Ventral Abdominal Hernia Repair

What is a ventral hernia?

Weakness in the abdominal wall can cause the internal organs to push out, forming a bulge. This condition is called a hernia. A ventral hernia is a condition wherein the abdominal wall bulges out due to weakness in the muscles of the abdomen, causing pain and other complications. A ventral hernia most commonly occurs at the midline, but can also be found on any other area of the abdomen.

What are the different types of ventral hernias?

Ventral hernias can be of different types depending on the location of the bulge.

Umbilical hernia: A bulge surrounding the belly button or navel
Incisional hernia: A bulge around or directly along a prior abdominal surgical incision
Hiatal hernia: A bulge in the upper region of the stomach
Epigastric hernia: A bulge above the navel

What are the causes of a ventral hernia?

A ventral hernia may develop at any stage of life. Sometimes, they form in infants, during or after pregnancy, or following a surgery. Ventral hernias are most commonly seen after open abdominal surgeries such as appendectomy. The risk of developing a ventral hernia increases if you are obese, have a history of hernias, have injuries to the bowel region, you begin heavy work relatively early after a surgery, have persistent coughing or develop an infection at the site of a surgical incision.

What are the signs and symptoms of a ventral hernia?

The most common symptom of a ventral hernia is sharp pain in the abdominal region that worsens with physical activities such as lifting heavy objects, coughing or during difficult bowel movements. Sometimes, the abdominal contents or intestines loop into the bulge and become trapped in the weakened muscle layer. If this occurs, the blood supply can get cut off, which may lead to death of the entrapped tissue. This is called strangulation and requires immediate medical attention. Vomiting and constipation, and discolouration of the bulge are common signs of strangulation. Other symptoms of a ventral hernia include bulging of the abdominal wall, accompanied by tenderness in the affected area, difficulty in standing up, pain while coughing and straining during bowel movements.

How is a ventral hernia diagnosed?

When you present to the clinic with severe abdominal pain, your doctor will conduct a medical history and physical examination of your abdomen. Your hernia pouch will be examined when you lie down and stand. Your doctor may try to push the bulge back inside your abdomen, and will ask you to cough to see if there is any change in the size of the bulge.

Your doctor may also order the following tests:

Blood tests: complete blood count test (red blood and white blood cell count) to check for infections
Ultrasound of the abdomen: to help your doctor determine the part of the abdomen protruding into the bulge
CT scan of the abdomen: to ascertain the presence of a hernia, its size and cause
Herniogram: A contrast dye is injected into the abdominal cavity, which will be viewed through X-ray images, confirming the presence of the hernia
Urinalysis: urine may be collected and tested to rule out other conditions like urinary tract infection

What are the consequences of not treating a ventral hernia?

Left untreated the herniated section of the intestine can get trapped and strangulated. With no blood supply, the tissue can get infected and die. This is a life-threatening situation and requires immediate attention. It can also put pressure on the neighbouring tissues, causing pain and swelling in the surrounding regions.

What are the options for ventral hernia treatment?

Small ventral hernias that do not cause any symptoms are usually not treated; your doctor may follow a wait-and-watch approach. Surgery is recommended for hernias that show symptoms, are enlarged and entrapped.

Am I a candidate for ventral hernia repair surgery?

Ventral hernia repair is indicated after a thorough examination of your condition. You may not be suitable for the following reasons:

Extensive previous abdominal surgery
Hernias located in difficult-to-reach regions

Suffering from an underlying medical condition

How do I prepare for ventral hernia surgery?

Before hernia repair, your physical and medical condition is thoroughly examined to ensure that you will be able to withstand the surgical procedure. You will be briefed about the entire procedure, along with the potential risks that the surgery may be associated with. Discuss all the medications that you take on a regular basis so your surgeon can advise you on those that you can take and those you should avoid. You are advised to stop smoking weeks before the surgery to avoid complications during the surgery.

