About Ventral Hernias
What is a ventral hernia?
A hernia is a gap, space or hole in the strong tissue (fascia) that holds muscles in place. Hernias occur if the layers of fascia in your abdomen (belly) become weak. The abdomen is the area in the middle of your body that holds many organs, including your intestines. A gap can form where the fascial layers are weak. Then the inner lining of the abdomen pushes through the gap. It forms a small sac, like a balloon. This is the hernia sac. A loop of intestine or other abdominal tissue can push through the hernia defect (hole) into the hernia sac. You may have discomfort, severe pain, or other problems that could require emergency surgery.
Hernias occur in both men and women, but more frequently in men. There are different types. A ventral hernia happens in the middle of your abdomen (belly). A hernia in the groin area is called an inguinal or femoral hernia. If you want more information about inguinal hernias, please read our Inguinal Hernia Patient Information.
A ventral hernia usually happens where you have a surgical scar. This is the place the doctor made the incision, or cut, for surgery. It can also happen at the belly button (navel) or anywhere else on the abdomen.
A hernia does not get better over time. It will not go away by itself, and it can get bigger over time. Surgery is the only way to fix a hernia, though not all hernias need to be repaired.
This brochure can help you understand what a hernia is and more about the treatment.
How do I know if I have a ventral hernia?
It is usually easy to recognize a hernia. You may notice a bulge under your skin. You may also feel pain or discomfort when you:
- Lift heavy objects
- Urinate (pee) or have a bowel movement
- Stand or sit for a long time
The pain may be sharp and sudden or it may be a dull ache that gets worse towards the end of the day. Sometimes, a doctor finds a hernia during an examination.
- Tissue can get trapped in the hernia. This can be dangerous. Call your doctor’s office immediately if you have the following symptoms.
- Severe, continuous pain
- A bulge that is red, tender, or painful to touch
- Nausea or vomiting
Hernias can be reducible, meaning that the tissue or organs are able to fall back or be pushed back into the abdomen. Hernias can also be incarcerated, meaning the tissue stays stuck, or trapped through the hernia defect. If this happens gradually, there may not be any problems. If this happens suddenly, and bowel is trapped, this can cause a blockage (bowel obstruction) . The hernia can even become strangulated, which means the blood supply to the bowel is cut off and can lead to the bowel dying. This is an emergency.
What causes a ventral hernia?
Some areas of your abdomen are more likely to become weak. Hernias can develop in these areas. The causes include:
- Obesity – Being overweight
- A past incision (cut) in the abdominal wall – This will always be a weak area. Having an infection in the area after surgery makes a hernia more likely. It can happen shortly after surgery or years later.
- Anyone can get a hernia at any age, but they are more common as you get older. Certain activities make getting a hernia more likely, including coughing a lot, straining when you urinate (pee) or have a bowel movement, or needing to strain for other reasons.
About Ventral Hernia Repair
Your doctor can repair a hernia with surgery to bring the tissue together and close the gap. They may use mesh to provide further strength. This can be done through a single large incision, or cut. Doctors call this “open” surgery), or through several small incisions (called laparoscopic or robotic surgery). The operation is called laparoscopic or robotic ventral hernia repair. It is a type of minimally invasive surgery. You may recover faster from minimally invasive surgery and have less pain.
What are the advantages of minimally invasive ventral hernia repair compared to open surgery?
- Less time in the hospital
- Less pain
- Earlier return to work and other activities
- Smaller incisions/scar(s)
- Less risk of infections and problems during healing
The results of every surgery are different depending on your health and the procedure.
Is laparoscopic/minimally invasive ventral hernia surgery for you?
Minimally invasive hernia repair has many benefits. However, it might not be an option if:
- You have had previous abdominal surgery
- Your hernia is in a place where surgery is difficult
- You have certain medical conditions
You need a complete physical examination by a surgeon who is trained and qualified in minimally invasive hernia repair. Finding an experienced surgeon is important. The surgeon and your primary care provider can help you decide if this operation is the best choice for you.
How should I prepare for my ventral hernia repair?
You will need a full physical examination. You might need some tests to make sure you are healthy enough for surgery. These may include an EKG, blood tests, and X-rays.
The doctor who will do your laparoscopic hernia repair will talk with you about the risks and benefits of surgery. Your doctor’s office will tell you what to do before surgery and what to avoid. The exact instructions depend on your doctor, but here are some common things to do.
- Quit smoking. Smoking may raise the risk that the hernia will come back after surgery. It may also raise your risk of getting an infection. Your doctor might require you to quit smoking at least 4 to 6 weeks before surgery.
- You might need to stop taking certain medicines before surgery. These include aspirin, blood thinners, and supplements such as Vitamin E. Do not take diet medications or St. John’s wort for the two weeks before surgery. Talk to your surgeon about what to stop taking before surgery.
