Abdominal wall reconstruction / ventral hernia repair
About the procedureA midline laparotomy incision (vertical midline incision) is one of the most common incisions in surgery and is used by general surgeons, gynecologists, bariatric surgeons, plastic surgeons, colorectal surgeons, surgical oncologists, urologists, vascular surgeons, transplant surgeons, and other surgical specialties. It is estimated that 2,000,000-4,000,000 laparotomy incisions are made in the United States each year for various procedures, and many are performed in Los Angeles and the surrounding areas as well. Although most of the time, these incisions heal well and patients do not have problems after surgery, around 10-20% of the time, the healing process results in a hernia.
A hernia occurs when the abdominal wall no longer fully contains the contents of the abdomen. There are many different sizes of hernias- sometimes, the hernia contains a small amount of intestines or organs, while other times the hernia is very large. In order to repair the hernia, it is necessary to return the contents of the abdomen to the abdomen, and then repair the abdominal wall. Because the abdominal wall is already weak due to previous surgery, Dr. Hirsch will often use a type of permanent mesh to support the abdominal wall repair, although this decision is made at the time of surgery in most cases. Dr. Hirsch will often combine the hernia repair surgery with a procedure called a “component separation,” otherwise known as a “separation of parts.” The component separation is a technique that Dr. Hirsch uses to increase the compliance of the abdominal wall, which helps bring the abdominal wall muscles together in the midline of the abdomen. Dr. Hirsch treats ventral (midline) hernias, hernias after C-section, umbilical hernias, and hernias of the upper abdomen (epigastrum). Hernias that occur in the inguinal or groin region are usually treated by general surgeons.
The recovery period after hernia repair depends on the size of the hernia and the extent of surgery. For small hernias around the belly button, patients can often go home the same day or stay one night in the hospital. For large hernias, patients will often remain in the hospital for 4-7 days until their pain is controlled and their bowels have resumed function. After large ventral hernia repair, there can be significant abdominal wall discomfort due to the extensive surgery needed to repair the ventral hernia. Although uncomfortable in the short term, over time hernia repair patients often have significant improvement in their abdominal symptoms, and even improved back pain and core stability.
Frequently asked questions about ventral hernia repair/abdominal wall reconstruction:
Is ventral hernia repair covered by insurance?
Most major insurance companies will cover ventral hernia repair. Occasionally, ventral hernia repair may be combined with an abdominal wall contouring procedure, such as a vertical abdominoplasty or liposuction. In this case, the ventral hernia repair is covered by insurance while the abdominal wall portion is not.
What is the difference between a ventral hernia and a rectus muscle diastasis?
A ventral hernia is a defect (or hole) in the layers of the abdominal wall so that the contents of the abdomen are no longer contained within the abdominal cavity. A rectus diastasis is a separation between the two rectus abdominis muscles, but with the covering of the rectus muscles intact so that the contents of the abdomen are still contained within the abdominal cavity. Rectus diastasis are very common after pregnancy or significant weight loss. Their functional significance is unclear, however.
When can I start exercising again after ventral hernia repair?
After most ventral hernia repairs, you will be inpatient for 4-5 nights until your bowel function returns and you are able to eat a normal diet. It is very important that you walk during the first night after ventral hernia repair! This will help minimize the chance of blood clots and also decrease the risks of pneumonia. Once you get home, you should continue walking but avoid strenuous activity until Dr. Hirsch clears you to begin exercising again. This usually takes place around 6 weeks after surgery.
When can I go back to work after ventral hernia repair?
You should plan to be off work for 2-4 weeks after ventral hernia repair. If you work at a job that involves a significant amount of heavy lifting or physical activity, you might need to be off work for up to 6 weeks.
Will I have drains after ventral hernia repair?
Most patients will have 2-3 drains after ventral hernia repair that will remain in place for 4-7 days.
Additional resources about abdominal wall reconstruction and ventral hernia repair
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