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Ventral Hernia Repair

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AMERICAN COLLEGE OF SURGEONS • DIVISION OF EDUCATION Ventral Hernia Repair Benefits and Risks of Your Operation Patient Education B e n e fi t s — An operation is the only This educational information is way to repair a hernia. You can return to help you be better informed to your normal activities and, in most about your operation and cases, will not have further discomfort. empower you with the skills and Risks of not having an operation— knowledge needed to actively The size of your hernia and the pain it participate in your care. causes can increase. If your intestine becomes trapped in the hernia pouch, you will have sudden pain and vomiting Keeping You Common Sites for Ventral Hernia and require an immediate operation. Informed If you decide to have the operation, Information that will help you possible risks include return of the further understand your operation The Condition hernia; infection; injury to the bladder, and your role in healing. A ventral hernia is a bulge through blood vessels, or intestines; and an opening in the muscles on the continued pain at the hernia site. Education is provided on: abdomen. The hernia can occur at a Hernia Repair Overview .................1 past incision site (incisional), above the navel (epigastric), or other weak Condition, Symptoms, Tests .........2 Expectations muscle sites (primary abdominal). Treatment Options….. ....................3 Before your operation—Evaluation may include blood work, urinalysis, Risks and Common Symptoms Possible Complications ..................4 ultrasound, or a CT scan. Your surgeon ● Visible bulge on the abdomen, and anesthesia provider will review Preparation especially with coughing or straining your health history, home medications, and Expectations .............................5 ● Pain or pressure at the hernia site and pain control options. Your Recovery and Discharge ....................................6 The day of your operation—You will Pain Control.............................................7 Treatment Options not eat or drink for 6 hours before the Glossary/References ........................8 operation. Most often, you will take your Surgical Procedure home medication with a sip of water. You will need someone to drive you home. Open hernia repair—An incision is made near the site, and the hernia Your recovery—You may go home within is repaired with mesh or by suturing 24 hours for small hernia procedures (sewing) the muscle closed. but may need to stay in the hospital longer for more complex repairs. The Laparoscopic hernia repair—The average length of stay for patients with hernia is repaired by mesh or sutures a complex hernia repair is 1.5 days.1 inserted through instruments placed into small incisions in the abdomen. Call your surgeon if you have severe pain, stomach cramping, chills with a Nonsurgical Procedure high fever (higher than 101°F), odor or Watchful waiting is an option for increased drainage from your incision, adults with hernias that are reducible or no bowel movement for 3 days. and not uncomfortable.1-3 This first page is an overview. For more detailed information, review the entire document. AMERICAN COLLEGE OF SURGEONS • SURGICAL PATIENT EDUCATION • www.facs.org/patienteducation The Condition, Symptoms, Ventral Hernia Repair and Diagnostic Tests SAMPLE Keeping You Abdominal muscle Informed Peritoneum Abdominal (lining of abdomen) Wall Hernias They are also called Large hernia with ventral hernias. loop of intestine They can occur: • At birth (congenital) Small hernia with • Over time due to intestine bulge muscle weakness • At a past incision site Fat Incisional Hernias2-4 Incisional hernias can develop at the laparoscopic port site in 5 of 1,000 patients and in up to 150 of 1,000 patients who have had a prior open abdominal incision. Most appear in Symptoms the first 5 years after an The most common symptoms of a hernia are: operation. Risk factors The Condition ● Visible bulge in the abdominal wall, that can contribute The Hernia especially with coughing or straining to incisional hernia formation include: A ventral hernia is a bulge through an opening in ● Hernia site pain or pressure the muscles on the abdomen. If the hernia reduces • Obesity, which Sharp abdominal pain and vomiting in size when a person is lying flat or in response creates tension may mean that the intestine has slipped to manual pressure, it is reducible. If it cannot and pressure on through the hernia sac and is strangulated. be reduced, it is irreducible or incarcerated, abdominal muscles This is a surgical emergency and and a portion of the intestine may be bulging immediate treatment is needed. • Large abdominal through the hernia sac. A hernia is strangulated incisions if the intestine is trapped in the hernia pouch • Postoperative and the blood supply to the intestine is Common Tests infection (note that decreased. This is a surgical emergency.2 smoking is related to History and