Laparoscopic Ventral Hernia
Laparoscopic Ventral Hernia Repair
What is it?
A ventral or incisional hernia occurs when there is a weakening of muscle tissue in the abdominal wall which allows nearby tissues to "pouch" or bulge out into a small sack. This most commonly occurs at the site of a previous surgical incision, but may also appear primarily at the umbilicus (navel), the epigastrium (upper abdomen), or lateral to the rectus abdominus muscle (Spigelian).
What causes it?
Various factors may contribute to the formation of incisional hernias. These include diabetes, wound infections around the time of surgery, and the use of certain medications that affect normal wound healing such as steroids. Primary ventral hernias occur at sites of congenital abdominal wall weakness. Both types of ventral hernias may be further exacerbated by factors such as chronic cough, liver disease, obesity, or straining with bowel movements.
What are the Symptoms?
Some common symptoms include a bulge under the skin, pain when lifting, coughing, straining during a bowel movement or urination and prolonged standing or sitting. It is important to note that hernias cannot improve by themselves and usually require surgery. Surgical repair may or may not prevent a hernia from recurring. Hernia-like symptoms should not be ignored but addressed immediately, as they may develop into more serious problems requiring emergency surgery. Hernia contents may become stuck outside the abdomen, a condition which may develop into a surgical emergency if intestines become entrapped with resultant blockage or even death of tissue.
How is it Diagnosed?
Hernias are usually diagnosed on physical exam, although diagnostic imaging techniques such as CT scan or MRI may be utilized to diagnose small hernias or to aid in preoperative planning.
Treatment Options
Very small hernias may be repaired by suturing the tissue edges of the defect together, but with larger hernias (>2cm) this approach is associated with a very high rate of recurrence (10-40%). For hernias such as these, repair involves the suturing of a patch of surgical mesh to the weakened area in a tension-free manner. This may be performed through a traditional incision, but more commonly a laparoscopic approach is taken.
A laparoscopic hernia repair is a minimally invasive approach that involves specialized video equipment and instruments that allow a surgeon to repair the weakened area through several tiny incisions, most of which are less than a half-centimeter in size. The advantages of this method include a brief hospitalization (it may be performed as an outpatient operation), less pain, fewer and smaller scars, and a shorter recovery.
Laparoscopic hernia repair is a safe and effective treatment for hernias. However, in the presence of infection, adhesions, or variations in anatomy, this method becomes dangerous and your surgeon may need to make the prudent decision to continue by making the traditional incision to safely complete the operation. This should not be seen as a failure, but as a wise decision by your surgeon to prevent dangerous complications.
Other complications, although rare, include bleeding and infection. It is extremely uncommon to require a blood transfusion for this operation. There is a slight risk of injury to the urinary bladder, the intestines, blood vessels, nerves or the sperm tube going to the testicle.
In an otherwise healthy person, little is required to prepare for surgery. Depending on your age, gender, and health problems, some routine blood tests, an EKG and a chest x-ray may or may not be needed. Your surgeon or family doctor will order these tests as needed. You will be asked to refrain from eating 8 hours before surgery. Be sure to let your doctor know what medications you are taking, as some will need to be stopped before surgery. In general, all blood thinners need to be stopped for several days. These include aspirin, Ibuprofen or Motrin, Coumadin and Plavix.
This operation is generally performed with general anesthesia. An IV line will be placed in your arm for fluids and you will be brought into the operation room. The anesthesiologist and nurses will use monitors to check your heart rate and breathing during the procedure. These may include EKG leads, a blood pressure cuff, an oxygen mask and sleeves on your legs to prevent clots from forming.
Once you are asleep, the operating room team will work together to perform your operation. When your operation is complete, you will be awakened from anesthesia in the operating room but you may not remember this. After a few hours in the recovery room, the nurses will help you out of bed and give you something to drink. It is common to feel groggy and nauseated soon after surgery and medication is available to help with these discomforts. At the Ohio State University Medical Center most elective hernia repair surgery is performed as an outpatient operation. A family member or friend should be available to take you home the same day of surgery.
This information is not intended to replace a visit with your physician. If you have further questions, please call 614-293-3230.