bowel | Kept far from the bowel | Stays away from the intestine | Stays in contact with the intestines |
| Trade-offs | Linked to more fluid collections and recurrences | Strongest track record for durability | Needs coated mesh to limit sticking |
| Usual setting | Requires lifting a wide area of skin | Goal of most open and robotic repairs | Usual position in laparoscopic repair |
Typical patterns only. Dr. Shakir recommends an approach after your exam.
Closing the gap with sutures before placing mesh, rather than only bridging it, generally gives a stronger repair. Dr. Shakir explains the mesh type and position planned for your repair before surgery.
Complex Repairs
Abdominal Wall Reconstruction for Large Defects
When a defect is too wide to close directly, the abdominal wall muscles can be released from some of their attachments, a technique called component separation. This lets them slide toward the midline so they can be sutured together, restoring a working abdominal wall that is then reinforced with a large mesh.
These are planned operations with a hospital stay and a longer recovery. They are appropriate for large, recurrent, or multiply operated hernias, not for typical small or medium defects. Dr. Shakir’s fellowship training in complex abdominal surgery applies directly to this work. If your hernia has already been repaired once, see recurrent hernia repair and what to do when a hernia comes back.
After Surgery
Recovery After Ventral or Incisional Hernia Repair
Recovery depends mostly on the size of the repair. A minimally invasive repair of a small or medium hernia usually means a short stay and a few weeks of restrictions, while a large open reconstruction takes months for full core strength to return.
Small to Medium Minimally Invasive Repairs
Most patients go home the same day or after one night. Expect abdominal soreness and a bloated feeling for several days. Walking starts on day one, showering is usually allowed after 24 to 48 hours, and desk work is often possible within one to two weeks. Lifting is limited to about 10 to 15 pounds for four to six weeks.
Large Open Reconstructions
A hospital stay of two to five days is typical. Drains may be placed and removed at follow-up, and an abdominal binder is worn for support. Lifting restrictions commonly last six to eight weeks or longer, and core strength returns over several months.
Helping the Repair Heal
Walk several times a day, drink plenty of fluids, and eat enough fiber to avoid straining. Stay off nicotine, keep blood sugar controlled, and follow your lifting limits even when you feel well. Our post-operative care guide covers general instructions, and Dr. Shakir gives you the specific timeline for your operation. For more detail, see the hernia recovery guide and when you can work out after hernia surgery.
Risks and Recurrence
Risks, Complications, and Recurrence
Ventral and incisional hernia repair is generally safe, but it carries more risk than a simple groin repair, and the risk rises with the size of the hernia and the patient’s health conditions. Before surgery, Dr. Shakir goes over the risks that apply in your situation. Possible complications include:
- A seroma, a fluid collection over the repair that usually settles on its own
- Wound infection or slow skin healing, more likely with smoking, diabetes, or obesity
- Bleeding or bruising
- Mesh infection, which is uncommon but may require removing the mesh
- Slow return of bowel function for a few days
- Injury to the intestine, which is rare
- Breathing problems, blood clots, or reactions to anesthesia
- Long-lasting pain at the repair
- Return of the hernia (recurrence)
Can a Repaired Ventral Hernia Come Back?
It can. Ventral and incisional hernias recur more often than groin hernias, especially when the defect was large, when the mesh was small or placed on top of the muscle, or when the patient smokes, carries significant excess weight, or has diabetes.
Three things lower the risk: closing the defect rather than only bridging it, placing mesh with wide overlap in the retromuscular position, and addressing weight, smoking, and blood sugar before surgery. Dr. Shakir builds all three into the plan whenever the situation allows.
When to Call the Office After Surgery
Call the office for a fever, spreading redness, warmth, or drainage at an incision, pain that is worsening instead of improving, or a new bulge at the repair. For severe pain, repeated vomiting, or trouble breathing, call 911.
Why Choose Us
Why Choose Surgical Associates of Southern Texas for Ventral & Incisional Hernia Repair?
Dr. Murtaza Shakir is board certified in General Surgery and Complex General Surgical Oncology and repairs ventral and incisional hernias, from small defects to large reconstructions.
- Robotic repair of small defects to open reconstruction
- CT-based planning that maps the defect before surgery
- Open, laparoscopic and robotic techniques matched to your history
- Mesh type, position and recovery explained before you decide
- Consultations and follow-up in Katy and Sugar Land
Insurance Coverage
Insurance for Ventral & Incisional Hernia Repair
Surgical Associates of Southern Texas accepts many major insurance plans for ventral and incisional hernia evaluation and surgery, including participating Aetna, Cigna, UnitedHealthcare, and Blue Cross Blue Shield plans. Our office can confirm whether your specific plan participates and whether a referral or prior authorization is needed before your visit.