You will be allowed to drink only clear liquids on the day before or several days before your surgery. You are instructed not to eat or drink anything the night before the surgery, except for your regular medication. Before the surgery, you will be given a cleansing solution to drink, which will help you completely empty and clean your colon.

How is ventral hernia repair surgery performed?

The commonly adopted surgical procedures are described below:

Open surgery

In this procedure, a large incision is made in the abdomen. The protruding tissue or organ is pushed back to its original position and sewed securely. A specially designed synthetic mesh patch is then sewn over the weakened area in the abdominal wall once the hernia is pushed back, to reinforce the abdominal wall, thereby reducing the risk of hernia recurrence.

Keyhole or laparoscopic surgery

In this procedure, your surgeon makes a few small incisions on your abdomen to insert the laparoscope (a slender viewing tube with an attached camera) and other surgical instruments. Carbon dioxide gas is introduced to help your surgeon view the surgical site more clearly. Images captured by the laparoscope on a video monitor guide your surgeon through the surgery. Your surgeon separates the hernia sac from the surrounding tissues. The other surgical instruments inserted along with the laparoscope are used to push the organs back into their original position. A special mesh is secured by sutures, staples or tacks behind the abdominal muscles, to reinforce the abdominal wall and minimise the risk of hernia recurrence.

What can I expect after ventral hernia surgery?

Following ventral hernia surgery, you may experience mild to moderate discomfort. Your surgeon will prescribe pain medication to keep you comfortable.

What are the benefits of ventral hernia surgery?

Surgery is the only means to repair a ventral hernia. Further, laparoscopic ventral hernia surgery has the below benefits when compared to an open approach.

Shorter hospital stay
Faster recovery
Smaller scars
Less postoperative pain
Less wound infection
Faster return to regular diet

Describe the stages of recovery and care.

After ventral hernia surgery, you will be able to go home on the same day or after 2-4 days, depending on the complexity of the surgery performed. Once you go home, you are encouraged to perform light activities while at home after surgery. Avoid lifting very heavy weights and engaging in physical exertion for 4-6 weeks after surgery. You will soon be able to resume normal activities such as showering, taking the stairs, driving and sexual intercourse.

Sometimes a lump or swelling may form at the region of the hernia. This will subside on its own or your surgeon can aspirate it with a needle.

What are the outcomes of ventral hernia surgery?

Ventral hernia surgery is associated with less chances of recurrence. You can also avoid another hernia by eating a healthy diet and exercising.

However, as with all surgical procedures, ventral hernia surgery may be associated with certain complications such as infections, bleeding, breathing problems and heart problems.

How long will I be off work?

You will be able to return to work after 2-3 days.

What is my post ventral hernia surgery recovery and care plan?

Your doctor will encourage you to eat a diet rich in fibre so that your bowels are not strained. Call your doctor immediately if you experience fever, chills, drainage from your incisions, prolonged soreness with no pain relief even with the prescribed medication, vomiting or you are unable to urinate.

What is the cost of the procedure?

We will provide you with a full explanation of the costs of the operation to assist you in your decision to proceed. The costs will vary depending on your level of private health insurance.

What are the current research regarding ventral hernia surgery?

Ongoing research on laparoscopic cholecystectomy include:

Ahonen-Siirtola M, Rautio T, Biancari F, Ohtonen P, Mäkelä J. Laparoscopic versus Hybrid Approach for Treatment of Incisional Ventral Hernia. Dig Surg. 2017 Apr 5. doi: 10.1159/000458713. [Epub ahead of print]
Picazo-Yeste J, Moreno-Sanz C, Sedano-Vizcaíno C, Morandeira-Rivas A, Sánchez-De Pedro F. Outcomes after laparoscopic ventral hernia repair: does the number of previous recurrences matter? A prospective study. Surg Endosc. 2017 Apr 3. doi: 10.1007/s00464-017-5510-4. [Epub ahead of print]