Procedure – An abdominal hernia, or ventral hernia, is a defect in the layers of the abdomen through which the intestines protrude. This defect is covered by your abdominal skin. These hernias most often occur following previous abdominal surgery, or after traumatic abdominal injuries. The deeper layers of the abdominal wall can separate, allowing the intestines or the fat surrounding them to protrude through the abdominal wall.
Generally, a piece of mesh is used to stabilize the defect. However, in some cases, the hernia can be massive or complicated by factors such as obesity, infection, fistula (bowel contents leaking through the skin), failure of a previous repair, or a problem with the overlying skin. In such cases, a more complex approach to reconstructing the hernia is required. The expertise of a reconstructive plastic surgeon trained in abdominal wall reconstruction is required.
Can abdominal hernia repair be combined with other surgeries? – In some cases, it may actually be beneficial to perform an additional procedure at the time of the hernia repair. For example, morbidly obese patients who have a large pannus of overhanging abdominal skin may benefit from undergoing a panniculectomy (removal of abdominal skin) at the time of hernia repair. Another situation when combining procedures may be appropriate is when your general surgeon or gynecologist is planning on performing other intra-abdominal procedures.
Surgery and the incisions – The surgery itself can take anywhere from 2-6 hours depending on the complexity and nature of your hernia. For example, a combined general surgery-plastic surgery team approach will add extra time to the operation. In some cases, the surgery can be done through your existing scar. Often, two small incisions on either side of the abdomen (just below the rib cage) are required. In more complex hernia repairs, additional incisions may also be needed. Dr. Brown will be able to explain to you exactly what he is planning to do and what scars you will be left with.
Preparing for surgery – Prior to surgery, you will have to see your primary care physician to be cleared for surgery. If you have heart or lung disease, you may be required to obtain other tests before surgery in order to ensure that you are in the best possible shape to undergo surgery. Finally, you will have to have a CT scan of the abdomen before surgery in order to help your plastic surgeon precisely plan the surgery.
Tell Dr. Brown about any medical problems you have, and any problems you may have had with surgery in the past. Most importantly, tell him if you have had any hernias or any abdominal surgery in the past. You will be told which medications to stop and which to take before surgery. If you smoke, you will be asked to quit for a minimum of 4 weeks prior to surgery as well as 4 weeks after surgery. If you get sick or have any health issues in the days before surgery, please notify the office at once in case we have to postpone your operation.
Depending on the size and nature of your hernia, you may be required to undergo “bowel prep” before surgery. This is very similar to the bowel prep done before a colonoscopy. This means taking a laxative prescribed by your surgeon that will help clean out your intestines prior to surgery. Finally, be sure to follow all the instructions given to you the day before surgery. If you get sick and have to cancel your surgery for any reason, please notify our office as soon as possible.
After Surgery Care
What can I expect? – A hospital stay of 3-7 days is required after abdominal wall reconstruction. Rarely, a one night stay in the intensive care unit may be required for patients who have bad heart or lung disease. You will probably spend the rest of the day of surgery in bed, but by the next day you will be out of bed and moving around. The day after surgery you can usually begin taking sips of water. Once your bowel function returns (this usually takes 2-5 days), you can begin drinking liquids and then eating regular food.
What if I have a problem? – When should I call the office? We always welcome calls from patients. If you have any concerns at any time, please feel free to contact our office. If it is an emergency, the answering service is available 24 hours a day, including weekends and holidays.