Laparoscopic Ventral Hernia Repair

Background

Hernia surgery is a common procedure with approximately 600,000 hernias repaired annually in the US. Hernias have been described since the earliest medical writings (Ebers papyrus - 3000 BC). The earliest known instance of named person with a hernia occurred in Pharaoh Ramesses V (c1141 BC) diagnosed by examining his mummified remains. Effective treatment of this ancient problem is a new phenomenon. The development of modern surgical techniques including anesthesia, asepsis, and attention to the anatomy of the area has lead to the only effective treatment for hernias. The most common form of hernia is the ingunial or groin hernia. Dr. Fusco's prefered approach for repairing groin hernia is the laparoscopic repair. Ventral hernia also can be repaired using minimally invasive (laparoscopic) techneques.

Intraoperative photo of a ventral hernia.

The hernia is the hole in the upper center of the photo.

• Open repair without prosthetic material (mesh)
  
• Open repair with prosthetic material
  
• Laparoscopic repair - Dr. Fusco's preferred method of repair since 1994

• Quicker return to full activity and work
  
• Exact definition of the anatomy
  
• Ability to assess and treat other hernias if found
  
• Lower short term recurrence rate
  
• Lower complication rate secondary to decrease rate of wound complications and infections

It is very important that you do not eat or drink anything after midnight the night prior to surgery. This includes coffee, water, mints, gum, candies. You may ingest only a small sip of water with your morning medications.

Dr. Fusco's office staff will advise you when to arrive at the hospital or surgery center. Since the procedures scheduled prior to yours may be longer or shorter than anticipated, we ask that you remain available prior to your arrival time so that you can be contacted and informed of any changes in your surgery time.

When patients bathe the night prior to surgery they should thoroughly cleanse the umbilicus (belly button).

Recovery
The surgery is done as an outpatient surgery or sometimes as an overnight stay. Patients can resume light daily activity immediately. The average patient will require 1-2 weeks recovery before resuming more vigorous activity. There is no forced limitation of activity, instead patients are asked to advance their activity as tolerated. This applies to the resumption of work, sports, and sexual activity.

Patients will want to eat light foods the night after surgery. Then they can eat food as tolerated.

Some patients will experience some difficulty in voiding (passing urine) the night after surgery. This usually resolves the morning after surgery. In some patients they are unable to void completely. This is called urinary retention. If patients are having difficulty with urinary retention prior to 5 pm, they are asked to contact the the office (725-4500 ext 420). The office will arrange for the patient to have a urinary catheter placed to drain the bladder. If patients have urinary retention after 5pm (when the office is closed), they are asked to proceed to the Emergency Department for this procedure. If patients are unsure what to do, they are encouraged to contact Dr. Fusco at 725-4500 ext 420.

Patients are seen in the office 5 to 9 days after surgery for a postoperative check, but patients are encouraged to contact the office sooner than this if they have any questions or problems. Dr. Fusco requests you contact the office for any of the following:

• Nausea or vomiting that persists for greater then 24 hours after surgery - nausea shortly after surgery is commonly due to general anesthesia and usually resolves within this time period.
  
• Temperature greater than 101.5 degrees - Temperature elevations less than this are very common after surgery and usually have little significance.
  
• Pain that is not relieved by the oral pain medication prescribed.
• Inability to pass urine.
• Any questions or concerns.
• Patients experiencing any difficulty breathing, chest pain, change in level of consciousness, or loss of vision or strength should promptly call 911 for transport to the nearest emergency department.
  

• Hernia recurrence (redevelopment of a hernia) 2-5%
• Bleeding (needing transfusion) - less than 1%
  
• Infection - 2%
  
• Conversion to open surgery - 1%
  
• Injury to other structures in the abdomen including small intestines, liver, and blood vessels - <1%
  Although this is an uncommon risk of surgery, these injuries can be very serious even leading to death.
  
• Hernia development at incision sites - < 1%
• Chronic nerve injury leading to chronic pain - 1%
• Seroma - Collection of fluid in the previous hernia area. With the laparoscopic techneque this happens virtually 100% of the time to some degree. This almost always resolves without any treatment. Depending on the size of the collection resolution may take many weeks to a few months.