Laparoscopic Ventral Hernia Repair

Laparoscopic Ventral Hernia repair is a procedure to repair the opening (hernial defect) in the abdominal wall. This repairing procedure is done by a small incision, laparoscopes (small telescopes inserted into the abdomen), and a mesh (patch of synthetic or biological material) to strengthen the abdominal wall. A hernia never resolves on itself. A ventral hernia can develop at the belly button (umbilicus) or other areas of the abdominal wall. They can be congenital (from birth) and Acquired. A hernia developing at the previous surgery site is also called as Incisional Hernia.

The abdominal wall of that area becomes weak due to the bulge. The inner lining of the abdomen pushes through the weak area of the abdominal wall and makes a balloon-like hernial sac. This can allow a loop of intestines or abdominal contents to push into the sac easily. If the abdominal contents get stuck within this sac, then it becomes incarcerated (trapped) or strangulated (blood supply hampered). This is a serious condition and requires emergency surgery.

A hernia is a bulge under the skin. Surprisingly it does not produce any discomfort when small, but you may feel pain on straining like lifting heavyweight, cough, strain during urination or bowel movement, and on prolonged standing. You should contact your doctor immediately if discomfort with sharp or mild ache gets worse at the end of the day, continuous or severe discomfort, redness, nausea, and vomiting.

Causes of Ventral Hernia:

• Congenital – As discussed above.
• It is a multifactorial disease and a typical cause is not present in all cases.
• Hernia never occurs due to lifting heavy weights or doing heavy exercise. They affect only AFTER hernia has already occurred.
• A hernia can be prominent in any age. It is more common in old age people. Certain activities increase the risk of hernia including persistent coughing, difficulty within a bowel movement, and urination.
• Incision hernia may occur in 30% abdominal surgery cases. It occurs at the place of a surgical scar that makes the tissue gets weak. It is more common after complicated and heavily infected surgeries.
• Smoking causes tissue weakness thus increasing the risk of hernia.
• Congenital weakness of the body tissues may be the cause.
• Risk is increased in obese people.
• It is more common in obese females.

Advantages of Laparoscopic Ventral Hernia Repair:

• Cosmesis – No long scars
• Less post-operative pain
• Short time in-hospital stay
• Faster return to a regular diet
• Quicker return to normal activity
• Less wound infections

Symptoms:

There are a few symptoms of Ventral Hernia. Sometimes symptoms may take weeks or months to get visible and sometimes are not visible at all. Few of them are as follows:

• Localized abdominal swelling with or without pain
• Swelling increases on standing and exertion and reduces on lying down
• Mild discomfort in the hernia
• Pain, Nausea, Vomiting, etc. if it becomes complicated

Diagnosis of Ventral Hernia:

The hernia is completely a clinical diagnosis. In the majority of cases, no imaging is required.  However, A doctor may suggest some imaging tests in certain special circumstances such as:

• Abdominal Ultrasound
• Abdominal CT Scan
• Abdominal MRI Scan

Treatment of Ventral Hernia:

There is NO MEDICATION for a hernia. It is a completely structural problem and ALWAYS requires surgery for treatment. Ventral hernia requires surgical corrections. If it is not treated, then it may enlarge and may turn in to a serious complication. Options of surgical treatments are:

• Mesh replacement Surgery: In this type of surgery, a surgeon pushes the tissue back and then sews in a mash. It is like a reinforcing patch that keeps the tissue and mash in place. It is a safe and reliable method and mesh placement reduces the risk of hernia recurrence.
• Laparoscopic Repair: As we know about the laparoscopic method, in this process a surgeon makes 3 or 4 small openings or cuts, and with the help of a small camera inside the patient’s body, he treats the hernia. A special mesh is placed. Benefits of laparoscopic surgery are:

1. More cosmesis
2. Small cuts
3. Low chance of infection
4. Reduce time of hospital stay; maybe leave hospital on the next day of surgery
5. Faster recovery time

• Open Surgery or Non-laparoscopic: A surgeon makes a large incision near to the hernia and then pushes the tissue back in the place and closes the area by stitches. Here also mesh is applied. A complicated hernia (incarcerated, obstructed, or strangulated) is almost always done by the open method.
• Repair without mesh: It is done if a hernial defect is very small (< 2cm) or in cases of complicated hernias where there is a high risk of mesh infection.

Dr. Pranay Gourav, Consultant – General Surgery, Narayana Multispeciality Hospital, Barasat