Ventral Hernia Repair

A ventral hernia occurs when there is a weakness or hole in the muscles of the abdomen and a loop of intestine or abdominal tissue pushes through the muscle layer. If the hernia reduces in size when a person is lying flat or in response to manual pressure, it is reducible. If it cannot be reduced, it is irreducible or incarcerated, and a portion of the intestine may be bulging through the hernia sac. A hernia is strangulated if the intestine is trapped in the hernia pouch and the blood supply to the intestine is decreased. This is a surgical emergency.

The three types of Ventral Hernias are:

Epigastric (stomach area) hernia: Just below the breastbone to the navel/umbilicus (belly button).

Umbilical hernia: Occurs in the area of the belly button.

Incisional hernia: Develops at a previous surgical incision site, as a result of scar tissue or weakened muscles at the site.

The most common symptoms are:

• Visible bulge in the abdominal wall, especially with coughing or straining
• Hernia site pain or pressure

Sharp abdominal pain and vomiting may mean that the intestine has slipped through the hernia sac and is strangulated. This is a surgical emergency and immediate treatment is needed.² 

History and Physical

The site is checked for a bulge.

Additional Tests (see Glossary)

• Other tests may include:
• Ultrasound
• Computerized tomography (CT) scan
• Blood tests
• Urinalysis
• Electrocardiogram (ECG)—for patients over 45 or if high risk of heart problems

Surgical Treatment

The type of operation depends on the hernia  size, location, and if it is a repeat hernia. Your health, age, anesthesia risk, and the surgeon’s expertise are also important. An operation is the only treatment for a hernia repair.^{1, 2}

Open Hernia Repair

The surgeon makes an incision near the hernia site. The bulging tissue is gently pushed back into the abdomen. Sutures, or a tissue flap is used to close the muscle. With large hernias, small drains may be placed. Primary open repair without mesh is often used for defects less than 2 cm¹. The site is closed using sutures, staples, or surgical glue.

Open Mesh Repair

The hernia sac is removed. Mesh is placed over the hernia site. The mesh is attached using sutures sewn into the stronger tissue surrounding the hernia site. Mesh is often used for large hernia repairs and may reduce the risk that the hernia will come back.⁸ 

Laparoscopic Hernia Repair

Repair is done through several small incisions made in the abdomen. Ports or trocars (hollow tubes) are inserted into the openings. Surgical tools are placed into the ports. The abdomen is inflated with carbon dioxide gas to make it easier for the surgeon to see the hernia. Mesh is sutured, stapled, or clipped to the muscle around the hernia site. The hernia site can also be sewn directly together.

Robotic Hernia Repair

The surgeon controls the operation using robotic arms attached to small tools and a camera placed into the incisions. Robotic and laparoscopic repair have similar outcomes.^7-10 

Nonsurgical Treatment

Watchful waiting is an option for a hernia without symptoms. In a large study, 1 out of 25 (4%) who waited, needed emergency surgery within 5 years.³ All patients should get treatment if they have sudden sharp abdominal pain and vomiting. These symptoms can indicate an incarcerated hernia and bowel obstruction.

Abdominal binders (support belt) may help a patient feel more comfortable. Surgery is the only option to fix the hernia.

Home Medication

Bring a list of all of the medications you are taking. This includes over-the-counter medication and supplements, weight loss meds and injections, alcohol, cannabis/ marijuana, and other drugs. Some may have to be stopped or changed before your surgery because of the effect on anesthesia and your recovery. You can usually take your morning medication with a sip of water. Learn more.

Anesthesia

Ask about what type of anesthesia (pain control) you will have during surgery. General, regional, epidural and spinal may be options. You will also be asked about your health, allergies, and if you have had nausea and vomiting after anesthesia in the past.

Smoking and vaping cigarettes or marijuana can increase your risk of problems with breathing and wound healing. Quitting at least 4 weeks before surgery can decrease these risks. Quitting for at least one day is needed to prevent irregular heart beats and blood pressure issues. Learn more.

Prepare for Home Care

Ask for clear guidance on how to care for your incision, your activity, and the type of help you may need.

Length of Stay

You may go home the same day for a small repairs.⁴ You may stay overnight for repair of a large or incarcerated hernia or if you have severe vomiting or cannot pass urine.

Questions to Ask About Your Operation

• What are the risks of this procedure for me?
• Will you be performing the entire operation yourself?
• What level of pain should I expect and how will it be managed?
• How long will it be before I can return to my normal activities (work, driving, lifting)

Check with your surgeon for when you have to stop eating and drinking. Usually, you stop eating for 6 hours before surgery. You may drink clear liquids up to 2 hours before.⁵

Shower and wash your abdomen the evening before and again in the morning of surgery. Use a clean cloth and antibacterial soap (ex. Dial^®).¹⁵

Brush your teeth and rinse your mouth with antiseptic mouthwash.

