Laparoscopic Ventral Hernia Repair: Procedure & Recovery

Laparoscopic Ventral Hernia Repair is an advanced surgical procedure performed to repair the ventral hernia. A ventral hernia is a type of hernia that usually develops because of an injury in the abdominal area, obesity or any past incision in the abdominal wall.

Anatomy and Physiology of Abdominal Wall

1. Skin, fat, fascia (thin tissue surrounding organs), muscle, and peritoneum (thin membrane lining the abdomen and abdominal organs) are among the layers that make up the abdominal wall. 
2. Increased intra-abdominal pressure causes repeated stress on the abdominal wall, resulting in microscopic tissue tears. This can weaken the tissue over time, making people more susceptible to hernia formation.
3. A hernia refers to the protrusion of abdominal tissue or intestine through a hole in the wall of the abdomen. A ventral hernia develops when a protrusion forms anywhere along the abdomen wall's midline.

A laparoscopic ventral hernia repair is mainly considered to treat hernias that are smaller in size and less complex. These include:

1. Ventral hernia
2. Recurrent hernia
3. Groin hernia

A doctor may recommend laparoscopic ventral hernia repair to a patient if he/she experiences:

1. An abdominal bulge or lump that grows in size over time
2. When lying down or pressing on the bulge, it may flatten
3. At the protrusion site, there is a burning or aching sensation
4. When a person exercises, lifts something, stands for a long time, or strains during bowel motions, a ventral hernia causes an increase in pain. Resting, on the other hand, helps to alleviate the pain
5. If the herniated tissue gets trapped in the abdominal muscle, it causes the following symptoms:
   1. Pain
   2. Nausea
   3. Vomiting
   4. Constipation

Your surgeon can only tell you if a laparoscopic ventral hernia repair is correct for you after a thorough evaluation. Some patients may not be candidates for the treatment if they have had extensive prior abdominal surgery, have hernias in unique or difficult-to-reach sites, or have underlying medical issues. Make sure to discuss with your doctor your situation.

A patient can expect the following during the surgery:

1. You will be placed in a supine (lying on the back with face facing upwards) position with the hands tucked at the patient’s sides. This is the standard position for ventral hernias.
2. Iodine, alcohol, or chlorhexidine-based solutions will be used to clean the surgical site before starting the procedure.
3. Once the chosen solution has dried, the surgeon will cover the surgical field with either iodine-impregnated sticky drapes or incise drapes.

Laparoscopic ventral hernia repair involves the following steps:

1. During the surgery, you will be administered general anaesthesia.
2. The surgeon will make several small incisions in your abdomen.
3. Then, the surgeon will insert a laparoscope (a tiny tube with a light source and a camera) through one of the incisions.
4. The camera projects an image of the inside of the abdomen to a huge for the surgeon to utilize as a guide throughout the procedure.
5. The surgeon will insert the surgical equipment into the other incisions to repair the hernia using surgical mesh and sutures (stitches) or surgical glue.

Before undergoing laparoscopic ventral hernia repair, the doctor/surgeon will discuss and prepare the patient for the surgery. These steps often involve:

Before Laparoscopic Ventral Hernia Repair

Before undergoing the laparoscopic ventral hernia repair procedure, the doctor will:

1. Hospital stay:
   1. Because most minor hernia operations are conducted as outpatient procedures, you will most likely be able to return home the same day or the next day.
   2. More difficult or repeated hernia surgeries may necessitate a stay in the hospital for several days.
2. Medicines: Blood thinners, anti-inflammatory drugs, herbal supplements, and Vitamin E must temporarily stop for a few days to a week before surgery. These drugs can heighten your risk of bleeding.
3. Smoking: It is very advised that you stop smoking before surgery.

On the day of Laparoscopic Ventral Hernia Repair

1. The patient must reach the hospital before the scheduled time for the surgery.
2. The patient will be asked to sign a consent form. 
3. The patient will be instructed to remove his/her street clothes and jewellery and wear a hospital gown.
4. If necessary, any pre-operative medications will be administered, and the vitals will be checked and documented.
5. A nurse will place an intravenous catheter in the patient’s hand or forearm, and then general anaesthesia will be administered.
6. The patient will be shifted to the operation theatre for the procedure.

