ventral hernia

Ventral Hernia Repair

Hernia Surgery Doctor in Ahmedabad

The Condition

A ventral hernia is a bulge through an opening in the muscles on the abdomen. A hernia can occur at a past incision site (incisional), above the navel (epigastric), or other weak muscle sites (primary abdominal)

common symptoms?

visible bluge on the he abdomen, especially with coughing or straining

Pain or pressure at the hernia site

Treatment Options

Surgical procedure

open hernia repair An incision is made near the site, and the hernia is repaired with mesh or by suturing (sewing) the muscle closed

laparoscopic hernia repair The hernia is repaired by mesh or sutures inserted through instruments placed into small incisions in the abdomen

Non-surgical procedure

Watchful waiting is an option for adults with hernias that are reducible and not uncomfortable

Benefits and Risks of Your Operation

Benefits—An operation is the only way to repair a hernia. You can return to your normal activities and, in most cases, will not have further discomfort.

Risks of not having an operation— The size of your hernia and the pain it causes an increase. If your intestine becomes trapped in the hernia pouch, you will have sudden pain and vomiting and require an immediate operation.

If you decide to have the operation, possible risks includereturn of the hernia; infection; injury to the bladder, blood vessels, or intestines; and

Expectations

Before your operation—Evaluation may include blood work, urinalysis, ultrasound, or a CT scan. Your surgeon and anesthesia provider will review your health history, home medications, and pain control options.

The day of your operation—You will not eat or drink for 6 hours before the operation. Most often, you will take your home medication with a sip of water. You will need someone to drive you home. Your recovery—You may go home within 24 hours for small hernia procedures but may need to stay in the hospital longer for more complex repairs. The the average length of stay for patients with a complex hernia repair is 1.5 days.

Call your surgeon if you have severe pain, stomach cramping, chills with a high fever (higher than 101°F), odor or increased drainage from your incision, or no bowel movement for 3 days.

The Condition, Symptoms, and Diagnostic Tests

The Condition

The Hernia

A ventral hernia is a bulge through an opening in the muscles on the abdomen. If a hernia reduces in size when a person is lying flat or in response to manual pressure, it is reducible. If it cannot be reduced, it is irreducible or incarcerated, and a portion of the intestine may be bulging through the hernia sac. A hernia is strangulated if the intestine is trapped in the hernia pouch and the blood supply to the intestine is decreased. This is a surgical emergency. 2 A primary abdominal hernia occurs spontaneously in an area of natural weakness of the abdominal muscle. An incisional hernia bulges through a past incision site. This issue can be the result of scar tissue or weak muscles around the site. An epigastric hernia bulges midline above the umbilicus.

Symptoms

The most common symptoms of a hernia are:

Visible bulge in the abdominal wall, especially with coughing or straining

Hernia site pain or pressure Sharp abdominal pain and vomiting may mean that the intestine has slipped through the hernia sac and is strangulated. This is a surgical emergency and immediate treatment is needed.

Common Tests

History and Physical

The site is checked for a bulge.

Additional Tests (see Glossary)

Other tests may include:

Ultrasound

Computerized tomography (CT) scan

Blood tests

Urinalysis

Electrocardiogram (ECG)—for patients over 45 or if high risk of heart problems

Keeping You Informed

Abdominal Wall Hernia

They are also called ventral hernias. They can occur: Large hernia with loop of intestine

• At birth (congenital)

• Over time due to muscle weakness

• At a past incision site

Incisional Hernias

Incisional hernias can develop at the laparoscopic port site in 5 of 1,000 patients and in up to 150 of 1,000 patients who have had a prior open abdominal incision. Most appear in the first 5 years after an operation. Risk factors that can contribute to incisional hernia formation include:

• Obesity, which creates tension and pressure on abdominal muscles

• Large abdominal incisions

• Postoperative infection (note that smoking is related to higher infection rates)

• Weakness of the connective tissue (the material between the cells of the body that gives it strength, sometimes called the cellular glue)

• Diabetes mellitus

• Pulmonary disease

The Surgical and Nonsurgical Treatment

Surgical Treatment

The type of operation depends on the hernia size, location, and if it is a repeat hernia. Your health, age, anesthesia risk, and the surgeon’s expertise are also important. An operation is the only treatment for a hernia repair. Single Mesh Repair PL Sutured Muscle Repair

Open Hernia Repair

The surgeon makes an incision near the hernia site. The bulging tissue is gently pushed back into the abdomen. Sutures, mesh, or a tissue flap is used to close the muscle. With complex or large hernias, small drains may be placed going from inside to the outside of the abdomen. The site is closed using sutures, staples, or surgical glue.

