Ventral Hernia: Lap is the way to go!

Hernias that occur in front of the belly, commonly seen in obese or multiparous ladies, are called ventral hernias. They may variously be called ‘umbilical’, ‘paraumbilical’, ‘epigastric’, or ‘incisional’ hernias.
Open operation is the commonest way of tackling this problem, and I hate the damn operation. It is quite an extensive and traumatic procedure, and wound problems are very common.
The lap approach is so much better, though it is still not the perfect solution yet (pain, recurrence, etc. still being issues). In my own personal experience, I have seen four recurrences after around 200 of these cases. All of these patients had a Goretex DualMesh placed, though this was because I used this product most when I started doing lap hernioplasties. Nowadays, I am using the Proceed or Parietex tissue-separating meshes, and so far, so good!
A recent article talks of the results of lap ventral hernia repair, and I recommend that you read it here.
One thing I find funny no one has seemed to notice, is: when I went in laparoscopically to repair my own recurrences, I saw that there were multiple small defects at the site of the full-thickness sutures that I had placed to anchor the mesh previously. It is as if the muscle just shrank between the sutures, and created a hole again. The article does not deal with this at all. Rather, the authors advise us to “stretch the mesh taut”, which seems to be overkill. If you over-stretch the mesh, you create tension, which, as all surgeons know, is not very good for long term integrity of the repair.
Anyways, the article will be good news for those of us who see ventral hernias on a daily basis, as the results keep getting better and better.

7 responses to “Ventral Hernia: Lap is the way to go!

  1. Interesting, Ramana, regarding the formation of ‘holes’ by the sutures. Makes sense. I suppose lap is again better, as the wall is already stretched when you put in the mesh.
    I prefer retromuscular mesh repair – open. Much less wound problems with excellent results. Why can’t you do that with lap approach? May become standard for lap hernia surgery.

  2. Rajdeep,
    Thanks for your comment. It hasn’t yet started getting warm here ;-).
    Essentially the lap repair, where the mesh is placed on the inner lining peritoneum, is a retromuscular approach. It saves extensive dissection that would otherwise be needed.

  3. Interesting article..Its goes beyond any contention , that LAP VENTRAL HERNIA seeing might look a simple proceedure but it is not a one..
    Carry on with your good job DOCTOR..

  4. I just underwent a Laproscopic(sp?) Ventral Hernia repair yesterday. My small hernia was just below my sternum. My surgery was quick and seemed to be over with before I even knew what happened, which is a good thing! Now I’m experiencing a little bit of pain (like I’ve been shot in the gut!), but my biggest concern is the feeling like I’m unable to completely void my bladder of urine. It seems like I have to pee all the time and yes, I’ve drank a lot of water rehydrating after the surgery but… sheesh. I urinate and try to relax, and when I think it’s over, I can just sit there and go again, it seems to never stop. Then finally I feel like I’m empty. Is this normal? How long will this feeling last? It will be 24 hours from my surgery in just a few minutes… 24 hours from my recovery moment will be in a couple hours. Please let me know if this is normal, or should I be concerned?

  5. Daniel,
    You don’t say how old you are: you are probably having prostatism: symptoms due to an enlarged prostate. Alternatively, it could be a mild urinary infection, both these being possible post-operative complications. It is not a big deal in most cases, and you should do fine, but I have to say your surgeon will be the best judge of that.

  6. Thank you Rambodoc. I’m 44, and have recently had my PSAs check normal (within the year), but haven’t had a rectal type exam *shudder*. My urine is clear though; if symptoms persist I won’t wait until my follow up meeting with my surgeon to contact him. Thank you again.


  7. And keep drinking plenty of water!

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