Laparoscopic Ventral / Incisional Hernia Repair

A ventral hernia is a weakness that develops in any area in the front of the abdomen, through the anterior abdominal wall. A bulge or sac containing fat or intestine pushes out through that weakness. A ventral hernia may be located at the bellybutton (umbilical), at the site of a previous surgical incision (incisional), or in the upper abdomen at the midline (epigastric).

Most patients with ventral hernias first notice an abdominal bulge or discomfort. Over time these hernias can get larger and more uncomfortable as the hernia sac gets pushed out from inside the abdomen. A hernia will not go away or get better with time without treatment. Ventral hernias can be diagnosed by your doctor or other healthcare provider, by listening to your history and performing a good physical examination. Sometimes radiographic testing (like a CAT scan) is used to confirm and characterize the presence of a hernia.

Like other hernias, any ventral hernia has the risk of becoming stuck. This is called incarceration and can be dangerous and necessitate emergency surgery. When a hernia becomes incarcerated, you won’t be able to flatten the bulge, and you would likely also have very strong pain at the hernia site. This is sometimes accompanied by nausea or vomiting, and the inability to pass gas from the rectum. This is an emergency, and if this happens, you should contact your doctor or go to the Emergency Room for prompt treatment.

Because of the risk of incarceration and symptoms caused by the ventral hernia, surgical repair is recommended for most patients. Surgical repair of ventral hernias can be done laparoscopically or the traditional open surgery method.

Surgical Options

Using a miniature videoscope attached to a camera, the surgeons at Mount Sinai view the hernia from the inside. Small incisions (about ½ - 1 inch long) are made for the laparoscope and several instruments. Any old scar tissue, called adhesions, can be removed. A mesh, or patch, is inserted inside the abdomen and placed over the side of the hernia using thin instruments. The mesh is held in placed by sutures and small tacks.

General anesthesia is used for all laparoscopic ventral hernia repairs. Patients are awoken immediately after the surgery is finished. Depending on the size of the hernia and the complexity of the surgery, patients either leave on the same day of the surgery or stay over in the hospital.

As in any operation, complications such as bleeding, infection, injury to the intestines, blood clots, or heart or lung problems may occur. Before your surgery, your surgeon will recommend testing to determine if it is safe for you to have surgery. A recurrence of the hernia is a late, but rare, complication.

Following Your Surgery

Postoperative recovery depends on the size and difficulty of the hernia repair. Pain is controlled by pain medications prescribed to you on discharge from the hospital. You will be able to walk after the surgery, though you willusually need about three weeks after surgery before restarting heavy physical activity.

Patients usually take 1-2 weeks off from work after a laparoscopic ventral hernia repair.