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VENTRAL HERNIA

UNDERSTANDING THE PROBLEM

When a part or whole of an internal organ (or tissues) protrudes through weak areas of the adjoining muscles or connective tissues, the condition is termed as a hernia. Hernia occurs through the weakened area, whenever there is increased pressure or strain on it. They most commonly occur in the abdomen region. When parts of the abdominal contents, such as the bowel or tissues attached to it (omentum or mesentery), protrude through the weakened anterior abdominal wall (in the belly area), the condition is called Ventral Hernia. These hernia types generally occur along the midline or close to the midline of the abdominal wall.

Ventral Hernia is not classified as one single type of hernia; rather, it is a group of hernias that occur in the anterior abdominal hernia. The most common types of Ventral Hernias include:

  • Incisional Hernia (or Ventral Incisional Hernia) is a hernia that occurs through a previous surgical scar
  • Umbilical hernia, which can occur in both infants and adults, at the belly button
  • Epigastric hernia (or fatty hernia of linea alba) occurs in the midline above the belly button. They are usually small in size, but may be multiple in numbers
  • Spigelian hernia (or Lateral Ventral Hernia or hernia Spiegeli) occurs below the level of the belly button on either side; they are not present in the midline. These types of hernias usually present with pain or discomfort, rather than a bulge. They need to be repaired surgically most of the times, because of the risk of complications.
UNDERSTANDING WHO SUFFERS
  • Ventral Hernia can occur in any individual, irrespective of age, sex, race, and ethnicity. However, the incidence varies for different types of ventral hernias.
    • Umbilical hernias are very common in infants and children, but it can affect adults too, especially adults over the age of 60 years
      • It is equally common in both male and female infants. However, in the case of adults, it is more common in females than males.
      • Statistically, it has been observed that African-Americans are more prone to Umbilical Hernias, than individuals of any other race.
      • The condition is seen worldwide
    • Up to 10% of all belly hernias are due to incisional hernias
      • As incisional hernia occurs following a surgery, it is more common with increasing age due to the fact that the probability of having surgeries increases with age. Moreover, wound healing gets poorer with age. However, individual of any age are prone to incisional hernia.
      • Generally, they are 2 times more common in women than men.
      • It may occur worldwide, in individuals of all races and ethnicities.
    • Spigelian hernias are rare types of Ventral Hernia
      • It is slightly more common in women than men
      • It is usually seen in individuals over 40 years of age
      • It may occur worldwide in individuals of all races and ethnicities
    • Epigastric hernias account for approximately 1-3% of all abdominal hernias
      • It is slightly more common in women than men
      • It is usually seen in individuals between the ages of 20-50 years
      • It may occur worldwide in individuals of all races and ethnicities

    The possible causes of Ventral Hernia are:

    • Ventral Hernia may develop due to a birth defect (incomplete closure of the belly wall during fetal development)
    • The abnormality may develop later in life (acquired form of Ventral Hernia), due to:
      • Weakening of the abdominal wall, which may be due to lifting of heavy objects, chronic coughing, chronic straining, and aging
      • Obesity
      • Pregnancy
      • Diabetes
      • Following a belly surgery
    • A family history can also predispose an individual to Ventral Hernia
    • For an individual to get incisional hernia he/she should have had a belly surgery in the past. The following factors may play a role in the development of Incisional Hernia:
      • Weaknesses of surgical wounds may develop due to hematoma, seroma, or an infection
      • Incisional hernia could occur due to inefficient surgical procedure techniques adopted by the surgeon
      • The condition is less common following a laparoscopic belly surgery than due to an open belly surgery
POTENTIAL SIGNS AND SYMPTOMS

The common signs and symptoms that distinguish Ventral Hernia are:

  • A bulge in the abdominal wall, which may expand when pressure is generated within the abdomen cavity. For example, when an individual strains while coughing the abdominal lump may decrease in size, when gentle pressure is applied, or while lying down. The lump may or may not be associated with other symptoms
  • A lump or bulge in the abdomen which may become painful, cause discomfort, or be painful to the touch. Spigelian hernia usually presents with pain or discomfort rather than a bulge
  • The skin over the abdominal lump may become red, if the intestine gets stuck in the hernia defect
  • In epigastric hernia, the pain can occur after eating and it may be associated with nausea and/or vomiting
  • The presence of certain symptoms may be warning sign(s) of life-threatening complications:
  • Swelling increases, the skin becomes tight and red in color
  • Unable to have bowel movements, unable to pass gas
  • High fever
  • Low urine output
  • Severe pain in the abdomen
  • Severe nausea and/or vomiting
  • Difficulty in standing-up straight
EXAMINATIONS USUALLY REQUIRED

A Ventral Hernia may be diagnosed through:

