Ventral Hernia Repair Surgery

Ventral Hernia Repair Surgery

Approximately 350,000-500,000 ventral hernia repairs are performed each year in the United States. Many are performed by the conventional “open” method. Dr. Schumacher has been performing laparoscopic ventral hernias since 1993. This document can help you understand what a hernia is and more about the treatment.

Laparoscopic ventral hernia repair is a technique to fix tears or openings in the abdominal wall using small incisions, laparoscopes (small lighted telescopes inserted into the abdomen) and a patch (screen or mesh) to reinforce the abdominal wall. It may offer a quicker return to work and normal activities with decreased pain for some patients.

About Hernias 

What is a Ventral Hernia?

When a ventral hernia occurs, it usually arises in the abdominal wall at a weak area of the abdomen. This typically is at the umbilicus or where a previous surgical incision has been made. In the same way that an inner tube pushes through a damaged tire, the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a balloon-like sac. This can allow a loop of intestines or other abdominal content to push into the sac. If the abdominal contents get stuck within the sac, they can become trapped or “incarcerated.” This could lead to potentially serious problems that might require emergency surgery. Once developed, a hernia does not get better over time, nor will it go away by itself. 

How Do I Know If I Have a Ventral Hernia? 

A hernia is usually recognized as a bulge under your skin. Occasionally, it causes no discomfort at all, but you may feel pain when you lift heavy objects, cough, strain during urination or bowel movements or with prolonged standing or sitting. 

The discomfort may be sharp or a dull ache that gets worse towards the end of the day. Any continuous or severe discomfort, redness, nausea or vomiting associated with the bulge are signs that the hernia may be entrapped or strangulated. These symptoms are cause for concern and immediate contact of your physician or surgeon is recommended. 

What Causes a Ventral Hernia? 

Abdominal hernias occur at weak areas of the abdominal wall. Typically, a prior incision causes the weakness and the abdominal wall does not completely heal. Hernias become more common as we age. Hernias can develop due to heavy straining, obesity, injury or following an infection at the incision site following a surgery. They can occur immediately following surgery or may not become apparent for years later following the procedure. Anyone can get a hernia at any age. Certain activities may increase the likelihood of a hernia including persistent coughing, lifting, difficulty with bowel movements or urination, or frequent need for straining. 

Laparoscopic Surgery 

What are the Advantages of Laparoscopic Ventral Hernia Repair? 

Results may vary depending on the type of procedure and each patient’s overall condition. Common advantages may include: 

Less post-operative pain 

Shortened hospital stay 

Faster return to regular diet 

Quicker return to normal activity 

Less wound infections 

How is Laparoscopic Ventral Hernia Repair Performed? 

There are a few options available for a patient with a ventral hernia. 

The use of an abdominal wall binder is occasionally prescribed but often ineffective. Ventral hernias do not go away on their own and may enlarge with time. Surgery is the preferred treatment and is done in one of two ways: 

1. The traditional approach or open approach is done through an incision in the abdominal wall. It may go through part or all of a previous incision, skin, an underlying fatty layer, and into the abdomen. The surgeon may choose to sew your natural tissue back together, but frequently, it requires the placement of mesh (screen) in or on the abdominal wall for a sound closure. This technique is most often performed under a general anesthetic but in certain situations may be done under local anesthesia with sedation or spinal anesthesia. Your surgeon will help you select the anesthesia that is best for you.

2. The second approach is a laparoscopic ventral hernia repair. In this approach, a laparoscope (a tiny telescope with a television camera attached) is inserted through a cannula (a small hollow tube). The laparoscope and TV camera allow the surgeon to view the hernia from the inside. Other small incisions will be required for other small cannulas for placement of other instruments to remove any scar tissue and to insert a surgical mesh into the abdomen. There are several different approaches from repairing the hernia with sutures, placing a portion of mesh to bridge the defect, under a primary repair or under the first layer of fascia. Your surgeon will discuss his technique, its risks and benefits. Then mesh is used it is fixed to the strong tissues of the abdominal wall held in place with special surgical tacks and in many instances, sutures. Usually, three or four 1/4 inch to 1/2 inch incisions are necessary. The sutures, which go through the entire thickness of the abdominal wall, are placed through smaller incisions around the circumference of the mesh. This operation is performed under general anesthesia. 

What Happens if the Ventral Hernia Repair Cannot Be Performed or Completed by the Laparoscopic Method? 

In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the “open” procedure may include a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation. 

The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. The decision to convert to an open procedure is strictly based on patient safety. 

After surgery 

What Should I Expect after Ventral Hernia Surgery? 

Patients are encouraged to engage in light activity while at home after surgery. Your surgeon will determine the extent of activity, including lifting and other forms of physical exertion. Follow your surgeon’s advice carefully. 

Post-operative discomfort is usually mild to moderate. Frequently, patients will require pain medication. 

If you begin to have fever, chills, vomiting, are unable to urinate, or experience drainage from your incisions you should call your surgeon immediately. If you have prolonged soreness and are getting no relief from your prescribed pain medication, you should notify your surgeon. 

Most patients are able to get back to their normal activities in a short period of time. These activities include showering, driving, walking up stairs, work and sexual intercourse. 

Occasionally, patients develop a lump or some swelling in the area where their hernia had been. Frequently this is due to fluid collecting within the previous space of the hernia. Most often this will disappear on its own with time. If not, your surgeon may aspirate this with a needle in the office. 

You should ask your physician when you need to schedule a follow-up appointment. Typically, patients schedule follow-up appointments within 2-3 weeks after their operation. 

Complications

What Complications Can Occur? 

Although this operation is considered safe, complications may occur as they might occur with any operation, and you should consult your physician about your specific case. Complications during the operation may include adverse reactions to general anesthesia, bleeding, or injury to the intestines or other abdominal organs. Other possible problems include pneumonia, blood clots or heart problems. If an infection occurs in the mesh, it may need to be removed or replaced. Also, any time a hernia is repaired it can come back. 

The long-term recurrence rate is not yet known. The early results indicate that it is as good as the open approach. Your surgeon will help you decide if the risks of laparoscopic ventral hernia repair are less than the risks of leaving the condition untreated. 

It is important to remember that before undergoing any type of surgery, whether laparoscopic or traditional, you should ask your surgeon about his/her training and experience. 

When to Call Your Doctor 

Be sure to call your surgeon if you develop any of the following: 

Persistent fever over 101 F (39 C) 

Bleeding 

Increased abdominal swelling or pain 

Pain that is not relieved by your medications 

Persistent nausea or vomiting 

Chills 

Persistent cough or shortness of breath 

Drainage from any incision 

Redness surrounding your incisions