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Ventral hernia repair

Ventral hernia repair is a procedure to repair a ventral hernia. A ventral hernia is a sac (pouch) formed from the inner lining of your belly (abdomen) that pushes through a hole in the abdominal wall.

Ventral hernias often occur at the site of an old surgical cut (incision). This type of hernia is also called incisional hernia.

Description

You will probably receive general anesthesia for this surgery. This will make you asleep and pain free.

If your hernia is small, you may receive a spinal or epidural block and medicine to relax you. You will be awake, but pain-free.

  • Your surgeon will make a surgical cut in your abdomen.
  • Your surgeon will find the hernia and separate it from the tissues around it. Then the contents of the hernia, such as intestines, will be gently pushed back into the abdomen. The surgeon will only cut the intestines if they have been damaged.
  • Strong stitches will be used to repair the hole or weak spot caused by the hernia.
  • Your surgeon may also lay a piece of mesh over the weak area to make it stronger. Mesh helps prevent the hernia from coming back.

Your surgeon may use a laparoscope to repair the hernia. This is a thin, lighted tube with a camera at the end. It lets the surgeon see inside your belly. The surgeon inserts the laparoscope through a small cut in your belly and inserts the instruments through other small cuts. This type of procedure often heals faster, and with less pain and scarring. Not all hernias can be repaired with laparoscopic surgery.

Why the Procedure is Performed

Ventral hernias are fairly common in adults. They tend to get bigger over time and there may be more than one in number.

Risk factors include:

  • A large abdominal incision
  • Being overweight
  • Diabetes
  • Straining when using the bathroom
  • Coughing a lot
  • Heavy lifting
  • Pregnancy

Sometimes, smaller hernias with no symptoms can be watched. Surgery may pose greater risks for people with serious medical problems.

Without surgery, there is a risk that some fat or part of the intestine will get stuck (incarcerated) in the hernia and become impossible to push back in. This is usually painful. The blood supply to this area may become cut off (strangulation). You may experience nausea or vomiting, and the bulging area may turn blue or a darker color due to loss of blood supply. This is a medical emergency and urgent surgery is needed.

To avoid this problem, surgeons often recommend repairing the ventral hernia.

Get medical care right away if you have a hernia that does not get smaller when you are lying down or a hernia that you cannot push back in.

Risks

The risks of ventral hernia repair are usually very low, unless the patient also has other serious medical problems.

Risks of having any anesthesia and surgery are:

A specific risk of ventral hernia surgery is injury to the bowel (small or large intestine). This is rare.

Before the Procedure

Your surgeon will see you and give you instructions.

An anesthesiologist will discuss your medical history to decide the right amount and type of anesthesia to use. You may be asked to stop eating and drinking 6 to 8 hours before surgery. Make sure you tell your surgeon or nurse about any medicines, allergies, or history of bleeding problems.

Several days before surgery, you may be asked to stop taking:

  • Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, Motrin, Advil, or Aleve
  • Other blood-thinning medicines
  • Certain vitamins and supplements

After the Procedure

Most ventral hernia repairs are done on an outpatient basis. This means that you will likely go home on the same day. If the hernia is very large, you may need to stay in the hospital for a couple of days.

After surgery, your vital signs such as pulse, blood pressure, and breathing will be monitored. You will stay in the recovery area until you are stable. Your surgeon will prescribe pain medicine if you need it.

Your surgeon or nurse may advise you to drink plenty of fluids along with a fiber-rich diet. This will help prevent straining during bowel movements.

Ease back into activity. Get up and walk around several times a day to help prevent blood clots.

Outlook (Prognosis)

Following surgery, there is a low risk that the hernia may come back. However, to reduce the risk of getting another hernia, you need to maintain a healthy lifestyle, such as maintaining a healthy weight.

References

Miller HJ, Novitsky YW. Ventral hernia and abdominal release procedures. In: Yeo CJ, ed. Shackelford's Surgery of the Alimentary Tract. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 52.

Poulose BK, Carbonell AM, Rosen MJ. Hernias. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. Philadelphia, PA: Elsevier; 2022:chap 45.

Webb DL, Stoikes NF, Voeller GR. Open ventral hernia repair with onlay mesh. In: Rosen MJ, ed. Atlas of Abdominal Wall Reconstruction. 2nd ed. Philadelphia, PA: Elsevier; 2017:chap 8.