  • A thorough evaluation of medical history
  • A physical examination by the doctor is sufficient enough to diagnose this condition, in many cases. However, it may be difficult to examine the hernia in some obese individuals.
  • The physician may ask the patient to cough, while examining the abdomen, to visual examine the bulge
  • Imaging tests may be undertaken, if the physical examination is not sufficient to arrive at a diagnosis, or to rule-out other conditions
    • Abdominal ultrasound may be done to visualize the hernia and organs of the abdomen
    • A CT scan may give more information and details than an ultrasound in certain select individuals
PROPOSING TREATMENT AND WHY AIMIS

Surgery for Hernia Repair

If your doctor recommends surgery for a disorder, you may be a candidate for a minimally invasive approach - da Vinci Surgery. Because it is minimally invasive, the precision of robotic technology is ideal for delicate and complex surgeries around the chest and abdomen AIMIS is an expert in Robotic Surgery for Robotic Assisted Hernia Repair including for:

Inguinal Hernia - Herniorrhaphy, Hernioplasty - Inguinal, Surgical repair with/without grafts, Femoral Hernia - Femorocele repair; Herniorrhaphy; Hernioplasty – femoral, Surgical repair with/ without grafts, Umbilical Hernia - Surgical repair with or without grafts, Ventral Hernia - Surgical repair with grafts and Hiatal Hernia - Surgical repair with/without grafts, Nissen Fundoplasty

Da Vinci Surgery uses state-of-the-art technology to assist doctors in performing a range of delicate operations for hernias and offers several potential benefits over traditional open and laparoscopic surgery, including:

  • Greater precision and Low rate of recurrence
  • Low rate of pain
  • Low conversion rate to open surgery
  • Low rate of major complications
  • Virtually scar less surgery with da Vinci Single Site Surgery®
  • High patient satisfaction
  • Reduced risk of blood loss
  • Shorter hospital stay

To see the procedures we undertake with Robotic Xi Surgery, please click here

GETTING MORE INFORMATION BEFORE MOVING FORWARD
YOU MAY HAVE QUESTIONS LIKE:
  • Can I get more information before I commit to this?
  • Can I get a second opinion from you before I commit to this?
  • How can I find out the cost before I have any obligation?
WHAT AIMIS CAN DO:

AIMIS will provide a full review, diagnosis and potential surgical options for your condition, after receiving the relevant examinations and information from you. They will also provide an estimate for your surgical procedure before you decide.

AIMIS’ mission is to the provision of “true” healthcare for those who require it. It provides world leading surgeons using state of the art procedures to optimize potential surgical outcomes, whilst taking care of all arrangements so as to allow concentration on recovery.

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AFFORDABILITY

AIMIS provide competitive prices for state of the art procedures. We also work with a large range of Insurance companies where your policy allows you to have surgery abroad.

 

FURTHER INFORMATION ON THE PROBLEM:

The possible complications arising out of Ventral Hernia could be:

  • If left untreated, the Hernia continues to grow slowly until it is able to cause serious complications.
  • Intestinal obstruction: The contents within the bowel may not be able to move, if the bowel gets kinked (sharp twist or bend) in the defect. The obstruction may be partial or complete.
  • Incarceration (intestine gets stuck in the umbilical hernia defect): It presents with severe pain and irreducible swelling (it is not possible to slowly push back the intestine or other contents into the abdomen).
  • Incarceration can progress and cause loss of blood supply to the trapped abdominal contents (strangulation), which may eventually lead to death of the bowel (gangrene).
  • Gangrene can lead to infection in the abdominal cavity (peritonitis) and sepsis (infection of blood).
  • Septic shock (whole body infection causing decreased blood supply to the organs) and multi-organ failure, as a consequence of strangulated hernia and/or gangrene.
  • Recurrence of the hernias despite surgical therapy.
  • Generally, hernias that cause symptoms other than bulging need to be treated. The treatment options depend on the type of Ventral Hernia. They may include:

  • Regular medical consultation with the physician to monitor and manage its progression may be required in asymptomatic, small hernias. However, this varies from one individual to another, and depends upon the type of the Ventral Hernia
  • Use of truss (binder), which is a garment (very much like a weight belt or girdle) to hold the organs in place may be tried in some individual. However, this does not correct the anatomical defect.
  • Epigastric, Spigelian, and umbilical hernias in the adult require surgery most of the times, because complications are more common with these type of hernias The most definitive treatment of Ventral Hernias is surgical repair of the defect. The surgical options include Open, Laparoscopic and Robotic Surgeries.
  • Open surgery, although less commonly done, may be performed by making a large incision in order to push the lump (hernia sac and its contents) back into the abdomen and repair the defect, either by approximating the tissues together or by using a mesh. A plastic mesh can be used during surgery to repair weakness in the abdominal wall
  • Laparoscopic or Robotic surgeries that are minimally-invasive are the preferred methods depending on the clinical situation. Usually minimal small incisions are made, and the surgeon uses microscopic instruments and surgical cameras to aid in the repair.
FURTHER INFORMATION ON INCREASED RISK GROUPS