Physical A primary abdominal hernia occurs higher infection rates) spontaneously at an area of natural The site is checked for a bulge. • Weakness of the weakness of the abdominal muscle. connective tissue Additional Tests (see Glossary) An incisional hernia bulges through a past (the material between Other tests may include: the cells of the body incision site. This issue can be the result of that gives it strength, scar tissue or weak muscles around the site. ● Ultrasound sometimes called An epigastric hernia bulges ● Computerized tomography (CT) scan the cellular glue) midline above the umbilicus. ● Blood tests • Diabetes mellitus ● Urinalysis • Pulmonary disease ● Electrocardiogram (ECG)—for patients over 45 or if high risk of heart problems 2 AMERICAN COLLEGE OF SURGEONS • SURGICAL PATIENT EDUCATION • www.facs.org/patienteducation Surgical and Ventral Hernia Repair Nonsurgical Treatment Open Repair Double Mesh Repair Laparoscopic Repair Single Sutured Muscle Repair Mesh Mesh Repair Repair Laparoscopic Hernia Repair Surgical Treatment Keeping You The surgeon will make several small The type of operation depends on the hernia punctures or incisions in the abdomen. Informed size, location, and if it is a repeat hernia. Your Ports or trocars (hollow tubes) are inserted health, age, anesthesia risk, and the surgeon’s into the openings. Surgical tools are placed Open versus Laparoscopic expertise are also important. An operation into the ports. The abdomen is infl ated Incisional Repair is the only treatment for a hernia repair. with carbon dioxide gas to make it easier There is no one type of repair for the surgeon to see the hernia. Mesh is Open Hernia Repair that is good for all ventral sutured, stapled, or clipped to the muscle hernias. Laparoscopic repairs are The surgeon makes an incision near the around the hernia site. The hernia site associated with lower infection hernia site. The bulging tissue is gently can also be sewn directly together. pushed back into the abdomen. Sutures, rates and shorter hospital mesh, or a tissue fl ap is used to close the stays. There is no diff erence in muscle. With complex or large hernias, small Nonsurgical Treatment recurrence rates, long-term pain, drains may be placed going from inside to or quality of life. For patients the outside of the abdomen. The site is closed Watchful waiting is an option for a hernia with strangulated intestines using sutures, staples, or surgical glue. without symptoms. All patients should and infections, the laparoscopic get treatment if they have sudden sharp approach may not be an option.1,6,7 Open Mesh Repair abdominal pain and vomiting. These Will My Hernia Come Back? The hernia sac is removed. Mesh is symptoms can indicate an incarcerated placed over the hernia site. The mesh hernia and bowel obstruction. Mesh reduces the risk that the hernia will return again.8 Mesh can is attached using sutures sewn into the Trusses or belts made to apply pressure on be tacked, stapled, or sutured. stronger tissue surrounding the hernia a hernia require correct fi tting. When used site. Mesh is often used for large hernia correctly, part or complete control of the Obesity and wound complications repairs and may reduce the risk that the hernia was achieved in 31% of patients, and increase the risk of recurrence.9 hernia will come back. The site is closed 64% found the truss to be uncomfortable.5 You may be placed on a weight using sutures, staples, or surgical glue. loss, smoking cessation, or a diabetes control program before an elective repair to support the best outcome. 3 Ventral Hernia Repair Risk of this Procedure SAMPLE Risks from Outcomes Reported Percentage Keeping You Informed in the Last 10 Years of Literature Urinary retention: Inability to urinate 21% General anesthesia, older age, prostate problems, and diabetes after the urinary catheter is removed may be associated with urinary retention. A temporary catheter or medication may be used to treat retention. Seroma: A collection of 12% A seroma usually goes away on its own within 4 to 6 weeks. serous (clear/yellow) fluid Rarely, the fluid is removed with a sterile needle.10 Recurrence: A hernia can recur Open 12% Recurrence rates are higher for complex or infected hernia repair up to several years after repair Laparoscopic 10% or for repairs done without mesh. In a 5-year follow-up, 6% to 20% 11 of patients with mesh repair experienced serious complications, Non-Mesh17% including bowel obstruction, fistulas, or tunneling wounds.12 Intestines/bowel injury Open Less than 1% Injury will be repaired at the time of operation. If there is bowel Laparoscopic 4.3% 13 leakage into the abdominal cavity, the hernia repair will be done after the bowel heals. A nasogastric (NG) tube will be placed to keep the stomach empty until fluid is moving through the bowel. Risks Based on the ACS Risk Percentage Keeping You Informed Calculator in June 2017* Wound infection: Infection at the Open 3.9% Antibiotics and drainage of the wound may be needed.
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