BASIC INFORMATION.
Approximately 90,000
ventral hernia repairs are performed each year in the United States.
Many are performed by the conventional “open” method. Some are
performed laparoscopically. Hernia repair is a technique to fix
tears or openings in the abdominal wall using a patch (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 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.
“A hernia does not
get better over time, nor will it go away by itself.”
HOW DO YOU KNOW IF YOU HAVE A VENTRAL HERNIA?
You should recognized a bulge under your skin. Occasionally, it causes no discomfort at all, but you may feel pain when you lift heavy objects, cough, 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.
ARE YOU A CANDIDATE FOR THE LAPAROSCOPIC REPAIR?
Only after a thorough examination 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, overweight or severe obesity, hernias found in unusual or difficult to approach locations, or underlying medical conditions (diabetes, high blood-pressure).
HOW IS THE PROCEDURE PERFORMED?
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 “open” approach is done through an incision in the abdominal wall. It may go through part or all of a previous incision, skin, an underlying 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 regional or
spinal anesthesia.
The second approach is a
laparoscopic ventral hernia repair. In this approach, a video-camera
is inserted through a small hollow tube and, with other small
incisions for other small tubes, the surgeon inserts a surgical mesh
into the abdomen. This mesh is fixed under the hernia defect to the
strong tissues of the abdominal wall with special surgical tacks and
sutures. This is performed ONLY with general anesthesia.
HOW A MESH WORKS?
Mesh is generally available in various measurements and can often be cut to size. Depending on the repair technique used, the mesh is placed either under or over the defect in the abdominal wall and held in place by a few sutures. Mesh acts as "scaffolding" for new growth of a patient's own tissue, which eventually incorporates the mesh into the surrounding area.
WHAT SHOULD YOU EXPECT
AFTER SURGERY?
Patients are encouraged
to engage in light activity while at home after surgery. Your surgeon
will determine the extent of activity, including lifting and other
forms of physical exertion. Follow your surgeon’s advice carefully.
Post-operative discomfort
is usually mild to moderate. Frequently, patients will require pain
medication. If you begin to have fever, chills, vomiting, are unable
to urinate, or experience drainage from your incisions you should
call your surgeon immediately.
If you have prolonged
soreness and are getting no relief from your prescribed pain
medication, you should notify your surgeon.
Most patients are able to
get back to their 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. If not, your surgeon may aspirate this with a needle in the
office.
You should ask your
physician when and if you need to schedule a follow-up appointment.
Typically, patients call to schedule follow-up appointments within
2-3 weeks after their operation.
WHAT COMPLICATIONS CAN OCCUR?
Although this operation
is considered safe, complications may occur as they might occur with
any operation, and you should consult your physician about your
specific case.
Complications during the
operation may include adverse reactions to 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.
RECOVERY AND FAQS
Q. Will my insurance
cover an hernia repair?
A. Since any hernia
repair is necessary surgery, your insurance should cover the
procedure.
Q. How long is the
recovery period?
A. It depends on what
type of hernia you have, the procedure used by your surgeon, and your
normal level of activity.
You may feel discomfort
for the first few days. Some patients experience minimal pain or
discomfort and are back to normal in just a few days. Other patients
may take longer to fully recover, especially if their normal routine
involves strenuous activity.
CONTACT INFORMATION
Miguel Angel Rico Hinojosa, MD
Certified General &
Digestive Surgeon
Hospiten Riviera Maya
miguelangel.rico@hospiten.com
