What is a Ventral Hernia?
- A ventral or abdominal wall hernia occurs when a defect develops in the muscles of the abdominal wall. This small opening may happen as a result of an injury, or it may occur at the site of a previous surgical incision. The injury or incision causes a weak spot in the abdominal muscle and this weakness causes a tear or opening. Then, the inner lining of the abdomen protrudes through the opening to form a bubble or balloon-like pouch.
- Sometimes a section of the intestines or other contents of the abdomen may also protrude into this pouch. If the bowel or other abdominal contents protrude and become lodged there, they can become stuck or “incarcerated.” This can escalate into a very serious situation quickly and emergency surgery may be required.
- Ventral hernias may also develop at the belly button (umbilicus) or at any other area of the abdominal wall.
What Causes an Abdominal Wall Hernia?
- Hernias can develop in the as a result of heavy lifting or straining, aging, obesity, injury, or after an abdominal surgery. An infection at an abdominal surgical site may increase a patient’s risk for ventral hernia. The hernia may occur soon after surgery or it may not become noticeable until many years later.
- Hernias can happen at any age, but they are more common in older people. Certain activities such as persistent coughing and difficulty/straining with bowel movements may increase the likelihood of developing a hernia.
How Do I Know If I Have a Ventral Hernia?
- One of the main symptoms of a ventral hernia is a bulge under the skin. Some people do not notice any pain with an abdominal hernia but most do have some discomfort with coughing, prolonged periods of sitting or standing, lifting heavy objects, or straining in the bathroom.
- The pain may be either a dull or sharp ache that worsens as the day continues. Patients who also experience nausea, vomiting, redness at the bulge, and/or unrelenting or severe pain could have a strangulated intestine. If you are experiencing these symptoms, contact us immediately or go to the nearest emergency room.
How are Abdominal Hernias Repaired?
A hernia will not heal itself or improve over time. Some patients who do not experience pain can be fitted with a belt-like device that holds the opening in the abdomen closed. This device is only to prevent the hernia from strangulating and is not a cure. A ventral hernia must be repaired surgically using traditional open surgery or via laparoscopy. There are benefits to having the laparoscopic procedure but not every patient is a candidate.
The traditional 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.
Laparoscopic abdominal hernia repair is the second option. With this method, a laparoscope (a tiny telescope with a camera attached) is inserted through a cannula (a small hollow tube). The laparoscope and camera allow the surgeon to see the hernia from the inside.
A few additional small incisions are made to allow the surgeon to perform the procedure with very specialized instruments. Surgical mesh is used to repair the hernia. The stronger tissues of the abdominal wall around the hernia are secured to the mesh to make the repair. This operation is usually performed under general anesthesia.
What are the Advantages of Laparoscopic Ventral Hernia Repair?
There are many advantages to having a ventral hernia repaired laparoscopically. Common advantages include:
- Less post-operative pain;
- A Shorter stay in the hospital;
- A quicker return to your regular diet;
- Faster return to normal activity level; and
- Decreased risk of infection at the hernia site.
Results will vary depending on the type of procedure and each patient’s overall condition.
Am I a Candidate for Laparoscopic Abdominal Hernia Repair?
Your surgeon will examine you and then determine if laparoscopic ventral hernia repair is right for you. Some patients who have underlying medical conditions, who have had extensive abdominal surgery in the past or who have hernias in unusual or difficult to approach locations may not be suited for the laparoscopic procedure. Be sure to consult your physician about your specific case.
What Can I Expect Before Laparoscopic Ventral Hernia Repair?
- Before surgery, you will undergo some preoperative testing. This will likely include a medical evaluation, blood work, a chest x-ray and an EKG, depending on your age and medical condition.
- Many abdominal hernia procedures are performed on an outpatient basis. You may be able to go home on the day of your surgery, or the following day.
- More complex or recurrent hernia operations may require a longer hospital stay after surgery.
- After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
- It is recommended that you shower the night before and/or morning of the operation.
- Your surgeon my request that you completely empty your colon and cleanse your intestines before surgery. Usually, you must drink a special preparation to do this. You may be placed on a diet of clear liquids only, for one or several days before surgery.
- After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon has told you are permissible to take with a sip of water the morning of surgery.
- Your surgeon will ask you to stop taking certain medications, temporarily, for a week or two prior to surgery. These medications include blood thinners, anti-inflammatories, diet pills, St. John’s Wort and Vitamin E among others.
- Smoking is hazardous to your health. You will be advised or required to quit smoking prior to surgery.
- You must have a ride home from the facility after your procedure.
- Arrange for any help you may need at home.
What Should I Expect the Day of Hernia Repair Surgery?
- You usually arrive at the hospital the morning of the operation.
- A qualified medical staff member will typically place a small needle or catheter into your vein to dispense medication during the surgery. Often pre-operative medications, such as antibiotics, may be given.
- Your anesthesia will last during and up to several hours following surgery.
- Following the operation, you will be taken to the recovery room and remain there until you are fully awake.
- Many patients go home the same day of surgery, while others may need to be admitted to the hospital for a day or two. This will vary depending on the patient’s general health, the circumstances of their hernia and the type of repair procedure.
What Happens if the Hernia Can’t Be Repaired Laparoscopically?
Occasionally, a surgeon will encounter conditions during the procedure that make laparoscopy an unviable method to repair the hernia. This is more likely to happen if the patient is obese, has had a prior abdominal surgery, or has abdominal scar tissue. Other situations that make laparoscopy unworkable are if the surgeon is unable to visualize the organs or if there is unexpected bleeding during surgery.
In these cases, the surgeon may convert the procedure to an open hernia repair. This is a judgment call made by the surgeon in order to ensure that the patient remains safe and that the procedure is completed successfully.
What Should I Expect after Ventral Hernia Surgery?
- Patients are encouraged to engage in light activity while at home after surgery. Follow your surgeon’s instructions carefully regarding restrictions on lifting and other forms of exercise.
- Post-operative discomfort will be mild to moderate. Most patients will need pain medication.
- Call your surgeon immediately if you experience fever, chills, vomiting, if you are unable to urinate, or if you experience drainage from your incisions.
- If you have prolonged pain and get no relief from your prescribed pain medication, call your surgeon.
- Most patients are able to resume normal activities in a short period of time. This includes showering, driving, walking up stairs, work and sexual intercourse.
- Occasionally, patients may develop a lump or swelling where their hernia was. This is due the collection of fluid in the space occupied by the hernia. This will usually disappear on its own but if it does not, your surgeon can remove the fluid with a needle in the office.
- Schedule a follow-up appointment with your surgeon for 2-3 weeks after your procedure, or sooner if your doctor wishes.
What Complications Can Occur?
- Although this operation is considered safe, complications may occur as they might occur with any operation. Complications that can occur with any operation include adverse reactions to general anesthesia, bleeding, infection, pneumonia, blood clots or heart problems.
- Complications that may happen with hernia repair include injury to the intestines or other abdominal organs or a possible recurrence of the hernia.
- The long-term recurrence rate of hernias repaired laparoscopically is not yet known but early results indicate that it is at least 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.
- Before you have any type of surgery, interview your surgeon carefully to learn about their training and experience.
When to Call Your Doctor
Call your surgeon if you develop any of the following:
- Fever over 101 F (39 C)
- Increased abdominal pain or swelling
- Pain that is not relieved by your medications
- Persistent nausea or vomiting
- Persistent cough or shortness of breath
- Drainage from an incision
- Redness around an incision