Ventral / Umbilical Hernia Repair

A ventral hernia usually arises in the abdominal wall where a previous surgical incision was made. In this area the abdominal muscles have weakened; this results in a bulge or a tear. 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 contents 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. Other sites that ventral hernias can develop are the belly button (umbilicus) or any other area of the abdominal wall. A hernia does not get better over time, nor will it go away by itself.

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.

An incision in your abdominal wall will always be an area of potential weakness. Hernias can develop at these sites due to heavy straining, aging, injury or following an infection at that site following 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. They are more common as we get older. Certain activities may increase the likelihood of a hernia including persistent coughing, difficulty with bowel movements or urination, or frequent need for straining.

Results may vary depending on the type of procedure and each patient’s overall condition. Common advantages include less post-operative pain, shortened hospital stay, faster return to regular diet and quicker return to normal activity.

Only after a thorough examination can your surgeon determine whether a laparoscopic ventral hernia repair is right for you. The procedure may not be best for some patients who have had extensive previous abdominal surgery, hernias found in unusual or difficult to approach locations, or underlying medical conditions. Be sure to consult your physician about your specific case.

Most hernia operations are performed on an inpatient basis, and you will probably go home on the same or following day. Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition. After Dr Simmons 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 or morning of the operation. After 22:00 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, or clear fluids as instructed by your surgeon. Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and vitamin E will need to be stopped temporarily for several days to a week prior to surgery. Quit smoking and arrange for any help you may need at home.

There are few options available for a patient with a ventral hernia. The use of an abdominal wall binder is occasionally prescribed but often ineffective. Surgery is the preferred treatment and is done in one of two ways:

• 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 in or on the abdominal wall for a sound closure. This technique is most often performed under a general anaesthetic but in certain situations may be done under spinal anaesthesia. Your surgeon will help you select the anaesthesia that is best for you.
• 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 port (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. This mesh is fixed under the hernia defect to the strong tissues of the abdominal wall. It is held in place with special surgical tacks and in many instances, sutures. Usually, three or four 5mm to 10mm 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 usually performed under general anaesthesia.

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 obesity, 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 Dr Simmons either before or during the actual operation. When Dr Simmons 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.

Hernia repair is a major abdominal operation and a certain amount of postoperative pain occurs. Nausea and vomiting are not uncommon. Once liquids or a diet is tolerated, patients leave the hospital the same day or day following the laparoscopic gallbladder surgery. Activity is dependent on how the patient feels. Walking is encouraged. Patients can shower the day after the operation. Patients will probably be able to return to normal activities within two weeks’ time, including exercise, walking upstairs, light lifting and working. In general, recovery should be progressive, once the patient is at home. Most patients can return to work within seven days following the laparoscopic procedure depending on the nature of your job. Patients with administrative or desk jobs usually return in a few days while those involved in manual labour or heavy lifting may require a bit more time. Patients undergoing the open procedure usually resume normal activities in four to six weeks. 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 by itself. If not, your surgeon may aspirate this with a needle in the office. Make an appointment with Dr Simmons within two weeks following your operation for wound inspection and stitch removal.

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 anaesthesia, bleeding, or injury to the intestines or other abdominal organs. If an infection occurs in the mesh, it may need to be removed or replaced. Other possible problems include pneumonia, blood clots or heart problems if someone is prone to them. 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 standard or traditional approach. Dr Simmons 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 Dr Simmons about his training and experience.

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

• Persistent fever over 39°C
• Bleeding
• Increasing abdominal swelling
• Pain that is not relieved by your medications
• Persistent nausea or vomiting
• Chills
• Persistent cough or shortness of breath
• Purulent drainage (pus) from any incision,
• redness surrounding any of your incisions that is worsening or getting bigger.
• You are unable to eat or drink liquids