Open Mesh Repair

The hernia sac is removed. Mesh is placed over the hernia site. The mesh is attached using sutures sewn into the stronger tissue surrounding the hernia site. Mesh is often used for large hernia repairs and may reduce the risk that a hernia will come back. The site is closed using sutures, staples, or surgical glue.

Laparoscopic Hernia Repair

The surgeon will make several small punctures or incisions in the abdomen. Ports or trocars (hollow tubes) are inserted into the openings. Surgical tools are placed into the ports. The abdomen is inflated with carbon dioxide gas to make it easier for the surgeon to see a hernia. Mesh is sutured, stapled, or clipped to the muscle around the hernia site. The hernia site can also be sewn directly together.

Nonsurgical Treatment

watchful waiting is an option for a hernia without symptoms. All patients should get treatment if they have sudden sharp abdominal pain and vomiting. These symptoms can indicate an incarcerated hernia and bowel obstruction Trusses or belts made to apply pressure to a hernia require correct fitting. When used correctly, part or complete control of a hernia was achieved in 31% of patients, and 64% found the truss to be uncomfortable



Keeping You Informed

Open versus Laparoscopic Incisional Repair

There is no one type of repair that is good for all ventral hernias. Laparoscopic repairs are associated with lower infection rates and shorter hospital stays. There is no difference in recurrence rates, long-term pain, or quality of life. For patients with strangulated intestines and infections, the laparoscopic approach may not be an option.

Will My Hernia Come Back?
Mesh reduces the risk that the hernia will return again. Mesh can be tacked, stapled, or sutured. Obesity and wound complications increase the risk of recurrence You may be placed on a weight loss, smoking cessation, or a diabetes control program before an elective repair to support the best outcome.

Risks of this Procedure

Risks Based on the ACS Risk Calculator

Risks from Outcomes Reported in the Last 10 Years of Literature Percent for Average Patient Keeping You Informed
Urinary retention: Inability to urinate after the urinary catheter is removed 21% General anesthesia, older age, prostate problems, and diabetes may be associated with urinary retention. A temporary catheter or medication may be used to treat retention.
Seroma: A collection of serous (clear/yellow) fluid 12% A seroma usually goes away on its own within 4 to 6 weeks. Rarely, the fluid is removed with a sterile needle
Recurrence: A hernia can recur up to several years after repair Open 12% Laparoscopic 10% Non-Mesh 17% 11 Recurrence rates are higher for complex or infected hernia repair or for repairs done without mesh. In a 5-year follow-up, 6% to 20% of patients with mesh, repair experienced serious complications, including bowel obstruction, fistulas, or tunneling wounds
Intestines/bowel injury Open Less than 1% Laparoscopic 4.3% Injury will be repaired at the time of operation. If there is bowel leakage into the abdominal cavity, the hernia repair will be done after the bowel heals. A nasogastric (NG) tube will be placed to keep the stomach empty until fluid is moving through the bowel.
Wound infection: Infection at the area of the incision or near the organ where surgery was performed Open 3.9% Laparoscopic Less than 1% Antibiotics and drainage of the wound may be needed. Smoking can increase the risk of infection.
Return to surgery: The need to go back to the operating room due to a problem after the prior surgery Open 2.5% Laparoscopic Less than 1% Significant pain and bleeding may cause a return to surgery. Your surgical and anesthesia team is prepared to reduce all risks of the return to surgery.
Pneumonia: Infection in the lungs Open: 1.2% Laparoscopic Less than 1% Stopping smoking, movement, and deep breathing after your operation can help prevent respiratory infections.
Urinary tract infection: Infection of the bladder or kidneys Open 1.2% Laparoscopic Less than 1% Drinking fluids and catheter care decrease the risk of bladder infection.
Heart complication: Includes heart attack or sudden stopping of the heart Less than 1% Problems with your heart or lungs can be aggravated by general anesthesia. Your anesthesia provider will take your history and suggest the best option for you.
Renal (kidney) failure: Kidneys no longer function in making urine and/or cleaning the blood of toxins Less than 1% Preexisting renal conditions; fluid imbalance, Type 1 diabetes; over age 65; antibiotics; and other medications may increase the risk.

