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Ventral Hernia

What is a ventral hernia?

A hernia is a defect in a wall that allows something to protrude through. A ventral hernia is a defect in the muscle wall anywhere in the front of the abdominal wall. The underlying fat protrudes through, though it can sometimes be bowel or another structure. They are given specific names in certain locations eg umbilical, epigastric (upper abdomen), Spigelian (below the umbilicus to the left or right). These hernias are often small, but nonetheless very troublesome potentially.

Hernias usually cause a swelling or bulge that comes and goes and an ache. They do not in themselves cause severe pain, but a complicated hernia or a hernia with a torn muscle or irritated nerve can cause pain. A complicated hernia is one which is stuck, and the contents could be dying and surgery is more urgent of course. Strangulation, where the contents are dying or dead, is an uncommon but potentially dire complication of a hernia.

Hernias never repair themselves. Surgery is the only way to repair hernias. All people with a hernia who are fit for surgery should consider having the hernia repaired sooner rather than later to prevent an urgent operation.

Ventral Hernia 

Intestine has pushed through the abdominal wall.

 

What operations are there?

There are 3 main surgical methods to repair a hernia: Open Suture, Open Mesh, and Laparoscopic Mesh Repair. Each has their merits.

Open suture repair is simply suturing the muscle defect with as many sutures as required. This is done via an incision made in the skin over the hernia.

Open mesh repair often involves re-suturing the defect and then buttressing this with a piece of mesh for added strength, or uses mesh alone to cover the defect which is sutured in position. This also involves making an incision in the skin over the hernia.

Laparoscopic mesh repair involves placing mesh in front of the defect and tacking and suturing this into position from the inside. The laparoscopic repair is preferred by many patients, because it has decreased pain, faster and easier recovery time, less wound infections, less hernia recurrences, less mesh infections, and better cosmesis compared to the other operations. Also, laparoscopic repair enables numerous hernias to be repaired without any additional pain (compared with having one hernia repaired), and often redo operations are much more successful when performed laparoscopically.

There are 3 main methods of laparoscopic ventral hernia repair, and they all sound the same: TEP, TAPP and TIP*. Which approach is the best depends on the location, size, content and nature of the hernia. However, in general terms, TAPP and TIP are the most common. An exception is the Spigelian hernias, which are uncommon hernias that are best managed by TEP, as though it were an inguinal hernia.

It is not easy to describe these operations. It is recommended you visit our website to watch a video of these procedures for a better understanding.

*TEP (Totally ExtraPeritoneal), TAPP (Trans Abdominal PrePeritoneal) and TIP (Totally IntraPeritoneal)

Incisions - Hernia

 

Operative Risks

For any operation there are risks, and in particular there is a risk of infection, bleeding and injury. The overall risk of major complications is less than 1%. The specific risks in laparoscopic hernia repair are bleeding (1 in 500) and injury to abdominal structures or organs (1 in 500). Surgery is required generally to repair these, and sometimes extensive surgery. The risks of the surgery are greater if there is scar tissue from previous surgery or conditions that have resulted in the matting down of adjacent structures. The most common outcome is no complications or a minor problem that will pass such as wound infection (5%).

Mr Draper has performed over 1000 laparoscopic hernia operations with 0.1% complications and 1% recurrence rate. All figures are approximate.

 

Post Operative Recovery

Most people are ready to go home 1 or 2 days post surgery and need 2 weeks convalescence before returning to work. Postoperative problems such as pain and nausea are usually easily managed. The time takenesuming your usual level of activity is not easy to predict, as it depends on your background level of fitness, amount of pain and what you want to resume doing. As a general guide it takes about 2 weeks for most people to return to work, gradually reintroducing activities as tolerated.

 

More Information

This brief information sheet is best considered a reference to be used in conjunction with discussions with your surgeon. For further information discuss your operation in detail with your surgeon, visit our website geoffreydraper.com.au, or read other relevant information sheets such as Laparoscopic Inguinal and Femoral Hernia Repair or our Patient Advice Sheet.

 

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