This is the side view of your abdominal wall. Here is your belly button. And here is the hernia, which is a hole in your abdominal wall. Over time, the inner layer pushes through the hole. Once the hernia is large enough, a bulge will become noticeable. This bulge usually comes and goes as stuff slips in and out of the hernia. It can become painful, especially with certain activities, or coughing and sneezing. There is a low risk your intestine could get trapped inside the hernia and this could become an emergency. At the time of surgery we bring all that tissue back inside the belly where it belongs. We close the hole, and place a piece of mesh in between the layers of your abdominal wall to reduce the risk of the hernia returning. If the inner layer is not robust enough, we use a mesh with a special non-stick coating. This coating is temporary, and over the first few months after surgery, your body will grow a new inner layer over the mesh.

What is a ventral (belly) hernia?

A hernia is a hole in your abdominal wall that allows stuff that should stay in your belly to slip out. This may occur around your bellybutton, higher up on your belly, or anywhere you have had a surgical incision in the past. Usually it causes a bulge that gets bigger and smaller at different times. Hernias tend to get larger over time and they can be uncomfortable and even painful.

Hernias occur because of a combination of risk factors and genetics. Lifestyles that involve heavy lifting or smoking, and medical conditions like chronic coughing and constipation can increase the risk of developing a hernia. In many cases though, hernias are just something you’re born with or happen because of the way you heal after surgery.

Do I need surgery for my hernia?

Surgery is a complex decision that should be made together with a licensed surgeon. It’s always a matter of balancing risk and benefit. If your hernia doesn’t bother you at all, it may be safe to simply watch it. If your hernia has any negative impact on your life – pain, worry, physical limitations – it is worth considering surgery. If you think you may have a hernia, see your primary care doctor or your local surgeon.

How is the surgery performed?

There are two major options: open repair or “keyhole” repair. The open repair can be done with “twilight” anesthesia in some cases, and involves a 1.5 to 3 inch incision over the lump. For larger hernias, the incision may be larger. The “keyhole” approach requires 3 very small incisions usually on the side of your belly, and typically offers less pain after surgery and a faster recovery. It may be performed with robotic instruments. All approaches involve using mesh. For more about robotic surgery, click here.

What is mesh?

Mesh is a piece of flexible material that is used to reinforce your abdominal wall. Without mesh, there is only the weak hernia-prone tissue, and any repair using only weak tissue has a higher risk of failure. The mesh looks like a window screen, and it works like a scaffolding, allowing your body to weave scar tissue all through and around it, creating a barrier of reinforced scar in between the layers of your abdominal wall. Most people don’t feel it at all once it has healed. For more about mesh, click here.

What are the risks of surgery?

There is a roughly 10% risk the hernia could return. This risk is increased if you are overweight. Risk of infection: less than 2%. Risk of significant bleeding: less than 2%. This risk is increased if you are taking blood thinners. There is always a risk of injury to other structures in your belly, particularly your intestine or colon, but thankfully these injuries are very rare. A rare injury like that could make it impossible to use a permanent mesh reinforcement because of the risk of infection from contamination. In such situations, an absorbable mesh may be used, which allows a lower risk of chronic infection but has higher risk of the hernia returning.

I take blood thinners. What should I do?

Many patients take medications to prevent blood clots. Some take aspirin alone, others take aspirin plus clopidogrel (Plavix) or similar, and still others may be taking warfarin (Coumadin), Xarelto, Eliquis, or other similar medications. Make sure your surgeon knows which you are taking and why, and which doctor prescribes it for you. Your surgeon will coordinate with your Cardiologist or other prescribing physician the best time to stop taking your medication and when to restart it after surgery. If you have any questions about when to stop or start your medication, contact your surgeon.

What can I expect on the day of surgery?

Most ventral (belly) hernia repairs are outpatient surgery, so you will not have to stay overnight in the hospital. For larger, more extensive hernias you may stay in the hospital for up to a few nights. The procedure itself takes 1-2 hours, but for larger hernias the procedure takes longer, sometimes up to 8 hours or more. There is also additional time for checkin you in, getting you off to sleep, getting our equipment set up, and waking up afterward. You will need someone to give you a ride home, and ideally someone to stay with you the first night or check in on you periodically.

What can I expect after surgery?

You will likely have pain and soreness. You may also have bruising and swelling of your abdominal wall and around the incisions. Certain sleeping positions may be uncomfortable, you may prefer to sleep in a recliner the first few nights. You should take the pain medication recommended by your surgeon. Typically it will be a combination of prescription medicine and over-the-counter pain medicines like Tylenol and Motrin. Using an ice pack or heating pad, or alternating both may provide some relief as well for the first 2-3 days.

You may not pass a bowel movement in the first 2-3 days after surgery – that is OK, don’t try to force it. If you get to 48 hours after surgery and you have not had a bowel movement, take something over the counter like Miralax or Milk of Magnesia to help get things going. If you have taken Miralax or Milk of Magnesia for two days and still not had a bowel movement, call your surgeon.

For the first 2 weeks after surgery, you should take it very easy. Walking and going up and down stairs is fine even on the day of surgery. After 24 hours, you can shower and drive. Typically, you will follow up with your surgeon about 2 weeks after surgery. Most people can begin increasing physical activities gradually at that point, ramping up over a month. By 6 weeks after surgery most people have no restrictions or limitations.