Ventral Hernia

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What is a Ventral Hernia?

A ventral hernia is a condition where a gap or an opening forms in the abdominal fascia, the strong tissue that keeps muscles in place. This type of hernia is typically seen in the abdomen's midsection. In this area, which houses various organs including the intestines, the fascial layers might weaken, leading to the formation of a gap. Through this gap, the abdominal lining protrudes, creating a sac similar to a balloon, known as the hernia sac. When a loop of intestine or other tissue from the abdomen slips into this sac through the hernia's defect, it can cause discomfort, intense pain, or other severe issues necessitating urgent surgery.

Ventral hernias, occurring more commonly in men, can develop in different areas of the abdomen. Often, they are found where a surgical incision was previously made, but they can also occur at the navel or other abdominal locations. Unlike inguinal or femoral hernias, which are found in the groin area, ventral hernias are specific to the central part of the abdomen.

Over time, a hernia will not heal on its own and can enlarge. The only effective treatment for a hernia is surgery, although not every hernia necessitates repair.

Recognising a hernia

Identifying a ventral hernia typically involves noticing a bulge beneath the skin. You might also experience pain or discomfort in certain situations, such as when you:

- Lifting weighty objects
- Experiencing a cough
- During urination or bowel movements
- Remaining seated or standing for long durations

The pain linked with a hernia may present itself as a sudden, sharp sensation or evolve into a persistent dull ache that worsens as the day goes on. Occasionally, a hernia might be identified by a physician during a routine check-up.

When to Reach Out to Your Doctor:

It is important to be cautious as hernias can become hazardous if tissue gets caught inside. It is crucial to seek immediate medical care if you experience:

- Continuous, severe pain
- A bulge that is red, sensitive to the touch, or causes pain when pressed
- Feelings of nausea or instances of vomiting

Hernias are classified as either reducible, allowing the protruded tissue or organs to be pushed back into the abdomen, or incarcerated, where the tissue remains immobile and trapped in the hernia. A gradual incarceration might not be immediately concerning, but a sudden one, especially involving the bowel, can result in a bowel obstruction. In extreme situations, a hernia may lead to strangulation, where the bowel's blood supply is severed, risking the death of bowel tissue. This constitutes a medical emergency.

What can lead to a ventral hernia?

Hernias in the abdomen, specifically ventral hernias, often develop in parts of the abdominal area that are prone to weakness. The factors contributing to their formation include:

- Physical injury to the abdomen.
- Excessive body weight or obesity, which puts additional strain on abdominal tissues.
- A previous surgical incision in the abdomen, which inherently creates a zone of weakness. The likelihood of a hernia increases if the incision area had post-surgical infections. Hernias may manifest shortly after the surgery or even years later.

Hernias can occur in individuals of any age, though their incidence increases with age. Certain actions can heighten the risk of developing a hernia, such as persistent coughing, straining during urination or bowel movements, or other instances that require straining.

What is Ventral Hernia Repair?

The surgical procedure to fix a ventral hernia involves your doctor stitching the tissue back together and closing the gap. In some cases, they might use mesh for added strength. This surgery can be performed in two distinct methods: through a single large incision, known as "open" surgery, or through several small incisions, a technique called laparoscopic surgery. Laparoscopic ventral hernia repair is a form of minimally invasive surgery, often resulting in faster recovery and reduced pain for the patient compared to traditional open surgery.

Advantages of laparoscopic vs open surgery:

Minimally invasive ventral hernia repair (laparoscopic), compared to open surgery, offers several advantages:

- Reduced hospital stay duration
- Lesser pain post-surgery
- Quicker resumption of work and daily activities
- Smaller incisions leading to less noticeable scarring
- Lower risk of infections and complications during recovery

However, surgical outcomes may vary based on individual health and the specific surgical procedure.

Considering laparoscopic ventral hernia surgery?

This option has numerous benefits but may not be suitable if:

- You have had prior abdominal surgeries
- The hernia's location makes surgery more complex
- You have certain health conditions

A comprehensive physical examination by a surgeon skilled in minimally invasive hernia repair is crucial. An experienced surgeon, in conjunction with your primary care provider, will help determine if this surgery is the right choice for you.

Preparation for Ventral Hernia Repair:

Thorough physical examination: Pre-surgery tests like an EKG, blood tests, and X-rays may be required to ensure you're fit for surgery.
Discuss the surgery's risks and benefits with the performing doctor. Follow the specific pre-surgery instructions provided by your doctor’s office, which can vary but typically include:
- - Lifestyle Adjustments: Quit smoking to reduce the risk of hernia recurrence and infection.
- - Medication Adjustments: Stop certain medications like aspirin, blood thinners, supplements such as Vitamin E, diet medications, and St. John’s wort as advised by your surgeon.
- - Hygiene: Bathe with antibiotic soap as instructed on the night before or the morning of the surgery.
- - Fasting: doing this for a specified period before surgery may include consuming a cleansing solution or sticking to clear liquids.
- - Medications: Take only approved medications with a small sip of water on the morning of your surgery.

3. Returning Home: Depending on the complexity of the hernia repair, you might return home the same day or require a hospital stay.

4. Post-surgery assistance: Coordinate with your doctor or nurse to understand the level of help needed after discharge. If required, consult a hospital or clinic social worker to arrange for caregiving support in your area.

About the Surgery:

The process of minimally invasive ventral hernia repair typically begins with your arrival at the hospital on the day of the operation. Upon arrival, a healthcare professional will set up an intravenous (IV) line to administer anesthesia, various medications, and fluids during the surgery. You might receive certain medications, like antibiotics, before the surgery commences. General anesthesia is commonly used for this procedure, ensuring you are asleep and unaware during the surgery.