  • Hernia

    Animation

  •  

    Hernia - Animation

    You're lifting a heavy box, when suddenly, you feel a strain in your stomach or groin. If you also feel a bulge there, you might have a hernia. The bump that you feel is a part of what's in your abdomen bulging out through a weak spot in the muscle or tissue that surrounds it. A hernia is kind of like pushing your finger against the side of a balloon. What type of hernia you have depends on where the bulge is located. A femoral hernia is a bulge in the upper part of your thigh. A hiatal hernia is located in the top part of your stomach. An umbilical hernia bulges around your belly button. Inguinal hernias are in the groin area. And incisional hernias usually form around a scar from a past surgery in your abdomen. You can get a hernia if you lift something that's too heavy, or strain too hard while coughing, urinating, or having a bowel movement. Sometimes babies are born with a hernia. That happens when the lining that is supposed to hold the abdominal organs doesn't totally close before birth. Some hernias don't cause any symptoms. You might live with a hernia for a while without even noticing that you have it. Or, you may see an actual bulge in your leg, stomach, or groin. Hernias can sometimes be painful, especially when you strain or lift something heavy. Your doctor should be able to locate the hernia during an exam. If your hernia is small and doesn't bother you, you may not need to do anything but keep in touch with your doctor to make sure it isn't growing. If the hernia is big or painful, your doctor may recommend surgery to plug the opening. The one big risk to having a hernia is that with some types the tissue can get caught inside the hole. This is called strangulation. It can be very dangerous, because blood is cut off to the part of the organ that's trapped. Eventually that tissue will die. If you have a strangulated hernia, you'll need to have emergency surgery. Surgery is the only way to reverse a hernia, although in young children umbilical hernias will often go away on their own. If you have a small hernia and decide not to have surgery, be on the lookout for any changes. Call the doctor right away if you have pain, nausea, vomiting, or a fever, or if your hernia turns red, purple, or another color. These could be signs of strangulation. To avoid a hernia in the first place, be careful when lifting heavy objects. Drink plenty of fluids and add fiber to your diet so you won't have to push too hard on the toilet. And see a urologist if you're straining while urinating.

  • Hernia

    Animation

  •  

    Hernia - Animation

    You're lifting a heavy box, when suddenly, you feel a strain in your stomach or groin. If you also feel a bulge there, you might have a hernia. The bump that you feel is a part of what's in your abdomen bulging out through a weak spot in the muscle or tissue that surrounds it. A hernia is kind of like pushing your finger against the side of a balloon. What type of hernia you have depends on where the bulge is located. A femoral hernia is a bulge in the upper part of your thigh. A hiatal hernia is located in the top part of your stomach. An umbilical hernia bulges around your belly button. Inguinal hernias are in the groin area. And incisional hernias usually form around a scar from a past surgery in your abdomen. You can get a hernia if you lift something that's too heavy, or strain too hard while coughing, urinating, or having a bowel movement. Sometimes babies are born with a hernia. That happens when the lining that is supposed to hold the abdominal organs doesn't totally close before birth. Some hernias don't cause any symptoms. You might live with a hernia for a while without even noticing that you have it. Or, you may see an actual bulge in your leg, stomach, or groin. Hernias can sometimes be painful, especially when you strain or lift something heavy. Your doctor should be able to locate the hernia during an exam. If your hernia is small and doesn't bother you, you may not need to do anything but keep in touch with your doctor to make sure it isn't growing. If the hernia is big or painful, your doctor may recommend surgery to plug the opening. The one big risk to having a hernia is that with some types the tissue can get caught inside the hole. This is called strangulation. It can be very dangerous, because blood is cut off to the part of the organ that's trapped. Eventually that tissue will die. If you have a strangulated hernia, you'll need to have emergency surgery. Surgery is the only way to reverse a hernia, although in young children umbilical hernias will often go away on their own. If you have a small hernia and decide not to have surgery, be on the lookout for any changes. Call the doctor right away if you have pain, nausea, vomiting, or a fever, or if your hernia turns red, purple, or another color. These could be signs of strangulation. To avoid a hernia in the first place, be careful when lifting heavy objects. Drink plenty of fluids and add fiber to your diet so you won't have to push too hard on the toilet. And see a urologist if you're straining while urinating.

     

    Review Date: 9/19/2021

    Reviewed By: Debra G. Wechter, MD, FACS, General Surgery Practice Specializing in Breast Cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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