General Information
A hernia is a defect in the muscle lining of the abdomen that allows abdominal
contents to bulge through. These defects may be congenital or at the site of
a previous surgery.
A ventral hernia is one
that occurs on the front wall of the abdomen. A hernia in the belly button or
an umbilical hernia is a type of a ventral hernia
Many ventral hernias occur
after a prior abdominal operation. When surgery is done on the abdomen, the
muscles and their outer covering (fascia) are sewn back together with strong
suture. The suture’s job is to hold things together until the body can
heal them in place. Sometimes this healing process leaves weak areas along the
old incision that, over time, develop into hernias.
Hernias will not go away
without surgical repair.
Symptoms/Diagnosis
Patients will typically notice a bulge or swelling in the area of the hernia.
A ventral hernia can cause pain, bloating, or bowel obstruction. The pain may
worsen with straining or coughing.
If the skin overlying a
hernia becomes red and extremely painful, you should seek immediate medical
attention. This may represent a surgical emergency.
Many ventral hernias can
be diagnosed by a thorough history and physical exam. Occasionally an ultrasound,
computed tomogram (CT scan), or MRI is needed to confirm the diagnosis or identify
bowel or internal organs within the hernia.
Treatment
Your SCOSA surgeon will discuss the potential repair of your hernia at your
appointment.
Traditionally, these hernias
have been repaired by re-opening the old incision and re-closing the abdominal
muscles with the aid of a prosthetic mesh. With this type of repair, patients
typically spend five to six days in the hospital and can usually return to normal
activity in six to eight weeks.
The laparoscopic repair is done from the inside using tiny incisions and a camera.
A piece of prosthetic mesh is placed to cover the defect and secured with strong
sutures and special tacks. The post- operative recovery is much shorter with
this procedure. Patients spend 24-72 hours in the hospital and usually return
to normal activity in one to two weeks.
Laparoscopic surgery normally means less pain, a shorter hospital stay, a faster
return to your day-to-day life, and an improved cosmetic result.
Surgery: Before
and After
The preoperative period
Your SCOSA surgeon will
review with you the risks and benefits of the procedure at your clinic appointment.
You will be sent for some routine lab work, X-rays, and an EKG. In addition,
your SCOSA surgeon will set up any further testing required before surgery.
On the day before surgery,
you should have only a clear liquid diet and nothing to eat or drink after midnight
with the exception of some medications. You may be asked to complete a bowel
preparation to minimize you chances of infection. This will be explained by
your SCOSA surgeon. You should shower the day before or the morning of your
operation.
Medications such as aspirin,
coumadin, or other blood-thinning agents should be stopped at least seven days
prior to surgery. Vitamin E, diet medications and St. John’s Wort should
also be stopped at least one week prior to surgery.
Please go over any specific
questions with your SCOSA surgeon.
Patients are encouraged
to stop smoking and begin an exercise program in advance of any operation.The
day of operation
Your SCOSA doctor will give
you detailed instructions about where and when you should be the morning of
your surgery.
Once you arrive at the hospital,
a nurse will start an IV, and you will meet with your anesthesiologist and your
SCOSA surgeon to answer any last-minute questions. You will likely receive some
pre-operative medications and then be taken to the operating room.
After surgery, you will
be in the recovery room until you are completely awake.
Your room will include a
breathing device called an incentive spirometer. It is important that you use
this several times each hour when you are awake. The nurses on the floor will
give you specific instructions about its use. In addition, it is important that
you get out of bed and walk in the hall. We like our patients to do this at
least once the afternoon after surgery and then at least four times each following
day. These activities are vitally important to prevent a blood clot from forming
in your legs, pulmonary embolism, breathing problems, and pneumonia.
After-effects of
surgery
Most patients spend one or two nights in the hospital. You should follow up
with your SCOSA surgeon two weeks after the operation.
The long-term recurrence
rate with the laparoscopic repair is not yet known.
Although this operation is very safe and has a less than 1 percent mortality
rate, this is an important decision for you and your physician. Potential acute
complications are rare, but can include bleeding, infection, damage to stomach,
esophagus, spleen or other internal organs. Other less common risks are hernia,
wound problems, need for open surgery or re-operation.
Some patients will develop a fluid collection or swelling in the area of the
hernia. This is the result of fluid build-up in the empty space that used to
be occupied by the hernia. In most cases, this will resolve without treatment
in a few weeks. Your surgeon may elect to aspirate the fluid with a needle or
place a small drain if it does not go away on its own.
You should call your SCOSA surgeon immediately if you experience any of the
following after this procedure: persistent fever of more than 101 degrees, persistent
nausea or vomiting; worsening abdominal pain- uncontrolled by medication; increasing
abdominal swelling; chest pain; shortness of breath; redness around or pus coming
from incisions; or the inability to tolerate liquids.
Outcomes
Patients usually return to normal activity in one to two weeks.
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