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Ventral and incisional

What are ventral and incisional ? A hernia may be painless, but you may feel discomfort when you lift heavy objects, cough, A ventral hernia is a type of abdominal (belly) or strain during urination or bowel hernia. Some of the contents of the abdomen movements, or with prolonged standing or bulge through a well-defined weak area sitting. (defect) in the abdominal muscles. The discomfort may be sharp, or a dull ache The defect which causes the hernia can that gets worse towards the end of the day. sometimes be present from birth. Any continuous or severe discomfort, redness, or vomiting associated with the bulge Ventral hernias occur through the front of the are signs that the hernia may be strangulated. abdomen, most commonly either between the These symptoms are cause for concern and umbilicus (belly button) and breast bone you must immediately contact your GP or the (epigastric hernia) or around the umbilicus emergency services. itself (para-). What is the treatment for a ventral or In some cases, a hernia may occur through a incisional hernia? weak scar from an unrelated operation (incisional hernia). A hernia which has been Not all hernias require treatment. Hernias previously repaired may also come back which are causing few or no symptoms may (recurrent hernia). not require treatment.

In adults, once present, hernias will not For those hernias which do require treatment, resolve of their own accord. only an operation offers a chance of a cure.

Some patients will present with a large Surgery can be offered to most patients who swelling in the upper abdominal wall due to require it, but some may not be fit enough, generalised weakness of the muscles, rather particularly if the hernia is large. than a well-defined defect. This is termed a divarification of the rectus muscles. In almost Surgery is usually ineffective for treating a all patients this does not require treatment. divarification.

How do I know if I have a hernia? What are the alternatives to surgery?

A hernia is usually recognized as a bulge under There are few options, other than surgery, the skin. Often, the swelling can be pushed available for a patient with a ventral hernia. back temporarily, only to pop out again later. An abdominal corset can be tried, but is often ineffective. 44

How are ventral and incisional hernia s For larger hernias, laparoscopic surgery may repaired? offer

The two methods of repair are:  Less post-operative pain  Shortened hospital stay 1. The traditional or ‘open’ approach is  Faster return to regular diet performed through an incision in the abdominal wall directly over the However, laparoscopic surgery is probably hernia. The hernia is pushed back into associated with a slightly higher likelihood of the abdomen. A small defect may be recurrence of the hernia. closed with stitches alone, but most will require a plastic mesh to reinforce involves passing instruments and the repair. placing a mesh directly into the abdominal

cavity. There is a small risk of damage to the 2. Laparoscopic (keyhole) repair. abdominal contents.

In this technique, a narrow camera is At open surgery, the abdominal cavity can inserted into the abdominal cavity. usually be avoided and the mesh is placed Several additional narrow instruments within, or outside, the abdominal muscles. are then inserted through separate incisions. The incisions are short (5- Patients undergoing open repair of large 10mm) and some distance form the hernias will often need a temporary drain tube hernia itself. under the skin. This is less common at

laparoscopic surgery. The hernia is pulled back into the

abdomen. A plastic mesh is then fixed Is my hernia suitable for laparoscopic repair? over the defect inside the abdomen, with stitches or tacks. Your surgeon will assess you thoroughly and explain the options to you. If there is a strong What anaesthetic will I need? reason to prefer one type of surgery, this will be recommended. A full general anaesthetic is required for the laparoscopic technique. Laparoscopic surgery may not be best for patients who have had previous extensive A general anaesthetic is also necessary for abdominal surgery. It cannot be offered to many open repairs but some smaller hernias patients unfit for a general anaesthetic. may be suitable for open repair under spinal or local anaesthetic. What complications can occur?

What are the advantages of each type of is usually safe but complications repair? may occur as with any operation.

