Ventral (Incisional) Hernia
What are Ventral Hernias?
Ventral hernias, also known as incisional hernias, form at the site of a prior surgical cut. They form because all cuts in the body heal with scar tissue which is always much weaker than the tissues we are born with. The most common cut on the abdomen is straight up and down, in the middle, between the six pack muscles. Hernias may occur in any surgical wound on the abdominal wall, in fact, it is estimated that as many as 30% of patients who undergo abdominal surgery may eventually develop an incisional hernia.
These hernias can be small (size of a finger tip) to large (size of a soccer ball). Ventral hernias, in general, should always be repaired. These type of hernias tend to grow substantially over a relatively short time which may lead to increased pain and risk of complications. As hernias increase in size they generally become more complex which requires a more involved operation to accomplish successful repair.
“No disease of the human body, belonging to the province of the surgeon, requires in its treatment a greater combination of accurate anatomical knowledge with surgical skill, than hernia in all its varieties.”
– Sir Astley Paston Cooper The Anatomy and Surgical Treatment of Abdominal Hernia, 1804
The successful treatment of ventral hernias has been a difficult problem for surgeons for hundreds of years. Historically, once a hernia was repaired the chance of it coming back was as high as 50% or even more in some cases. The most significant advances in hernia repair were developed by the French surgeons Rives and Stoppa back in the 1950’s. They described the unique process of placing a large piece of mesh behind the abdominal muscles to reinforce hernia repairs.
The Rives retro-muscular style hernia repair is the most successful type of hernia operation that has been described. The risk of a hernia coming back after a properly performed Rives repair should be less than 4-5%. Unfortunately, this style of repair was only introduced into the United States in the 1990’s and, for various reasons, did not gain widespread acceptance among US surgeons. As a result, only a small portion of US surgeons perform this operation.
Mesh Repair of Ventral Hernias
In 2000, a landmark study from Europe demonstrated that patients whose ventral hernias were repaired with permanent mesh had a 50% lower risk of the hernia coming back when compared to patients whose hernias were repaired without mesh. At 10 years after surgery, 63% of patients repaired without mesh had hernias again compared to only 32% of patients repaired with mesh. In this study, mesh was placed inside the abdomen, next to the intestines (the style operation most commonly performed in the US), rather than next to the muscles. This study was very important in helping to define the benefit of mesh in the repair of ventral hernias; However, an often overlooked feature of the study was that even in patients repaired with mesh their recurrence rate was over 30%, much higher than the 5% rate expected when a retro-muscular operation is performed.
Robotic Repair of Ventral Hernias
The Rives retro-muscular style hernia repair remains, to this day, the best surgical option for many patients with ventral hernias. This operation was always previously performed “open”, through a single cut on the abdomen, and was never able to be performed laparoscopically (camera surgery) due to limitations in the design of surgical instruments.
Robotic assisted surgery overcomes these previous limitations, and now, complex retro-muscular hernia operations may be performed through several small (1/4″) holes on the abdomen rather than one large cut which results in less pain after surgery and quicker return to normal activities.
Call 248-551-9090 today to learn more about our surgical expertise and how we may be able to help you!