A hernia is a defect in the muscle lining of the abdomen that allows abdominal contents to bulge through. These defects may be congenital or at the site of a previous surgery.
A ventral hernia is one that occurs on the front wall of the abdomen. A hernia in the belly button or an umbilical hernia is a type of a ventral hernia.
Many ventral hernias occur after a prior abdominal operation. When surgery is done on the abdomen, the muscles and their outer covering (fascia) are sewn back together with strong suture. The suture’s job is to hold things together until the body can heal them in place. Sometimes this healing process leaves weak areas along the old incision that, over time, develop into hernias.
Hernias will not go away without surgical repair.
Patients will typically notice a bulge or swelling in the area of the hernia. A ventral hernia can cause pain, bloating, or bowel obstruction. The pain may worsen with straining or coughing.
If the skin overlying a hernia becomes red and extremely painful, you should seek immediate medical attention. This may represent a surgical emergency. Many ventral hernias can be diagnosed by a thorough history and physical exam. Occasionally an ultrasound, computed tomogram (CT scan), or MRI is needed to confirm the diagnosis or identify bowel or internal organs within the hernia.
Your SCOSA surgeon will discuss the potential repair of your hernia at your appointment.
Traditionally, these hernias have been repaired by re-opening the old incision and re-closing the abdominal muscles with the aid of a prosthetic mesh. With this type of repair, patients typically spend five to six days in the hospital and can usually return to normal activity in six to eight weeks. The laparoscopic repair is done from the inside using tiny incisions and a camera. A piece of prosthetic mesh is placed to cover the defect and secured with strong sutures and special tacks. The post- operative recovery is much shorter with this procedure. Some patients go home the same day as surgery and patients with more extensive hernias can spend 1-3 days in the hospital. Laparoscopic surgery normally means less pain, a shorter hospital stay, a faster return to your day-to-day life, and an improved cosmetic result.
Before and After
Your SCOSA surgeon will review with you the risks and benefits of the procedure at your clinic appointment. You will be sent for some routine lab work, X-rays, and an EKG. In addition, your SCOSA surgeon will set up any further testing required before surgery.
On the day before surgery
You should have nothing to eat or drink after midnight with the exception of some medications. You may be asked to complete a bowel preparation to minimize you chances of infection. This will be explained by your SCOSA surgeon. You should shower the day before or the morning of your operation.
Medications such as aspirin, coumadin, or other blood-thinning agents should be stopped at least seven days prior to surgery. Vitamin E, diet medications and St. John’s Wort should also be stopped at least one week prior to surgery.
Please go over any specific questions with your SCOSA surgeon.
Some patients with ventral hernias are encouraged to lose some weight pre-op, so there will be less strain on the repair and better chance for a good result.
Patients are encouraged to stop smoking and begin an exercise program in advance of any operation.The day of operation
Your SCOSA doctor will give you detailed instructions about where and when you should be the morning of your surgery.
Once you arrive at the hospital, a nurse will start an IV, and you will meet with your anesthesiologist and your SCOSA surgeon to answer any last-minute questions. You will likely receive some pre-operative medications and then be taken to the operating room.
After surgery, you will be in the recovery room until you are completely awake.
Your room will include a breathing device called an incentive spirometer. It is important that you use this several times each hour when you are awake. The nurses on the floor will give you specific instructions about its use. In addition, it is important that you get out of bed and walk in the hall. We like our patients to do this at least once the afternoon after surgery and then at least four times each following day. These activities are vitally important to prevent a blood clot from forming in your legs, pulmonary embolism, breathing problems, and pneumonia.
After-effects of surgery
You should follow up with your SCOSA surgeon two weeks after the operation.
The long-term recurrence rate with the laparoscopic repair is not yet known. Although this operation is very safe and has a less than 1 percent mortality rate, this is an important decision for you and your physician. Potential acute complications are rare, but can include bleeding, infection, damage to stomach, esophagus, spleen or other internal organs. Other less common risks are new or recurrent hernia, wound problems, need for open surgery or re-operation.
Some patients will develop a fluid collection or swelling in the area of the hernia. This is the result of fluid build-up in the empty space that used to be occupied by the hernia. In most cases, this will resolve without treatment in a few weeks. Your surgeon may elect to aspirate the fluid with a needle or place a small drain if it does not go away on its own. You should call your SCOSA surgeon immediately if you experience any of the following after this procedure: persistent fever of more than 101 degrees, persistent nausea or vomiting; worsening abdominal pain- uncontrolled by medication; increasing abdominal swelling; chest pain; shortness of breath; redness around or pus coming from incisions; or the inability to tolerate liquids.
Patients usually return to normal activity in one to two weeks.