The actual surgical process involves several steps:

Making the Initial Incision: Your surgeon starts by making a small incision in the abdomen. Through this incision, they insert a thin tube-like device known as a port.
Inserting the Laparoscope: Through the port, the surgeon then inserts a laparoscope, a small camera that transmits images to a screen in the operating room, allowing the surgeon to view the surgical area.
Additional Ports and Instruments: The surgeon makes more incisions, usually ranging between three to five, each being about a quarter to a half-inch long. Through these additional ports, long, narrow surgical instruments are inserted into the abdomen.
Repairing the Hernia: The surgeon then proceeds to repair the hernia. This may involve stitching the hernia defect closed. In many cases, the surgeon also places a mesh patch over the area to strengthen the repair and reduce the risk of recurrence.

The minimally invasive approach, involving smaller incisions, typically leads to a faster recovery, less postoperative pain, and smaller scars compared to traditional open surgery.

Who is a Suitable Candidate for Laparoscopic Ventral Hernia Repair?

Whether you are a candidate for minimally invasive ventral hernia repair depends on several factors, and in some cases, a surgeon may need to switch to open surgery during the procedure. Factors influencing the decision or necessitating a switch to open surgery include:

- Previous Abdominal Surgery: Extensive scar tissue from prior abdominal surgeries can complicate the minimally invasive approach.
- Intraoperative Bleeding: Should bleeding issues arise during the surgery, open surgery may be chosen for better management and control.
- Injury: if there's accidental damage to the bowel, intestines, or any other organ, this might lead to a switch from minimally invasive to open surgical procedures.
- Size of the Hernia: If the hernia is too small or too large for minimally invasive techniques, open surgery might be the more appropriate choice.
- Limited Visibility: In cases where the laparoscope doesn't provide sufficient visibility for the surgeon, open surgery can be a more viable option.
- Excessive Body Weight: Being significantly overweight may pose challenges for laparoscopic surgery, making open surgery a preferable alternative.

When considering this surgery, discussing your surgeon's experience in both minimally invasive and open hernia repairs is vital. This conversation should include a comparison of the risks of surgery versus the risks of non-treatment.

Complications:

Minimally invasive ventral hernia repair is generally safe, but as with any surgical procedure, there are potential complications, both during and after the surgery. These complications might include:

Bleeding: The possibility of internal or external bleeding following the surgery.
Pneumonia: A lung infection that could develop post-operatively.
Adverse Reaction to Anesthesia: Complications arising from the anesthesia used during the operation.
Organ Damage: Potential injury to nearby organs like the bowel or intestines during the surgery.
Blood Clots: The formation of clots which could pose serious health risks.
Heart-Related Issues: Emergence of complications related to the heart.

There might be swelling or a lump formation at the hernia site, often attributed to fluid accumulation beneath the skin. This usually resolves on its own over time. If it persists, however, medical intervention such as fluid aspiration by your doctor may be necessary.

Your surgeon will provide a detailed discussion about these potential risks and help you weigh the benefits of the surgery against these risks, ensuring an informed decision-making process.

In cases where the surgical mesh gets infected, removal or replacement by your doctor might be necessary.

It is important to note that hernias can recur after repair. To enhance the success rate of the surgery in the long term, maintaining a healthy weight and avoiding smoking are beneficial.

For assurance, discuss with your doctor their expertise in both minimally invasive and open techniques for ventral hernia repair. It is also crucial to compare the risks of undergoing surgery with the potential risks of opting out of treatment.

Post-Surgery Expectations and Guidelines

After your minimally invasive ventral hernia repair, you will be taken to the post-operative care area. Here, healthcare professionals will monitor you for a few hours until you are fully awake.

Depending on the complexity of your surgery and your overall health, you may be able to go home the same day or you might need to stay in the hospital overnight or for a longer period.

Pain Levels and Medications:

It is common to experience discomfort after hernia repairs, and this varies in intensity based on the type and location of the surgery. You can take over-the-counter pain medications unless your doctor advises against it. Acetaminophen (Tylenol®) and ibuprofen (Advil®) are examples of such medications. Applying ice to your incision sites can also be helpful. Make sure to ask your doctor or nurse about the correct way to use ice.

Note: If the prescription pain medication does not alleviate your pain, it is important to contact your doctor’s office.

Activities Post-Surgery:

You should be able to stand and move around at your home after the surgery. Your doctor will provide specific instructions regarding how active you should be, including limitations on lifting weights and other physical activities. Following your doctor's advice carefully is crucial.

Most patients are able to resume their normal activities relatively quickly after surgery. This includes activities like taking showers, driving, climbing stairs, working, and engaging in sexual activities. However, you should consult your doctor for advice specific to your situation, especially regarding work and physical activities.

Follow-Up Appointment:

Discuss with your doctor the best time for a follow-up visit after your hernia surgery. This visit is usually scheduled for 1 to 4 weeks after the operation.

Important Note: The above information is not a substitute for a thorough discussion with your surgeon regarding ventral hernia repair surgery.

If you have inquiries about the appropriateness of a ventral hernia repair surgery for your situation, alternative options, billing, insurance coverage, or your surgeon's qualifications and expertise, please feel free to contact us.

Should you have any questions pertaining to the surgical procedure or post-operative care, it is advisable to engage in discussions with your surgeon either prior to or following the operation.