Expectations: Preparing for Your Operation

What You Can Expect

Home Medication

Bring a list of all of the medications, vitamins, and any over-the-counter medicines that you are taking. Your medications may have to be adjusted before your operation. Some medications can affect your recovery and response to anesthesia. Most often you will take your morning medication with a sip of water.

Anesthesia

Let your anesthesia provider know if you have allergies, neurologic disease (epilepsy, stroke), heart disease, stomach problems, lung disease (asthma, emphysema), endocrine disease (diabetes, thyroid conditions), or loose teeth; use alcohol or drugs; take any herbs or vitamins; or if you have a history of nausea and vomiting with anesthesia.

If you smoke, you should let your surgical team know, and you should plan to quit. Quitting before your surgery can decrease your rate of respiratory and wound complications and increase your chances of staying smoke-free for life. Resources to help you quit may be found at www.facs.org/patienteducation

Lenght of stay

If you have local anesthesia, you will usually go home the same day. You may stay overnight if you have a repair of a large or incarcerated hernia. A laparoscopic repair may result in a longer anesthesia time. Complications such as severe nausea and vomiting or an inability to pass urine may also result in a longer stay

safety checks

An identification (ID) bracelet and allergy bracelet with your name and hospital/clinic number will be placed on your wrist. These should be checked by all health team members before they perform any procedures or give you medication. Your surgeon will mark and initial the operation site.

Fluids and Anesthesia

An intravenous line (IV) will be started to give you fluids and medication. For general anesthesia, you will be asleep and pain-free during the operation. A tube may be placed in your throat to help you breathe during the operation. For spinal anesthesia, a small needle with medication will be placed on your back alongside your spinal column. You will be awake during the operation but pain-free.

The Day of Your Operation

Do not eat for 4 hours or drink anything but clear liquids for at least 2 hours before the operation.

Shower and clean your abdomen and groin area with a mild antibacterial soap.

Brush your teeth and rinse your mouth out with mouthwash.

Do not shave the surgical site; your surgical team will clip the hair nearest the incision site.

What to Bring

Insurance card and identification

Advance directives (see Glossary)

List of medicines

Loose-fitting, comfortable clothes

Slip-on shoes that don’t require that you bend over

Leave jewelry and valuables at home

After Your Operation

You will be moved to a recovery room where your heart rate, breathing rate, oxygen saturation, blood pressure, and urine output will be closely watched. Be sure that all visitors wash their hands.

Preventing Pneumonia and Blood Clots

Movement and deep breathing after your operation can help prevent postoperative complications such as blood clots, fluid in your lungs, and pneumonia. Every hour, take 5 to 10 deep breaths and hold each breath for 3 to 5 seconds. When you have an operation, you are at risk of getting blood clots because of not moving during anesthesia. The longer and more complicated your surgery, the greater the risk. This risk is decreased by getting up and walking 5 to 6 times per day, wearing special support stockings or compression boots on your legs, and, for high-risk patients, taking a medication that thins your blood.

Questions to Ask


About My Operation:

What are the side effects and risks of anesthesia?

What technique will be used to repair the hernia (laparoscopic or open; mesh or with sutures)?

What technique will be used to repair the hernia (laparoscopic or open; mesh or with sutures)?

What are the risks of this procedure for me?

Will you be performing the entire operation yourself? After Your Operation

What level of pain should I expect and how will it be managed? You will be moved to a recovery room where your heart rate, breathing rate, oxygen saturation, blood pressure, and urine output will be closely watched. Be sure that all visitors wash their hands.

How long will it be before I can return to my normal activities (work, driving, lifting)?

May I have my hernia repaired during a gastric bypass surgery?

Your Recovery and Discharge

Your Recovery and Discharge

Thinking Clearly

If general anesthesia is given or if you are taking narcotic pain medication, it may cause you to feel different for 2 or 3 days, have difficulty with memory, or feel more fatigued. You should not drive, drink alcohol, or make any big decisions for at least 2 days

Nutrition

When you wake up, you will be able to drink small amounts of liquid. If you do not feel sick, you can begin eating regular foods.

Continue to drink lots of fl uids, usually about 8 to 10 glasses per day.

Eat a high-fi ber diet so you don’t strain during bowel movements

Activity

Slowly increase your activity. Be sure to get up and walk every hour or so to prevent blood clots.

Do not lift or participate in strenuous activity for 3 to 5 days for laparoscopic and 10 to 14 days for open procedure.

