Abdominal Wall Hernia Repair

Abdominal Wall Hernia Repair

Umbilical Hernia, Epigastric Hernia and Recuts Diastasis

Umbilical and epigastric hernia’s occur when fat or organs from within the abdominal cavity protrude through the abdominal wall. Umbilical hernia’s are at the navel which is an obvious weak point from the passage of the umbilical cord in utero.

Epigastric hernia’s occur in the midline between the lower end of the breast bone down to the umbilicus, they occur through a thin sheet of tendon called the ‘linea alba’ (white line) where the abdominal muscles meet.

Small single epigastric and umbilical hernia’s may be repaired through the traditional open approach with a transverse incision over the site of the bulge however when larger defects or multiple small hernia are present the laparoscopic approach is preferred.

Rectus Diastasis also known as rectus divarication is seen as a midline bulge and occurs when the linea alba has been stretched leading to a wide separation of the abdominal muscles, although not a hernia (there are no organs or fat pushing through a defect) this can lead to problems with core stability, back pain and cosmesis.

Weak spots in the abdominal wall can enlarge more rapidly with ongoing strain, such as
  • Lifting weights
  • Lifting on the worksite
  • Chronic cough
  • Chronic constipation
  • Obesity
  • Pregnancy
  • Enlarged prostate
These factors also increase the risk of hernia recurrence after repair and need to be addressed prior to surgery.

Laparoscopic Ventral Hernia Repair - IPOM plus technique

  • Under general anaesthetic 3 small incisions are made on the left side of the abdomen, the abdominal cavity is inflated with carbon dioxide and the hernia defect is visualized
  • Tissue and organs around the hernia are carefully dissected free from the defect
  • Small to medium defects are closed using permanent sutures
  • If rectus diastasis is present 4-5 small midline puncture incisions are made in order to pass non-absorbable suture and bring the borders of the abdominal muscles together along the length of the defect
  • A large mesh is trimmed to size, inserted into the abdomen and placed over the repair. The mesh is then tacked into place to ensure that it will not migrate away from the hernia site
  • All instruments are removed and the abdominal cavity is deflated
  • Skin incisions are closed with buried absorbable sutures, local anaesthetic injected and dressings applied
  • An abdominal binder will need to be worn post-operatively for repairs of large defects

Post-Operative Recovery

  • Laparoscopic ventral hernia repair requires hospital stay of 2-3 nights
  • A script for pain medication will be provided on discharge
  • Dressings should remain in place for one week
  • An abdominal binder will need to be worn for 4-6 weeks for large hernia defects
  • Mobilisation is encouraged from day 1 however strenuous activity such as household cleaning chores and vigorous exercise should be avoided for 4 weeks.
  • No heavy lifting for 6 weeks to avoid an early recurrence of your hernia.

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