Coverage, network participation, authorization requirements, and your share of the cost vary by plan. You can also review the insurance accepted for surgical care at our practice.
Aetna, Cigna, UnitedHealthcare, and Blue Cross Blue Shield are only some of the plans we accept. Plan-specific details are on our Aetna, Cigna, UnitedHealthcare, and Blue Cross Blue Shield pages. If your plan is not listed, contact our office and our team will help verify it.
Insurance participation and benefits vary by individual plan. Verification does not guarantee coverage, authorization or payment. Please contact our office and your insurer to verify benefits before treatment.
Our Locations
Two Convenient Fort Bend County Offices
Learn more about our Katy and Sugar Land practices, or view all locations.
Katy Office
410 W Grand Pkwy S, Suite 4D
Katy, TX 77494
Serves: Katy, Fulshear, Richmond, Cinco Ranch and West Houston
Sugar Land Office
17510 W Grand Pkwy S, Suite 320
Sugar Land, TX 77479
Serves: Sugar Land, Richmond, Stafford, Missouri City, Fort Bend County and Southwest Houston
Approximate Drive Times
From West Houston (Energy Corridor): about 15 minutes to Katy, or 25 to 30 minutes to Sugar Land.
From North Houston: about 40 to 50 minutes to either office, depending on traffic.
Common Questions
Frequently Asked Questions About Ventral & Incisional Hernia Repair
What is the difference between a ventral and an incisional hernia?
Ventral hernia is the general term for any hernia through the front abdominal wall outside the groin. An incisional hernia is a ventral hernia that forms in the scar of a previous operation.
Why did I get a hernia after abdominal surgery?
A healed incision is never as strong as the original abdominal wall. Infection, obesity, smoking, diabetes, steroid use, or strain while the scar was healing can weaken it further, so a hernia can appear months or years later.
Can an incisional hernia get bigger?
Yes. Incisional hernias usually enlarge as the gap stretches, which makes the repair more complex. Early evaluation gives you more options.
What is an epigastric hernia?
An epigastric hernia is a small gap in the midline between the breastbone and the belly button, usually containing a small knob of fat. It can be tender despite its size and is repaired the same way as other small ventral hernias.
Is diastasis recti a hernia?
No. Diastasis recti is a widening of the midline seam without a hole, so it does not trap intestine. It can occur alongside an epigastric or umbilical hernia, which may change how the repair is planned.
Can a ventral hernia be left alone?
A small, painless ventral hernia is sometimes observed in a patient with high surgical risk. Most symptomatic or enlarging hernias are better repaired electively, because they tend to grow and emergency repair of a trapped hernia is a harder operation.
Can a ventral hernia be repaired robotically?
Yes. Robotic repair is well suited to small and medium ventral and incisional hernias, allowing the gap to be closed and mesh placed within the abdominal wall through small incisions. Very large defects are usually repaired open.
Is mesh always used?
Almost always for adult ventral and incisional hernias, because mesh substantially lowers recurrence. Where the mesh sits, ideally behind the rectus muscles, matters as much as the mesh itself.
How long is recovery after ventral hernia repair?
After a minimally invasive repair of a small or medium defect, desk work is usually possible in one to two weeks, with lifting restricted for four to six weeks. After a large open reconstruction, expect a hospital stay of several days and lifting restrictions of six to eight weeks or more.
Can a ventral hernia come back after repair?
Yes. Ventral and incisional hernias recur more often than groin hernias. Closing the defect, placing mesh with wide overlap behind the muscles, and controlling weight, smoking, and blood sugar all lower the risk.
Sources and references
- Ventral hernia repair, MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine
- Ventral Hernia Repair Surgery: Patient Information, Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)
- Midline incisional hernia guidelines: the European Hernia Society, Sanders DL et al., British Journal of Surgery, 2023
- Ventral Hernia, Smith J, Parmely JD, StatPearls, National Library of Medicine
- Diastasis recti, MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine
Reviewed by the Review Team at Surgical Associates of Southern Texas.
Medical Disclaimer: This page provides general information and is not a substitute for medical advice. For a painful, hard, or discolored abdominal bulge, severe abdominal pain, vomiting, or other emergencies, call 911 or go to the nearest emergency room. Last updated October 16, 2026.
Schedule a Ventral or Incisional Hernia Consultation
Have a bulge on your abdomen or along a surgical scar? Schedule an evaluation with Dr. Murtaza Shakir to learn how large the defect is, whether to repair it now, and which technique and mesh position fit. Offices in Katy and Sugar Land serve Richmond, Fulshear and Greater Houston.
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