Ventral hernia repair

You will probably receive general anesthesia for this surgery. This will make you asleep and pain free.

If your hernia is small, you may receive a spinal or epidural block and medicine to relax you. You will be awake, but pain-free.

• Your surgeon will make a surgical cut in your abdomen.
• Your surgeon will find the hernia and separate it from the tissues around it. Then the contents of the hernia, such as intestines, will be gently pushed back into the abdomen. Your surgeon will only cut the intestines if they have been damaged.
• Strong stitches will be used to repair the hole or weak spot caused by the hernia.
• Your surgeon may also lay a piece of mesh over the weak area to make it stronger. Mesh helps prevent the hernia from coming back.

Your surgeon may use a laparoscope to repair the hernia. This is a thin, lighted tube with a camera at the end. It lets your surgeon see inside your belly. Your surgeon inserts the laparoscope through a small cut in your belly and inserts the instruments through other small cuts. This type of procedure often heals faster, and with less pain and scarring. Not all hernias can be repaired with laparoscopic surgery.

Ventral hernias are fairly common in adults. They tend to get bigger over time and there may be more than one in number.

Risk factors include:

• A large abdominal incision
• Being overweight
• Diabetes
• Straining when using the bathroom
• Coughing a lot
• Heavy lifting
• Pregnancy

Sometimes, smaller hernias with no symptoms can be watched. Surgery may pose greater risks for people with serious medical problems.

Without surgery, there is a risk that some fat or part of the intestine will get stuck (incarcerated) in the hernia and become impossible to push back in. This is usually painful. The blood supply to this area may become cut off (strangulation). You may experience nausea or vomiting, and the bulging area may turn blue or a darker color due to loss of blood supply. This is a medical emergency and urgent surgery is needed.

To avoid this problem, surgeons often recommend repairing the ventral hernia.

Get medical care right away if you have a hernia that does not get smaller when you are lying down or a hernia that you cannot push back in.

The risks of ventral hernia repair are usually very low, unless the patient also has other serious medical problems.

Risks of having any anesthesia and surgery are:

• Reactions to medicines
• Breathing problems, such as pneumonia
• Heart problems
• Bleeding
• Blood clots
• Infection

A specific risk of ventral hernia surgery is injury to the bowel (small or large intestine). This is rare.

Your surgeon will see you and give you instructions.

An anesthesiologist will discuss your medical history to decide the right amount and type of anesthesia to use. You may be asked to stop eating and drinking 6 to 8 hours before surgery. Make sure you tell your surgeon or nurse about any medicines, allergies, or history of bleeding problems.

Several days before surgery, you may be asked to stop taking:

• Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn)
• Other blood-thinning medicines
• Certain vitamins and supplements

Most ventral hernia repairs are done on an outpatient basis. This means that you will likely go home on the same day. If the hernia is very large, you may need to stay in the hospital for a couple of days.

After surgery, your vital signs such as pulse, blood pressure, and breathing will be monitored. You will stay in the recovery area until you are stable. Your surgeon will prescribe pain medicine if you need it.

Your surgeon or nurse may advise you to drink plenty of fluids along with a fiber-rich diet. This will help prevent straining during bowel movements.

Ease back into activity. Get up and walk around several times a day to help prevent blood clots.

Following surgery, there is a low risk that the hernia may come back. However, to reduce the risk of getting another hernia, you need to maintain a healthy lifestyle, such as maintaining a healthy weight.

Miller HJ, Novitsky YW. Ventral hernia and abdominal release procedures. In: Yeo CJ, ed. Shackelford's Surgery of the Alimentary Tract. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 52.

Poulose BK, Carbonell AM, Rosen MJ. Hernias. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 45.

Webb DL, Stoikes NF, Voeller GR. Open ventral hernia repair with onlay mesh. In: Rosen MJ, ed. Atlas of Abdominal Wall Reconstruction. 2nd ed. Philadelphia, PA: Elsevier; 2017:chap 8.

Updated by: Debra G. Wechter, MD, FACS, General Surgery Practice Specializing in Breast Cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.