The risk factors can vary for different types of Ventral Hernias. Common or general factors that increase the risk of Ventral Hernia include:

  • History of abdominal surgery, with the risk increasing with multiple surgeries
  • Chronic constipation
  • Chronic cough
  • Prostate gland enlargement, or any condition that constantly increase intra-abdominal (within the belly) pressure
  • Family history of hernia
  • Activities that put pressure on the abdomen, such as weightlifting or improper lifting techniques
  • Malnutrition
  • Obesity (or being overweight) puts more strain on the abdomen muscle
  • Pregnancy. The risk increases with multiple pregnancies
  • Smoking
  • Advancing age: The muscle and supporting structures (fascia, connective tissue) weaken with an increasing age
  • Use of steroids (corticosteroids) for other medical conditions
  • In infants, Low birth weight, Premature or preterm babies, African American and genetic order increase the risk.

For an incisional hernia, the most important risk factor is a history of belly surgery. Besides the general factors above, conditions that may increase one’s risk for incisional hernia include:

  • Wound infection after belly surgery can increase the risk of acquiring hernia in the future
  • Improper surgical techniques used during belly surgeries
  • History of previous incisional hernias
  • History of or associated ventral hernias that include umbilical or epigastric hernias
  • Medical conditions in which there may be poor wound healing such as due to diabetes mellitus
  • Elderly adults are more likely to be affected because the healing process slows with aging

Ventral Hernia that occurs due to a birth defect cannot be prevented. In adults not all acquired hernias can be prevented from taking place. However, the following preventive measures can be adopted to minimize the occurrence or prevent further complications of a Ventral Hernia:

  • Treatment for chronic constipation so as to avoid straining during bowel movements
  • Treatment for chronic cough and if due to smoking, smoking cessation and can also be a reason for poor wound healing
  • Treatment for prostate conditions
  • Avoid improper lifting of heavy objects (especially in individuals with a history of hernia)
  • Avoiding physical over-exertion
  • Maintain age and height appropriate body weight
  • Enroll or participate in weight loss programs if you are overweight or obese
  • The incidence of incisional hernias can be decreased, if a surgeon adopts appropriate surgical techniques and treats wound infection promptly with antibiotics (and drainage)
  • Follow the recovery instructions very carefully, after abdominal surgery
  • Follow a healthy diet: A proper diet before and after surgery can also help with good wound healing
FURTHER EXAMINATION THAT MAYBE REQUIRED OR REQUESTED

When surgery is planned, additional tests, such as imaging, blood tests, and urine exam, will be necessary.

WHY AIMIS FOR THIS SURGERY

AIMIS is an expert in Robotic Surgery for Robotic Assisted Hernia Repair including:

Inguinal Hernia - Herniorrhaphy, Hernioplasty - Inguinal, Surgical repair with or without grafts, Femoral Hernia - Femorocele repair; Herniorrhaphy; Hernioplasty – femoral, Surgical repair with or without grafts, Umbilical Hernia - Surgical repair with or without grafts, Ventral Hernia - Surgical repair with grafts and Hiatal Hernia - Surgical repair with/without grafts, Nissen Fundoplasty
and other minimal invasive procedures involving the best American and International surgeons who are experts in the field.

Da Vinci Surgery uses state-of-the-art technology to assist doctors in performing a range of delicate operations for Hernia Repair and offers several potential benefits over traditional open and laparoscopic surgery, including:

  • Greater precision and Low rate of recurrence
  • Low rate of pain
  • Low conversion rate to open surgery
  • Low rate of major complications
  • Virtually scar less surgery with da Vinci Single Site Surgery®
  • High patient satisfaction
  • Reduced risk of blood loss
  • Shorter hospital stay

Some procedures can be achieved through the belly button traditional single incision laparoscopy or da Vinci® Single-Site® Surgery. The da Vinci System features a magnified 3D high-definition vision system and flexible Single-Site instruments. These features enable your doctor to operate with enhanced vision and precision and provide virtually scar less surgery.

OTHER SERVICES PROVIDED BY AIMIS

In addition to its Innovative Healthcare, AIMIS provides seamless service along the way. From the start of your journey you'll know the best flights to take, where you'll be staying, what paperwork you will need. You will have a personal assistant assigned; from your pick up at the airport, to your accommodation, continuous assistance at your pre-consultation, through surgery and in your postsurgical care. Our Patients have said that they feel they have become "part of our family" and some even asked to stay a little longer! AIMIS is here to assist you in an all you requirements, allowing you to focus on your health and recovery.

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