You may go home in 1 to 2 days for a laparoscopic repair. If your appendix ruptured or you have other health issues or complications, you may stay longer.

It is normal to feel tired. You may need more sleep than usual.

Work and Return to School

You may usually return to work 1 week after laparoscopic or open repair, as long as you don’t do any heavy lifting. Discuss the timing with your surgeon.

Do not lift items heavier than 10 pounds or participate in strenuous activity for at least 4 to 6 weeks

Wound Care

Always wash your hands before and after touching near your incision site.

Do not soak in a bathtub until your stitches or Steri-Strips are removed. You may take a shower after the second postoperative day unless you are told not to.

Always wash your hands before and after touching near your incision site.

Do not soak in a bathtub until your stitches or Steri-Strips are removed. You may take a shower after the second postoperative day unless you are told not to.

Follow your surgeon’s instructions on when to change your bandages.

A small amount of drainage from the incision is normal. If the drainage is thick and yellow or the site is red, you may have an infection, so call your surgeon.

If you have a drain in one of your incisions, it will be taken out when the drainage stops.

Steri-Strips will fall off in 7 to 10 days or they will be removed during your fi rst offi ce visit.

If you have a glue-like covering over the incision, allow the glue to fl ake off on its own.

Avoid wearing tight or rough clothing. It may rub your incisions and make it harder for them to heal.

Protect the new skin, especially from the sun. The sun can burn and cause darker scarring.

Your scar will heal in about 4 to 6 weeks and will become softer and continue to fade over the next year.

Sensation around your incision will return in a few weeks or months.

Bowel Movements

Avoid straining with bowel movements by increasing the fiber in your diet with high- fiber foods or over-the-counter medicines (like Metamucil® and FiberCon®). Be sure you are drinking 8 to 10 glasses of water each day

Pain

The amount of pain is different for each person. Some people need only 1 to 3 doses of pain control medication, while others need more. The new medicine you will need after your operation is for pain control, and your doctor will advise how much you should take. You can use throat lozenges if you have sore throat pain from the tube placed in your throat during your anesthesia.

When to Contact Your Surgeon

Contact your surgeon if you have:

Pain that will not go away

Pain that gets worse

A fever of more than 101°F or 38.3°C

Continuous vomiting

Swelling, redness, bleeding, or bad-smelling drainage from your wound site

Strong or continuous abdominal pain or swelling of your abdomen

No bowel movement 2 to 3 days after the operatio

Pain control

Everyone reacts to pain in a different way. A scale from 0 to 10 is used to measure pain. At a “0,” you do not feel any pain. A “10” is the worst pain you have ever felt. Following a laparoscopic procedure, pain is sometimes felt in the shoulder. This is due to the gas inserted into your abdomen during the procedure. Moving and walking help to decrease the gas and the right shoulder pain

Extreme pain puts extra stress on your body at a time when your body needs to focus on healing. Do not wait until your pain has reached a level “10” or is unbearable before telling your doctor or nurse. It is much easier to control pain before it becomes severe.

Non-Narcotic Pain Medication

Most non-opioid analgesics are classified as non-steroidal anti-inflammatory drugs (NSAIDs). They are used to treat mild pain and inflammation or can be combined with narcotics to treat severe pain. Possible side effects of NSAIDs are stomach upset, bleeding in the digestive tract, and fluid retention. These side effects usually are not seen with short-term use. Let your doctor know if you have heart, kidney, or liver problems. Examples of NSAIDs include ibuprofen, Motrin®, Aleve®, and Toradol® (given as a shot).

Narcotic (Opioid) Pain Medication

Narcotics or opioids are used for severe pain. Possible side effects of narcotics are sleepiness, lowered blood pressure, heart rate, and breathing rate; skin rash and itching; constipation; nausea; and difficulty urinating. Some examples of narcotics include morphine, oxycodone (Percocet®/Percodan®), and hydromorphone (Dilaudid®). Medications can be given to control many of the side effects of narcotics..

Pain Control without Medicine

Splinting your stomach by placing a pillow over your abdomen with firm pressure before coughing or movement can help reduce the pain.

Distraction helps you focus on other activities instead of your pain. Listening to music, playing games, or other engaging activities can help you cope with mild pain and anxiety. Splinting Your Stomach

Guided imagery helps you direct and control your emotions. Close your eyes and gently inhale and exhale. Picture yourself in the center of somewhere beautiful. Feel the beauty surrounding you and your emotions coming back to your control. You should feel calmer.