|What is a ventral hernia?|
Ventral hernia is an abnormal outpouching through the wall of the abdomen. It is a common problem that affects both men and women, but incisional hernias affect twice as many women as men.
The hernia can be a small lump that is asymptomatic (causes no pain or discomfort) or it can be painful and troublesome, especially during physical activity. The cause of ventral hernias depends on the type of hernia it is. Incisional hernias (15%-20% of all hernias) are usually caused because something did not heal properly following surgery. This could be for many reasons. The patient had a weak kind of tissue (a collagen disorder) or they had other problems that affected healing such as diabetes. Other types of hernia such as epigastric and umbilical (10% of all hernias) can be caused through a stress event causing a small rupture of the muscles. Or they could have been there as weakness since birth (congenital).
The hernia is caused by the contents of the abdomen (such as the bowels) pushing through a weakness or hole that is not normally there in the abdominal wall. It forms a pouch that can be felt or seen. Sometimes they are small and sometimes they can be very large.
|Do I need to see a doctor?|
Yes. If you suspect you have any type of ventral hernia, it is advisable to see a physician as soon as possible so they can make an assessment on your condition.
|Do I need surgery?|
Not everyone with a ventral wall hernia needs surgery. Some hernias, if small and not troublesome can follow what is called "watch and wait". Your physician will be able to examine you and determine if you require surgery or not. However the majority of ventral hernias may require a surgical intervention.
|What are the surgical options?|
Today there are a wide variety of surgical options to treat ventral hernia. The options offered will depend on your needs and wishes, as well as the clinical condition of your hernia, your physical health and the procedures offered by the surgeon. Generally ventral hernia operations fall into two categories:
Keyhole or Laparoscopic
What's the difference?
|What are meshes and are they safe?|
The most common option today (either keyhole or open) is to use something called a "hernia mesh" or "hernia implant".
Historically to fix the hernia, the surgeon would make an incision, then dissect (free up) the hernia pouch and return it to the abdomen. They would then close the hole in the abdominal wall by only using sutures to stitch the hole together. The problem with this was that it put those tissues under a lot of tension and this would cause a lot of pain and discomfort to patients. Also in many patients the tissue being sewn together was not very strong so the hernia would come back (recurrence). This led surgeons to think about "reinforcing" the hernia area with a patch.
The advantages of placing a patch were the reduction in tension (sometimes called a tension free repair) and the patch would help to reinforce the abdomens natural tissues - like putting a patch on the elbow of a sweater.
This patch was often made out of a synthetic mesh material - this patch is the hernia mesh. Every patient reacts differenty to material and not everyone will have an "inert" reaction, discuss with your health care provider risks associated with implanting foreign materials into the body prior to surgery.
Today there are also non synthetic materials called biologics. They are made from very special tissues (either animal or human) that have been recovered and treated to be inert and safe. They are often used when the hernia is very complex, such as infected hernias.
The mesh can be placed either above the hernia, below the hernia or both. In a keyhole repair the mesh is generally placed below the hernia hole (underlay), in open it can be placed above (onlay), or below (sublay). The mesh is generally held in place with sutures (stitches) or there are new devices that place small absorbable tacks that hold the mesh in place while the body grows natural tissue over it.
Are they safe?
However they do carry risks that are different to not using a mesh. Synthetic meshes have a higher risk of becoming infected. They also carry a risk of a foreign body reaction, which can include pain, fever, discomfort, sensation of the foreign body, rejection of the foreign body and other side effects your doctor can discuss with you in detail - but make sure before deciding to have a mesh or implant that you discuss fully with your doctor.
|What does the FDA say?|
Please read this advice from the FDA and consult fully with your doctor.
Food & Drug Administration, The Food and Drug Administration (FDA) is an agency within the U.S. Department of Health and Human Services. The core functions of the agency: Medical Products and Tobacco, Foods and Veterinary Medicine, Global Regulatory Operations and Policy, and Operations.
Please follow this link to the FDA
Information on Surgical Mesh for Hernia Repairs
Hundreds of thousands of hernia repair operations are performed each year both with and without surgical mesh, and patients generally recover quickly and do well after surgery.
However, FDA has received reports of complications associated with the mesh. The complications include adverse reactions to the mesh, adhesions (when the loops of the intestines adhere to each other or the mesh), and injuries to nearby organs, nerves or blood vessels . Other complications of hernia repair can occur with or without the mesh, including infection, chronic pain and hernia recurrence.
Most of the complications reported to us so far have been associated with mesh products that have been recalled and are no longer on the market. For further information on the recalled products, please visit the FDA Medical Device Recall website.
We are continuing to analyze and evaluate incoming reports of adverse events, and are speaking with patients, surgeons and researchers. We will inform the public as new information becomes available.
Talking to your doctor
There are also certain questions you should consider asking your surgeon:
What are the pros and cons of using surgical mesh in my particular case?
You can report any problems to the FDA's MedWatch Adverse Event Reporting program either online, by regular mail or by FAX.
Online : MedWatch Online Voluntary Reporting Form (3500)
|What are the common problems with hernia surgery?|
In general ventral hernia surgery is safe and is a frequently performed procedure. However like all surgery it carries certain risks, that you should discuss with your physician. The risks will vary depending on any previous surgery, your weight, if you have a diabetes, cardiac problems or other issues. Again, you should discuss all of these factors with your physician to understand the risks.
There are risks associated to all surgery, such as complications with anesthesia, infection, bleeding etc.
Other problems in ventral hernia repair can be accumulation of fluid (seroma), or accumulations of blood (hematoma) especially when large meshes are placed. Generally these problems are transient and can be resolved without second operations.
Post operative pain and or discomfort is a common problem associated with ventral hernia repair procedures. In the early days after your surgery this can be caused by the incision (in an open repair) or by the actual operation itself, especially if it was a large hernia. This is an "acute" pain generally associated to the fact you've been operated on. But your doctor can help by prescribing pain killers to take in the weeks after surgery. The level of pain is very patient dependent.
Of more concern is long term pain and discomfort. There are many reasons this can happen. The nerves in the abdomen can be touched, inflamed or damaged during surgery. Your surgeon will take every care to avoid those nerves, but each patient has them in different places so avoidance cannot be guaranteed. Long lasting nerve pain will need to be treated by your doctor and could include second procedure to treat the nerves. If the nerves are "entrapped" in any implant or mesh, then the mesh may need to be surgically removed or replaced. You should discuss this with your doctor, especially any procedure to remove the mesh.
In some patients the mesh can have a "shrinkage" reaction. This is generally where the natural scarring that occurs in the mesh becomes aggressive, and causes a contraction of the mesh. This can cause pain or discomfort or even a sensation of feeling the mesh. It is a rare complication but you should discuss this risk before deciding to have a mesh placed. Ask your doctor about removing the mesh should such a problem arise.
Although the above complication and problems are rare, it is vital before deciding to have a permanent implant, to weigh the risks and benefits and have a direct and clear conversation with your physician about all the options.
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