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What is a ventral hernia?

Ventral hernias are a type of abdominal hernia that commonly occurs along the midline of the abdominal wall, although they can occur at any location on the abdominal wall. Umbilical hernias are those that occur beneath or near the navel. Ventral hernias that occur at the site of a previous abdominal surgery are called incisional hernias, and incisional hernias are fairly common. As many as a third of those who have open abdominal surgeries later develop incisional hernias.

You may experience pain with a ventral hernia, or have no pain at all. Typically, this type of abdominal hernia appears as a bulge in the abdomen that gets larger over time. Most ventral hernias are reducible, as their contents can be pushed back into the abdomen temporarily. Treatment requires surgery to reduce the contents of the hernia and to close and reinforce the opening in the abdominal wall.

If swelling is present, it can lead to entrapment, or “incarceration,” of the hernia contents. Incarceration can ultimately pose a risk of reduced blood supply to the tissues involved, resulting in tissue “strangulation.” Tissue strangulation is typically accompanied by intense pain, and it constitutes a medical emergency that requires immediate treatment to prevent tissue death (necrosis).

Tissue strangulation is a potentially life-threatening medical emergency requiring immediate medical intervention to reduce your risk of bowel or other tissue death. if you, or someone you are with, experience symptoms such as profuse sweating; severe abdominal pain; increased swelling with tight, glistening red skin; rapid heart rate (tachycardia); severe nausea and vomiting; change in bowel habits such as the inability to have bowel movements or pass gas; a decrease in or absence of urine output; or high fever

Seek prompt medical care if you develop a bulge in the abdomen, especially if it increases in size or becomes painful, or if you have been treated for a ventral hernia but symptoms recur.

What are the symptoms of a ventral hernia?

You may experience no symptoms with a ventral hernia, or you may notice a bulge in the abdominal wall. The bulge can expand under increased abdominal pressure, such as when you cough or push or lift a heavy object. The area may also be painful.

 

What causes a ventral hernia?

A ventral hernia may be present at birth (“congenital” hernia) or develop over time. Congenital hernias generally result from incomplete or inadequate closure of part of the abdominal wall. Most umbilical hernias are congenital. Ventral hernias that develop over time do so in weakened areas of the abdominal wall.

 

How is a laparoscopic ventral hernia repair performed?

A surgeon uses special instruments, small incisions, and a videoscope and television monitors to perform the hernia repair. A small incision is made in the abdominal wall in a location chosen to minimize the risk of running into organs or scar tissue from prior operations. Surgeons make as few other tiny incisions as is feasible, depending on how much scar tissue there is and how well they can see.

A laparoscope (a tiny telescope with a television camera attached) is inserted through a small hollow tube. The laparoscope and TV camera allow the surgeon to view the hernia from the inside.

Other small incisions will be made for placement of other instruments to remove any scar tissue, and to insert a surgical mesh into the abdomen. This mesh is fixed under the hernia defect to the strong tissues of the abdominal wall. The surgeon will use mesh to reinforce the weakened area of the abdominal wall. This will help prevent the hernia from recurring.

What are the advantages of the laparascopic approach?

There are many advantages to this approach, including quicker recovery and shorter hospital stays, as well as a significantly reduced risk of infection and recurrence.

Patients usually go home within 24 hours after laparoscopic repair, as opposed to a longer hospital stay after open repair, and report less pain and quicker return to normal activity.

What is the chance of recurrence, compared with the traditional approach?

The rate of recurrence is much less with the laparasocpic approach (less than 10%) as compared to the 20-40% recurrence rate with the open procedure.


 

 

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Dr Clement Tsang
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