A ventral hernia repair is a common surgical procedure that fixes a weakness in the abdominal wall. This weakness allows internal tissues or organs to push outward, creating a noticeable bulge. The term “ventral” refers to the front or belly area. The surgery involves returning the protruding tissue into the abdominal cavity and reinforcing the muscle layer. This repair alleviates symptoms and prevents serious complications if the hernia is left untreated.
Identifying a Ventral Hernia and When Repair is Needed
A ventral hernia occurs when internal tissue pushes through a defect in the abdominal wall, resulting in a visible bulge. This bulge may become more prominent when a person laughs, coughs, or strains. Common types include incisional hernias (at a previous surgical scar) and umbilical hernias (near the belly button).
Causes often relate to factors that increase pressure or weaken the muscle over time, such as prior abdominal surgery, obesity, pregnancy, or heavy lifting. While small hernias may not cause symptoms, others can cause pain or pressure at the site. Diagnosis is typically made through a physical exam, sometimes supported by imaging like a CT scan for complex cases.
Repair is necessary because hernias tend to grow and can lead to severe complications. If the tissue becomes trapped outside the abdominal wall (incarceration), it can cause sudden pain and vomiting. A more dangerous condition is strangulation, where the blood supply to the trapped tissue is cut off, requiring immediate emergency surgery. Surgical repair is recommended for most ventral hernias to avoid these life-threatening events.
How the Surgical Repair is Performed
The goal of a ventral hernia repair is to push the protruding tissue back into the abdomen and close the defect. Surgeons use two main approaches: open repair or a minimally invasive technique. The choice depends on the hernia’s size, location, and whether it is a first-time repair or a recurrence.
Open Repair
An open repair involves a single, larger incision made directly over the hernia site. The surgeon separates the herniated tissue, repositions it, and then closes the muscle wall defect. For defects larger than two centimeters, this procedure almost always involves placing a surgical mesh to reinforce the repair and reduce recurrence risk.
Minimally Invasive Repair
Minimally invasive approaches, including laparoscopic and robotic surgery, use several small incisions (ports) for a camera and specialized instruments. The surgeon inflates the abdomen with gas to create a working space, allowing them to view the hernia from the inside. The protruding tissue is pulled back into the cavity, and a mesh material is placed over the defect, often secured with tacks or sutures.
The use of surgical mesh (hernioplasty) is the standard of care for most ventral hernias. Mesh provides a tension-free repair, which significantly lowers the chance of recurrence. Mesh materials can be synthetic (permanent) or biological (absorbed by the body over time). Laparoscopic mesh repair is often associated with less post-operative pain, a shorter hospital stay, and a quicker return to daily activities than the open method.
Life After the Procedure
Recovery varies based on the surgical method and hernia complexity. Laparoscopic repair often results in less pain and a shorter hospital stay, sometimes allowing patients to go home the same day. Open repair, especially for larger hernias, may require a longer inpatient stay.
Pain management is a priority in the first few days, usually involving prescribed and over-the-counter medication. Patients are encouraged to walk shortly after surgery to promote circulation. Some swelling, bruising, or a firm lump (a temporary fluid collection called a seroma) is normal at the site.
Strict physical activity restrictions are implemented to allow the abdominal wall to heal properly. Patients must avoid strenuous activities, including heavy lifting, for about six weeks. The lifting restriction is typically set at no more than 10 to 15 pounds. Most individuals with desk jobs can return to work within one to two weeks, but those with physically demanding careers may need four to six weeks.