VENTRAL HERNIAS

A ventral hernia is a hole in the strong part of the abdominal wall (fascia and muscle).  It can cause pain, affect normal activity, increase in size, become unsightly, or risk incarceration and strangulation.  Ventral hernias include primary ventral hernias such as umbilical hernias, epigastric hernias, spigelian hernias, or lumbar hernias as well as ventral incisional hernias

Umbilical hernias are a type of ventral hernia that occur at the belly button unrelated to any prior surgery. A bulge can form, causing discomfort and an altered appearance. In adults, when the intestine pushes through the hole, it can become strangulated, presenting a serious condition that requires immediate medical care. 

An incisional hernia is a particularly challenging type of ventral hernia that occurs at the site of a prior surgery or incision.  Thirty percent of patients who have had abdominal surgery will develop an incisional hernia at the surgery site. Incisional hernias are challenging because repairs by generalists results in recurrence rate of over 50%. 

Ventral hernias occur due to weaknesses in the fascial tissue that surrounds your abdomen. After birth, the area the umbilical cord connected to usually closes off completely. However, if this doesn’t heal fully, it can cause a weakness in the tissue that can lead to an umbilical hernia during infancy or later in life. 

In addition, certain risk factors can increase the pressure in your abdomen leading to the formation of an umbilical hernia, including:

• Obesity
• Straining frequently due to chronic cough, enlarge prostate, constipation, etc.
• Smoking
• Pregnancy (especially twins or more than 2 pregnancies)
• Fluid buildup in your abdominal cavity

While incisional hernias can occur in any individual following abdominal surgery, there are certain risk factors that make them more likely to occur. Anything that negatively impacts your body’s ability to heal properly or anything that increases the pressure in the abdomen can contribute to the development of an incisional hernia, including:

• Complications from initial surgery
• Improper closure of the tissue at the time of initial surgery
• Obesity
• Smoking
• Taking certain medications such as immunosuppressants or steroids

Incisional hernias substantially affect an individual’s quality of life.  They can cause pain, discomfort, and impair the ability to perform normal activities.  In addition, patients may experience bulging at the prior incision or bulging that increases with straining.  If intestine protrudes through the hernia, causing incarceration or strangulation, patients may experience, nausea, vomiting, discoloration, and severe pain.  This requires urgent repair.

While an umbilical hernia can be debilitating, Dr. Liang provides umbilical hernia repair surgery that is uniquely tailored to your needs. If your umbilical hernia is causing any discomfort or is at risk for strangulation, Dr. Liang may recommend surgery. Both open surgery and minimally invasive laparoscopic procedures are available, depending on your unique situation.

If you’re seeking relief from an incisional hernia, Dr. Liang can help. If the hernia is small enough, it may not require surgery at this time. However, if it’s growing or is causing pain, incisional hernia repair may be necessary. 

This process involves reducing the protruding organs or tissue back into your abdominal cavity and then properly closing the hole through which they protruded. This can be performed both with open surgery or minimally invasive (laparoscopic or robotic) surgery, depending on the situation.  Dr. Liang will develop a treatment plan that uniquely fits the type of hernia you have and your lifestyle. 

Most patients are able to undergo outpatient surgery and return home the same day or the next day following ventral hernia repair with Dr. Liang. 

Immediately following surgery, you are encouraged to walk a few times a day indoors with assistance and perform light activities.  Within 1-2 weeks, you should be able to perform much of your normal daily activities and within 4 weeks, you can engage in all regular activities in a scaled process.  However, it’s very important to be aware of how your body is feeling and consult with Dr. Liang to individualize your recovery and undergo an optimal healing process. 

More complicated hernias may require abdominal wall reconstruction.  This most often happens after complications from prior surgery or failed previous hernia repairs. 

The aim of abdominal reconstruction is to restore the integrity and function of the abdominal wall allowing you to regain a normal function and quality of life.

Abdominal wall reconstruction is a complex procedure where each operation is uniquely designed to correct the abdominal wall defect and restore the normal function and appearance to your abdomen.

Dr. Liang is specialized to perform these complex procedures with open or robotic techniques where the muscle layers are separated and sewn together with mesh reinforcement.  Many of the techniques Dr. Liang uses techniques that only highly trained and specialized surgeons are able to perform (such as posterior component separation or transversus abdominus release) and most generalists are experienced in performing. 

The results of these complex surgeries can be catastrophic in the hands of inexperienced surgeons.  However, with Dr. Liang’s experience, advanced surgical technique, and individualized treatment strategies, he is able to achieve exceptional results. 

Since abdominal wall reconstruction surgery is more complicated, you likely need to stay in the hospital for 1-7 days depending on how significant or complex your surgery is, in order to give your body time to rest and heal.  Within four to six weeks you’ll likely be able to perform much of your normal daily activities, and within eight weeks many people can engage in their regular exercise.