Repair of Ventral Hernia
A ventral hernia is an out pouching of the abdominal wall contents through a defect in the anterior abdominal wall. A common example of a ventral hernia is the incisional hernia, usually the consequence of poor wound healing of a surgical incision. Once diagnosed, surgical repair of the defect is usually recommended to prevent or address the complications of intestinal obstruction or compromise of blood supply to the intestine due to the hernia.
There are no other methods to repair a hernia except through surgery. A non-surgical option may be recommended if there are medical conditions which may increase the risk of surgery, or if there is a high chance of recurrence of the hernia following the surgery such as in cases of morbid obesity.
Both procedures are usually performed under general anaesthesia. In some cases, the open procedure can also be performed under regional or local anaesthesia. Most cases will be suitable for day surgery, but those with larger hernias may require a day or two of inpatient stay.
The aim of the surgery is to reduce the hernia back into the abdomen, and strengthen the abdominal wall muscles by putting in a mesh, which is a form of reinforcement. Or the abdominal muscles can just be stitched in an overlapping fashion to repair the area of weakness.
There are two methods whereby this can be performed:
- The conventional open method. In the open method, an incision is made over the previous scar or directly over the hernia, and the abdominal wall defect is repaired either by using sutures to bring the sides of the defect together, or by stitching a mesh (a permanent prosthesis) to strengthen the abdominal wall.
- The keyhole or laparoscopic method. In the keyhole method, usually 3 small incisions are made to introduce instruments to perform the surgery. A mesh is also placed in this method to repair the hernia. When the keyhole operation is performed, there is a possible conversion to the open procedure should it be deemed unsafe or unsuitable to proceed with the keyhole procedure. This decision is made during the surgery itself.
|This animation produced by Nucleus Medical Media gives an excellent illustration of what a laparoscopic ventral hernia is.|
|This footage is an actual case of a para-umbilical hernia repaired by us.|
The advantages of the laparoscopic method compared to the open method are:
- The laparoscopic method will have less pain because of the smaller wounds
- Because of the smaller wounds, patients will have an earlier return to their usual activities including work and social activities
- The laparoscopic method have better cosmetic outcomes since the scars are smaller
Both techniques are available at Nexus Surgical Laparoscopic and MIS Centre. Whenever possible, our surgeons will use the laparoscopic method.
The main risks of ventral hernia repair are:
- Bleeding and seroma formation (accumulation of fluid in the wound)
- Wound infection, including infection of the mesh which will necessitate removal of the mesh
- Recurrence of the hernia may occur in 5% of patients
- Bowel injury
When a mesh is used to strengthen the abdominal wall, there is also a small risk of scar formation (adhesions) between the intestines and the mesh. This can lead to pain, intestinal obstruction and occasionally erosion of the mesh onto the bowel wall, causing leakage of bowel contents. This is fortunately very rare nowadays, given the new generation of meshes available in Singapore.
Following surgery, the pain should be quite manageable and controlled with oral painkillers. You should be able to carry on with your daily activities without any restrictions except for driving and operating equipment whilst the effects of the anaesthesia are still present. In some cases of open surgery, a drain may be placed during the operation to allow the efflux of fluid and prevent its accumulation within the wound. This will be removed after a few days.
When you are up to it, you can also start exercising, including jogging, especially once the skin wounds have healed, which usually takes about 1 week. The only restriction is not to carry heavy loads for about 3 months.
Most times the wound will be closed with absorbable sutures, so there is no need for removal of the stitches.