Do not shave your abdomen for 5-7 days before surgery. This will decrease any small cuts or ingrown hairs at the incision site. Your surgical team will clip the hair nearest the incision site.¹⁵

What to Bring

• Insurance card and identification
• Advance directives (see glossary)
• List of medicines
• Loose-fitting, comfortable clothes
• Slip-on shoes that don’t require that you bend over

What You Can Expect

An identification (ID) bracelet and allergy bracelet with your name and hospital/clinic number will be placed on your wrist. These should be checked by all health team members before any procedures or given any medicine.

Fluids

An intravenous line (IV) will be started to give your fluids and medication.

After Your Operation

You will be moved to a recovery room where your heart rate, breathing rate, oxygen level, blood pressure, glucose level, and urine will be watched. Ask for warm blankets if you feel cold in the recovery room. Keeping your body warm after surgery can decrease your risk of infection.¹⁵ Be sure that all visitors wash their hands.

Preventing Pneumonia and Blood Clots

Movement and deep breathing after your operation can help prevent blood clots, fluid in your lungs, and pneumonia. Every hour, take 5 to 10 deep breaths and hold each breath for 3 to 5 seconds.

The risk of blood clots are decreased by getting up and walking 5 to 6 times per day, wearing compression stockings or compression boots on your legs, and, for high-risk patients, taking a medication that thins your blood.

Thinking Clearly

Anesthesia and pain medication may cause you to feel tired and be forgetful for 2-3 days after surgery. You should not drive, drink alcohol, or make any big decisions for at least 2 days.

Nutrition

• When you wake up from the anesthesia, you will start drinking fluids. If you do not feel sick, you can begin eating regular foods.
• Continue to drink about 8 to 10 glasses of water each day.
• Eat a high-fiber diet so you don’t strain while having a bowel movement. Add over the counter stool softeners if needed such as Metamucil™ and or FiberCon™.
  • Foods high in fiber include beans, bran cereals and whole-grain breads, peas, dried fruit (figs, apricots, and dates), raspberries, blackberries, strawberries, sweet corn, broccoli, baked potatoes with skin, plums, pears, apples, greens, and nuts.

Activity

• Slowly increase your activity. Patients usually take 1 to 3 weeks to return comfortably to normal activity.
• Do not lift items heavier than 10 pounds or participate in strenuous activity for at least 6 weeks. Sexual activity can be resumed following any lifting/activity restrictions.
• Discomfort in the abdomen, while improved may still be felt in about one-third of patients 3 years after surgery.^{9, 13}
• Lifting limitations may last for 6 months for complex or recurrent repairs. 

Wound Care

• Always wash your hands before and after touching near your incision site.
• You may take a shower usually 1-2 days after surgery.¹⁵ Let the water run over the incision site, but do not scrub.
• Do not soak in a bathtub until your stitches, Steri-Strips^®, or staples are removed.
• A small amount of drainage from the incision is normal. If the dressing is soaked with blood, call your surgeon.
• If you have Steri-Strips leave them in place. They will fall off in 7 to 10 days.
• If you have surgical glue covering over the incision, let the glue to flake off on its own.
• Avoid wearing tight clothing. It may rub your incisions and make it harder for them to heal.
• Protect the new skin, especially from the sun. The sun can burn and cause darker scarring.
• Your scar will heal in about 4 to 6 weeks and will become softer and continue to fade over the next year.

Learn more 

When to Contact Your Surgeon

Contact your surgeon if you have:

• Pain that gets worse or will not go away 
• A fever of more than 100.4°F (38.0°C)
• Repeated vomiting
• Swelling, redness, bleeding, or foul-smelling drainage from your wound site
• Swelling of your abdomen
• No bowel movement by 3 days after the operation 

Ask about the level of pain you should expect and how it should be managed. Your pain can usually be controlled using acetaminophen (Tylenol) and Ibuprofin (Motrin, Advil). Nonmedication therapies, such as ice may also be effective. For severe pain that is keeping you from moving and sleeping, an opioid may be needed. By day 4, most people report no severe pain after an operation. See the Safe and Effective Pain Control Guide below or for more information.

Pain and Discomfort after Ventral Hernia Repair

At 1-, 6-, and 12-months follow-up, more laparoscopic repair patients experienced discomfort and movement limitations. After 6, 12 and 36 months, there were no differences in quality of life between repair types.^{9, 13, 14}

At three years, 33% of patients reported feelings of discomfort and 21% reported mild bothersome pain.