A patient who has undergone a laparoscopic ventral hernia repair can expect the following after the surgery:

The recovery process at the hospital

1. After the surgery, the patient will be moved to a recovery room where the vitals (heart rate, blood pressure, respiratory rate) and urine output will be constantly monitored. 
2. If the patient was given general anaesthesia, the coordination and reasoning might be compromised for a brief period. So, the patient must avoid driving, alcohol, and making big decisions for 48 hours after the surgery.
3. The surgical site will be sore and uncomfortable after the operation. Painkillers will be provided to the patient to help deal with the pain.
4. The patient will only be discharged from the hospital when the condition of the patient stabilises.
5. The patient would be able to go home on the same day if he/she were administered a local anaesthetic.

Recovery process/expectation after hospital discharge

1. All the instructions provided by the doctor must follow at home.
2. Diet and lifestyle:
   1. After the surgery, there is no need for any dietary restrictions.
   2. Drink approximately eight to 10 glasses of water every day.
   3. Consume a high-fibre diet to avoid straining during bowel movements.
   4. You cannot drive if you are using pain relievers. Consult your doctor about when you can go back behind the wheel.
3. Wound Care:
   1. Showering is permitted starting 36 hours following surgery.
   2. If the wounds have small areas of white gauze or band-aids on them, remove them before showering.
   3. In case there are surgical tapes (called steri-strips) attached to your skin, you do not need to remove them while showering. They'll loosen and fall away on their own. You may remove them after 10 days if they haven't fallen off.
   4. For the next two weeks, no hot tubs, baths, or pools are permitted.
   5. Applying ointment or other medications to your incisions will not help them heal faster.
   6. Hands should always be washed before and after touching the incision site or anything near it.
4. Work and activity:
   1. Gradually raise your activity level. To avoid blood clot formation, get up and move every hour or so.
   2. For at least six weeks, refrain from lifting anything more than four and a half kgs or engaging in intense activity.
   3. There are no specific timelines regarding going back to work after hernia repair. However, on average, most people take at least four to six weeks off before returning to work.
5. Exercise:
   1. Exercise will improve your strength and make you feel better.
   2. Walking is a great way to get some exercise. 
   3. Gradually increase your walking distance. Before beginning more severe exercises, check with your doctor.

First follow-up appointment

1. The first follow-up appointment with the doctor will usually be scheduled within 2 to 3 weeks after the surgery.
2. During the follow-up, the doctor will do a thorough check-up of the surgical site to check for the recovery process.
3. The doctor might also change the medication or advise the patient to continue with the previous medication for some more time, depending on the condition and recovery of the surgical area.
4. The doctor will advise the patient for further timely follow-ups as well.

Laparoscopic ventral hernia repair is an advanced surgical procedure which is safe. The procedure has several benefits which include:

1. Minimal invasive
2. Smaller incisions/scar(s)
3. Less pain
4. Less risk of infections and problems during the healing
5. Short hospital stay
6. Quick recovery

Like any other surgical procedure, laparoscopic ventral hernia repair also has risks and complications associated with it. These include:

1. Infection
2. Bleeding
3. Blood clots
4. Allergic reactions to anaesthesia, other medications, or materials used during surgery.
5. Damage to other blood vessels or organs
6. Damage to the nerves
7. Long-term pain in the cut area
8. Return of the hernia

When is consultation with the doctor needed?

A patient must contact the doctor/surgeon right away if he/she experiences any of the following symptoms: 

1. Bleeding from the incision site
2. Foul-smelling discharge from the incision site
3. A temperature greater than 38°C for an extended period 
4. Increased abdominal swelling or discomfort that isn’t alleviated by painkillers
5. Consistent nausea or vomiting, as well as chills
6. Increasing redness around the incisions 
7. Continuous coughing or shortness of breath 

Delaying surgery for a ventral hernia can lead to the following complications:

1. With time, ventral hernias can grow larger and worsen.
2. Incarcerated hernia: An incarcerated hernia occurs when herniated tissue becomes lodged (stuck) and cannot be easily moved back into place.
3. Strangulated hernia: An incarcerated hernia can become a strangulated hernia if left untreated. The blood supply to the gut can be cut off, resulting in its strangulation. This is a potentially fatal medical condition.

The cost of a laparoscopic ventral hernia repair ranges from ₹50,000 to ₹2,00,000. The cost varies based on the following factors:

1. Age of the patient
2. Type of the procedure done
3. Technique and equipment used
4. The medical condition of the patient
5. The type of hospital facility availed - individual room or shared.