How can I counsel patients regarding the risks and benefits of surgical versus conservative management for incisional hernias?

Counseling patients on surgical versus conservative management for incisional hernias involves explaining the benefits and risks of each approach to support informed decision-making.

Conservative management may be appropriate for patients with minimal symptoms or those who decline surgery. It avoids surgical risks but may not resolve the hernia or prevent progression.

Surgical management offers definitive repair and symptom relief but carries risks such as infection, recurrence, and complications related to anaesthesia and the surgical procedure itself.

When discussing surgery, explain the type of procedure, expected recovery time, potential complications including recurrence, and the possibility of long-term adverse effects. Use decision aids where available to facilitate shared decision-making.

Patients should be informed that surgery is generally offered when symptoms are significant or conservative management has failed, and that the choice depends on individual factors including hernia size, symptoms, comorbidities, and patient preference.

Follow-up after surgery is important to monitor for recurrence or complications.

Although the provided guideline context focuses on pelvic organ prolapse and mesh-related surgery, the principles of counseling about surgical versus conservative management, including discussing benefits, risks, uncertainties, and using decision aids, are applicable to incisional hernia management as well ¹.