Ventral (abdominal) hernia

TREATMENT FOR A VENTRAL HERNIA AT THE MEDFEMINA HOSPITAL IN WROCŁAW

What is a ventral hernia and what causes it?

A ventral hernia occurs when abdominal organs push out through the abdominal wall through acquired or natural openings. The contents of your abdomen are held in place by the abdominal wall, mainly the muscles and the aponeurosis (a flattened tendon).

Ventral hernias are usually associated with previous surgeries. The fascia is separated and a hernial sac with its contents protrudes through the opening. This is best seen when you stand: your upper or lower abdomen will not be flat, but there will be a bulging of varying sizes. Some women after giving birth have an “ab gap”, caused by the separation of the long muscles of the abdomen. This is caused by an injury to the muscle called rectus abdominis, which became weak and was pushed away by a growing baby. Some ventral hernias may be inborn due to deficiencies in the fascia. They are present from childhood and get bigger with time. Ventral hernias may also develop after trauma (not only due to surgery, but also blunt trauma to the abdomen). Most often they will develop along the midline of the body, where the abdominal muscles come together in a place called linea alba. These are the weakest spots, and hernias may develop both in the upper or lower abdomen.

Ventral hernias usually occur around the navel (congenital or acquired). Some people have hernias with large openings, stretching from the breastbone to the pubic area.

How to diagnose a ventral hernia?

The easiest method to diagnose a ventral hernia is a physical examination. When a patient is standing, the protruding hernial sac will be visible from the side, in the upper or lower abdomen or the navel. When a patient is lying down, the hernial sac will protrude and go back when the chin is bent towards the neck, and when a patient is asked to cough.

If a doctor is uncertain about a suspected hernia, or a hernia is very small, an ultrasound will be helpful. A CT scan is recommended for large ventral hernias which have already been treated several times.

What happens during surgery for a ventral hernia?

Ventral hernia repairs may be either open or laparoscopic. In both cases a surgical mesh is implanted. According to data from France, 56% of the patients who have had no-mesh repairs will experience a relapse within 5 years. The reason you should consider surgery even if your hernia does not give serious symptoms is the risk of strangulation (tissue getting trapped inside the hernia), which may have serious consequences for your health, possibly life-threatening.

The most common type of surgery worldwide is conventional (open) surgery. During the procedure you will be put to sleep with anaesthesia, and your surgeon will make an incision, prepare the hernial sac with its contents, push it back to its original location in the abdomen and repair the abdominal wall tissues to prevent the hernia from coming back. In open surgery the abdominal wall may be reinforced using different artificial materials (with a synthetic mesh), or without a mesh – using the patient’s own tissues. In laparoscopic surgeries synthetic meshes are used. During surgery the surgeon will find the opening through which the hernia protrudes and will implant a suitable synthetic mesh there.

Are there any non-surgical treatments for a ventral hernia?

No, unfortunately, there are no treatments alternative to surgery. All the other methods involve wearing a hernia belt, also called a truss, for the rest of your life. With time the opening will get bigger, and elastin fibres will be depleted, which will make surgery more difficult.

Which of these treatment methods is currently most recommended?

At the Medfemina hospital in Wrocław we currently recommend conventional (open) surgery.

What are the consequences of an untreated ventral hernia?

If untreated, a hernia tends to get bigger fast, since the abdominal wall, which contains the hernia, is the part of body that we use a lot. In untreated ventral hernias the bowels or the omentum (the membrane lining the abdominal cavity) may become incorporated into the hernia, which may cause blockage. This will require an emergency surgery.

How should I prepare for hernia surgery?

Before the procedure you should have the necessary laboratory tests done: blood count, coagulation, electrolytes, urea and creatinine. You should not eat for 6 hours before the procedure. You can do all the tests needed before the hernia repair procedure at our hospital in Wrocław.

What happens after hernia surgery? How long is the recovery and hospitalisation?

If your surgery was without complications, the pain is slight, your bowels work properly, you do not have nausea and you do not vomit, you will be able to go home on the day after the procedure. After the procedure you should use the hernia truss for 12 weeks. You can take it off for the night. The truss will not prevent the hernia from coming back, but it will ease the pain and hold the abdominal walls in one position, limiting their mobility. You can resume daily activities, including lifting objects up to 5 kg, on the next day after the surgery.

What should I do after going home?

First of all, eat a light fibre-rich diet. Avoid foods which cause bloating to prevent constipation. Do not lift objects heavier than 5 kg. Your wound should be fully healed 9 to 11 days after the procedure. Pay special attention to your body temperature, redness, or pain in the wound accompanied by tenderness to make sure that no complications have developed.

The hernia repair procedure at the Medfemina hospital in Wrocław is performed by experienced surgeons:

• Janusz Orzechowski, MD, PhD
• Jakub Targowski, MD
• Dariusz Houdail, MD
• Olaf Mędraś, MD

To find out more call us at (71) 333 000 3, or write us at szpital@medfemina.pl