What is Laparoscopic Ventral Hernia Repair

Laparoscopic ventral hernia repairis a procedure to fix a bulge of tissue that pushes through a weak area of muscle in the abdomen (ventral hernia). A ventral hernia may be at the belly button (umbilical), above the belly button (epigastric), or at the incision site from previous abdominal surgery (incisional hernia).

You may have this procedure as emergency surgery if part of your intestine gets trapped inside the hernia and starts to lose its blood supply (strangulation).

Laparoscopic surgery is done through small incisions using a thin surgical telescope with a light and camera on the end (laparoscope). During surgery, your surgeon will use images from the laparoscope to guide the procedure. A mesh screen will be placed in the hernia to close the opening and strengthen the abdominal wall.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs in the abdomen.
• Trouble urinating or having a bowel movement after surgery.
• Pneumonia.
• Blood clots.
• The hernia coming back after surgery.
• Fluid buildup in the area of the hernia.

In some cases, your health care provider may need to switch from a laparoscopic procedure to a procedure that is done through a single, larger incision in the abdomen (open procedure). You may need an open procedure if:

• You have a hernia that is difficult to repair.
• Your organs are hard to see.
• You have bleeding problems during the laparoscopic procedure.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotic medicine to help prevent infection.

General instructions

• You may be asked to take a laxative or do an enema to empty your bowel before surgery (bowel prep).
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• You may need to have tests before the procedure, such as:
  • Blood tests.
  • Urine tests.
  • Abdominal ultrasound.
  • Chest X-ray.
  • Electrocardiogram (ECG).
• Plan to have someone take you home from the hospital or clinic.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• A small incision will be made in your abdomen. A hollow metal tube (trocar) will be placed through the incision.
• A tube will be placed through the trocar to inflate your abdomen with air-like gas. This makes it easier for your surgeon to see inside your abdomen and do the repair.
• The laparoscope will be inserted into your abdomen through the trocar. The laparoscope will send images to a monitor in the operating room.
• Other trocars will be put through other small incisions in your abdomen. The surgical instruments needed for the procedure will be placed through these trocars.
• The tissue or intestines that make up the hernia will be moved back into place.
• The edges of the hernia may be stitched together.
• A piece of mesh will be used to close the hernia. Stitches (sutures), clips, or staples will be used to keep the mesh in place.
• A bandage (dressing) or skin glue will be put over the incisions.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You will continue to receive fluids and medicines through an IV tube. Your IV tube will be removed when you can drink clear fluids.
• You will be given pain medicine as needed.
• You will be encouraged to get up and walk around as soon as possible.
• You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
• You will be shown how to do deep breathing exercises to help prevent a lung infection.
• Do not drive for 24 hours if you were given a sedative.

Laparoscopic Ventral Hernia Repair, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain, discomfort, or soreness.

Follow these instructions at home:

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing) or before you touch your abdomen. If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• Keep your bandage (dressing) dry until your health care provider says it can be removed.

Activity

• Do not lift anything that is heavier than 10 lb (4.5 kg) until your health care provider approves.
• Do not drive or use heavy machinery while taking prescription pain medicine. Ask your health care provider when it is safe for you to drive or use heavy machinery.
• Do not drive for 24 hours if you were given a medicine to help you relax (sedative) during your procedure.
• Rest as told by your health care provider. You may return to your normal activities when your health care provider approves.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Drink enough fluid to keep your urine clear or pale yellow.
• Hold a pillow over your abdomen when you cough or sneeze. This helps with pain.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have:
  • A fever or chills.
  • Redness, swelling, or pain around your incision.
  • Fluid or blood coming from your incision.
  • Pus or a bad smell coming from your incision.
  • Pain that gets worse or does not get better with medicine.
  • Nausea or vomiting.
  • A cough.
  • Shortness of breath.
• Your incision feels warm to the touch.
• You have not had a bowel movement in three days.
• You are not able to urinate.

Get help right away if:

• You have severe pain in your abdomen.
• You have persistent nausea and vomiting.
• You have redness, warmth, or pain in your leg.
• You have chest pain.
• You have trouble breathing.

Summary

• After this procedure, it is common to have pain, discomfort, or soreness.
• Follow instructions from your health care provider about how to take care of your incision.
• Check your incision area every day for signs of infection. Report any signs of infection to your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.