Laparoscopic Ventral Hernia Repair

Introduction

Approximately 90,000 ventral hernia repairs will be performed this year in the United States. Many are performed by the conventional "open" method. Some are performed laparoscopically. The following information can help you understand what a hernia is and more about the treatment.

Laparoscopic hernia repair is a technique to fix tears or openings in the abdominal wall using small incisions, laparoscopes (small 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.

What Is A Ventral Hernia?

• When a ventral hernia occurs, it 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. 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 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

How Do I Know If I Have A 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, and 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

Why Do People Get Ventral Hernias?

• An incision in your abdominal wall will always be an area of potential weakness. Hernias can develop at these sites due to obesity, 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

Treatment Options For A Ventral Hernia

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
• 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

The traditional approach is done through an incision in the abdominal wall. It may go through part or all of a previous incision, skin, subcutaneous 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.

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 extra cannulas for placement of other instruments to remove any scar tissue and to insert a surgical mesh into the abdomen. This mesh, or screen, 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 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 usually performed under general anesthesia.

The Advantages Of The Laparoscopic Repair

he 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

Who Is A Candidate For The Laparoscopic Repair?

fter a thorough examination, then, only 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.

Complications Of Laparoscopic Hernia Repair

• Although this operation is considered safe, complications may occur as they might occur with any operation. Complications during the operation may include adverse reactions to general anesthesia, 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
• Your surgeon will help you decide if the risks of laparoscopic ventral hernia repair are less than the risks of leaving the condition untreated

Conversion Of Laparoscopic Operation To Open Operation

n a small number of patients the laparoscopic method is not feasible because of the inability to visualize or handle the organs effectively. In these cases, your surgeon will convert to an open repair. Factors that may increase the possibility of converting to the open procedure may include finding extremely dense scar tissue, obesity, bleeding problems during the operation, or an injury to the intestine or other abdominal tissues. The decision to perform the open procedure is a judgment decision made by your surgeon before or during the actual operation. The decision to convert to an open procedure is based on patient safety. The decision to convert does not necessarily indicate that a complication has occurred.

Preparations Prior To Laparoscopic Ventral Hernia Repair

eeting with your surgeon will include a discussion of your prior surgical and medical history. A thorough examination will be required and possibly some blood tests and X-rays, also. Depending on your particular medical condition, further or more extensive testing of lung or heart function may be required. The following list includes typical preparations for this surgery.

• Your surgeon will review with you the techniques of the operation, the benefits, the risks and the possible need for performing this operation in the traditional manner
• You may need to completely empty your colon and cleanse your intestines prior to surgery. It may be necessary for you to be on a clear liquid diet for one or several days prior to surgery. Our staff will inform you if that is needed in your case
• It is advised that you shower the night before or morning of the operation
• The night before the operation, you should not eat or drink any food or liquid. You should discuss with your physicians what medications are permissible the morning of surgery
• Typically, drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and large doses of Vitamin E may need to be temporarily stopped for several days to a week before your surgery. Similarly natural supplements or herbs e.g. St John’s wort, ginsung, biloba etc need to be stopped for a week before surgery because they can interfere with anesthesia or cause excessive bleeding

What Should I Expect The Day Of 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
• Few patients may go home the same day of surgery, while others may need admission for a day or more post-operatively. The need to stay in the hospital will be determined according to the extent of the operative procedure and your general health

What Should I Expect After Surgery?

• Patients are encouraged to engage in light activity while at home after surgery. You should avoid lifting anything heavier than 10 lbs for 4 weeks after laparoscopic and 6 weeks after open repair of ventral hernia
• Post-operative discomfort is usually mild to moderate. Frequently, patients will require pain medication
• Most patients are able to get back to normal activities in a short period of time. These activities include showering, driving, walking up stairs, lifting, 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
• Typically, patients call to schedule follow-up appointments within 2-3 weeks after their operation

When To Call Our Office?

f you develop any of the following, be sure to call our office at (814) 877-6997 during business hours (9am-5pm Monday-Friday)

• Persistent fever (over 100°F)
• Bleeding
• Increased abdominal swelling or pain
• Persistent nausea or vomiting
• Chills
• Persistent cough or shortness of breath
• Drainage from any incision
• Redness surrounding your incisions
• Unable to urinate
• If you have prolonged soreness and are getting no relief from your prescribed pain medication

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