Small hernias can be repaired, using either Complications include adverse reactions to technique, as a day case. general anaesthesia, chest infection, bleeding, or injury to the intestines or other abdominal For some small hernias, the scarring is less organs. Injury the abdominal organs may with an open operation than with a require reconstructive surgery. laparoscopic repair 44

when to stop eating and drinking. Please Wound infection is a possibility and can be a problem when a mesh is used: an infected How long do I have to stay in hospital? mesh may need to be removed. Most hernia operations are performed as a A hernia may return following an apparently day case or with a short inpatient stay. successful operation. The risk can be 10-15%. Therefore many patients will go home on the The risk of recurrence increases each time a same day, or the day following your operation. hernia is repaired. If a larger hernia has been repaired, or if There is a small risk of a clot forming in the leg drains are necessary, you may stay in hospital veins (Deep Venous Thrombosis or DVT) for several days. associated with any form of abdominal surgery. This is the same type of clot that Your surgeon will be able to advise you passengers on long aeroplane flights further. may develop. A DVT may cause the leg to swell and occasionally the clot may break What should I expect after surgery? loose and lodge in the lung (Pulmonary embolism or PE). Overall the risk of a DVT or Patients are encouraged to engage in light PE is small and we will take active measures to activity while at home after surgery. Your minimise this risk to you. surgeon will determine the extent of activity, including lifting and other forms of physical A DVT may only be obvious after you have exertion. Please follow your surgeon’s advice gone home. If you notice any swelling of the carefully. calf or more rarely the thigh, or you experience pain or tenderness in the calf, or Significant post-operative discomfort is notice that your leg is shiny or discoloured you unusual . Patients will require pain relieving should seek medical advice quickly. You medication and will be given an adequatre should also contact a doctor immediately if supply on discharge. Most patients are able to you develop shortness of breath or pain on get back to normal activities in a short period breathing following surgery. of time.

What happens before the operation? What will my abdomen look like after surgery? Prior to admission you will need to have a pre- operative assessment. This is an assessment of A successful operation should abolish any your health to make sure you are fully swelling due to the hernia. However, the prepared for your admission, treatment and overall shape of you abdomen otherwise will discharge. The pre-operative assessment remain the same. nurses are there to help you with any worries or concerns that you have, and can give you If an incisional hernia was repaired, it is likely advice on any preparation needed for your that your original scar will persist. If you have surgery. an open repair, it will possibly be larger; if you have laparoscopic surgery, there will be Before the date of your admission, please read additional scars. very closely the instructions given to you.

If you are undergoing a general anaesthetic For some patients with large para-umbilical you will be given specific instructions about hernias, it may be best to excise the navel. 44

Make sure you discuss any concerns regarding When should I seek help? cosmetic appearance with your surgeon before your operation.  If you develop a fever above 38C or chills. I can still feel a swelling after my operation  Persistent vomiting or nausea.  Increasing abdominal pain or A hernia creates a space in the fat under the distension. skin. In a large hernia, the space is similarly  Increasing pain, redness, swelling or large. In most cases, the space shrinks and discharge of any of the wound sites. disappears after the operation.  Severe bleeding.  Difficulties in passing urine However fluid may collect in this space and cause a further swelling. The liquid may be Where should I seek advice or help? watery tissue fluid (seroma), blood (haematoma) or both. If you are unwell or develop any of the symptoms above please contact your GP or Often, the best advice is to wait for the body 111. If you are not unwell but do wish to to reabsorb the fluid but if the collection is discuss a problem please contact your causing significant problems, it may be surgeons secretary via switch board and they advisable to drain it. Depending on the size, will arrange for you to be seen in clinic. the collection can be drained simply with a syringe or a temporary drainage tube may have to be inserted.

If a laparoscopic repair was performed, gas will have been used to create a space in the abdominal cavity for the operation. It is quite February 2020 v3 normal for some of this gas to remain in the Review date: February 2022 space occupied by the hernia under the skin. Consultant Upper GI Surgeon There may be an unusual sensation at the site of the hernia immediately after the operation- it can feel “crackly”. This sensation disappears in a couple of days as the body safely absorbs the gas.

If you feel a swelling at the site of your operation, particularly if one was not present immediately afterwards, you should seek help.

If a mesh has been used and there is suspicion of infection at the site of the repair, you should ask to be seen back at the hospital on the Ambulatory Care Unit.