- Take a shower the night before surgery or the same morning. Your surgeon might ask you to use an antibiotic soap.
- Stop eating and drinking at the time your doctor tells you before surgery. Your intestines might need to be empty and clean before surgery. If so, you might need to drink a special cleansing solution or only clear liquids for a certain time before the operation.
- The morning of your surgery, you may take medications your doctor told you are allowed. Take them with just a sip of water.
Some hernia repairs are same-day surgery, allowing you to go home following your repair. Other larger or more complex hernia repairs require staying in the hospital for some time for additional monitoring and pain control.
Finally, ask your doctor or nurse how much help you might need after going home from the hospital. You can arrange for this help before your surgery. If you need to find someone to help, ask to talk with a hospital or clinic social worker. They can help you find someone in your area.
How is minimally invasive ventral hernia repair done?
You usually arrive at the hospital the morning of the operation. A nurse or other health care provider will put in an IV to give anesthesia, other medicines, and fluids during surgery. You may start getting medicines such as antibiotics before surgery starts. Your anesthetic will last through your surgery and for several hours afterward.
You will probably have general anesthesia for your hernia repair. This means you are asleep during surgery.
To start a minimally invasive hernia repair, your doctor makes an incision in the abdomen and inserts a small device called a port. This looks like a small narrow tube. Next, they insert a small camera through the port. This is the laparoscope. The camera shows the surgery on a screen in the operating room.
Once the doctor can see clearly, they put in more ports into the abdomen and insert long, narrow instruments through them to fix the hernia. You will probably have 3 to 5 incisions (cuts), from one-quarter inch to one-half inch long. Your doctor may choose to sew your hernia defect back together, and often they need to put in a mesh patch to make the repair stronger.
Can I have a minimally invasive ventral hernia repair?
Minimally invasive hernia repair is not the best option for some people, and other times the surgeon may need to switch to an open surgery in the operating room. Some reasons for having or switching to open surgery are:
- You have obesity – This means being very overweight.
- You have too much scar tissue in your abdomen from prior surgery.
- The surgeon cannot see very well inside your body through the laparoscope.
- You have bleeding problems during surgery.
- There is an injury to the bowel/intestines or another organ during surgery.
- Your hernia may be too small or too large for minimally invasive surgery – this will be a decision between you and your surgeon prior to surgery.
The surgeon will switch to open surgery if it is the safest option for you. They might not know this until after the operation starts. They will use their best judgment about the safest surgery for you.
What are the possible complications of minimally invasive ventral hernia repair?
Complications are problems that happen during medical care or afterward. This operation is considered safe, but any operation can have complications. Complications of this operation can include:
- A bad reaction to anesthesia
- Injury to the bowel/intestines or other organs
- Pneumonia (a lung infection)
- Blood clots
- Heart problems
You may get a lump or some swelling in the area where the hernia was. This is often caused by fluid collecting in that space underneath the skin. It usually goes away on its own over a few weeks to months. If not, your doctor may choose to remove the fluid with a needle in their office.
If the mesh becomes infected, your doctor may need to take it out or replace it.
Any time a hernia is repaired, it can come back. You can increase the chance for long term success by maintaining a healthy weight and not smoking.
Ask your doctor about their training and experience doing minimally invasive and open ventral hernia repair. You can also talk with your doctor about whether the risks of surgery are less than the risks of not getting treatment.
What to Expect After Surgery
What should I expect after minimally invasive ventral hernia repair?
You will go to the recovery room after surgery. Nurses will check on you for an hour or two until you are fully awake.
You may be able to go home the same day. Or you might need to stay in the hospital for a night or longer. This depends on how complicated your surgery was and your general health.
Will I be in pain?
Hernia repairs do cause pain, though this is different for each patient depending on the type and location of the repair. You can take non-prescription medications for pain, unless your doctor tells you not to. Acetaminophen (Tylenol®) and ibuprofen (Advil®) are non-prescription pain medicines. Putting ice on your incisions can also help. Ask your doctor or nurse about the correct way to use ice.
Your doctor might prescribe pain medicine. If your prescription medicine does not help the pain, call your doctor’s office.
What activities can I do after surgery?
You should be able to get up and walk around at home after your surgery. Your doctor will talk with you about how active to be. This includes how much weight you should lift, and other activities. Follow your doctor’s advice carefully.
Most people can start doing their normal activities soon after surgery. This includes taking a shower, driving, walking up stairs, working, and having sex. Ask your doctor about specific activities and types of work.
When should I see my doctor after surgery?
Talk with your doctor about when they would like to see you after hernia surgery. This is usually 1 to 4 weeks later.
Brought to you by:SOCIETY OF AMERICAN GASTROINTESTINAL AND ENDOSCOPIC SURGEONS (SAGES)
11300 West Olympic Blvd., Suite 600
Los Angeles, CA 90064
- (310) 437-0544
- February 19, 2022