VENTRAL and SPIGELIAN HERNIAS
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It has been determined that you have a Ventral or Spigelian Hernia. Because of your current symptoms and/or findings, and the potential for complications arising from the presence of this hernia, surgical repair has been recommended. Ventral Hernias, (including Spigelian Hernias) occur due to a weakness, gap or opening in the muscles or tendons of the front of the abdominal wall, resulting in a bulge of intra-abdominal contents and/or associated pain or discomfort. This pain and discomfort is the result of nerves in this area being irritated or stretched as the surrounding abdominal wall is also stretched and weakened. If these hernias enlarge, intestine may become trapped within the hernia leading to intestinal blockage or damage (Incarceration or Strangulation). This is an emergency surgical situation. Page 1
Surgery involves repair of the area of weakness and return of the abdominal contents back into their normal position. We utilize a plastic screen or mesh (made from non-reactive polypropylene, Gortex® or at times both) to safely reinforce the area in repairing the overwhelming majority of incisional hernias (both primary and recurrent hernias). The decision on which type, size and specific manufacturer of mesh to be utilized will be made by your surgeon at the time of surgery based on clinical evaluation of the defect, measurements of the defect and surrounding weakness and tissue integrity. Surgical repair of hernias is called a HERNIORRHAPHY. Since muscle is neither cut nor sewn together under tension, this technique is called a TENSION-FREE
Most often in adults, small to moderate sized Ventral and Spigelian hernia repair surgery will be performed under local anesthesia with sedation. What this means is that although you are somewhat sedated by our Department of Anesthesia, you will not be put to sleep. Rather, the area will be numbed with the use of several injections of Novocaine-like medication. You will be kept relaxed, comfortable and pain-free during the short procedure. After surgery, you will be observed in our ambulatory surgery center where you will be active, able to walk and offered a light snack. Most patients with small or moderate size, non-complex Ventral or Spigelian Hernia repairs are discharged on the day of surgery "Safely and Comfortably". A prescription for pain medication will be provided, or you will be instructed in taking over-the counter pain medication.
In patients with larger, multiply recurrent or complex incisional type Ventral hernias, general anesthesia may however be necessary. This can only be determined after a comprehensive evaluation and examination by your surgeon before surgery. Under certain circumstances, over-night hospital stay may also be advised, especially in large and complex Ventral Hernia repairs.
We have extensive experience in the repair of Ventral and Spigelian Hernias with hundreds of such repairs annually (and nearly 1000 hernia repairs overall annually). The surgeons of the North Penn Hernia Institute have received special training in hernia repair, and truly "Specialize" in this field of surgery. This permits us to provide you, our patients, with the safest, most advanced and most effective hernia repair available. As such, our success rate is extremely high, in most instances better than the national average. Additionally, our complication rate is extremely low, again comparable to or below the rates which are reported nationally.
So that you may be fully informed, as required by Pennsylvania law, we have listed below the possible major complications of Ventral or Spigelian Hernia surgery, based on national averages. Again, we believe our success is better than these averages, but they are listed for your information.
All surgical incisions may be associated with some local numbness, as virtually invisible nerves within the skin and lower layers are divided during the initial incision process. Most of this will be temporary, however a very small area of residual numbness around the incision may persist. This is generally well tolerated, minimally noticeable and creates no functional problems. This mild numbness may be located in a small area of skin at or below the incision.
- Recurrence of the Incisional Hernia...................About 1/2% (1 in 200 patients)
- Infection of Incision...........................................Less than 1%
- Bleeding (controlled in OR)..............................Less than 1%
- Swelling and black/blue......................................................About 5% (temporary)
- Injury to intestine or other intra-abdominal organs..........Less than 1 in 1000
- Numbness or Chronic Incisional Pain**..............................1-2%
(*Generally mild, non-debilitating and resolves over time)
Source:HERNIA, Nyhus, Condon 5th Ed. 2002
Chronic incisional pain or discomfort occurs in approximately 1-2% of all surgical procedures, including all hernia repair techniques. With our method, because muscle is neither cut nor pulled together under undue tension, this discomfort is generally mild and usually temporary, lasting 2-3 months or less. More chronic pain is less likely. Severe and long lasting pain at the area of the incision can occur, but is extremely rare (less than 1/2%).
If your hernia is being repaired for the second or more time, the chance of recurrence and other complications listed above may be only slightly higher. We will however utilize our extensive experience and expertise, and take every available precaution and use contemporary technique to reduce these complications for you.
While the over-whelming majority of small and moderate size Ventral hernias are both safely and effectively repaired using just local anesthesia and mild sedation (over 95% of such patients here at NPHI), on extremely rare occasions, because of hernia size and/or complexity, multiple recurrence, extreme obesity and even patient comfort, conversion to a safe, light form of mild general anesthesia under the supervision of a Certified Anesthesiologist may be required. This need can at times be anticipated on initial physical examination. Our Anesthesiologists, therefore, must reserve the right to such a conversion during surgery if in their opinion, patient safety so dictates.
According to Law, I attest that I have read and understand the three (3) pages presented here, and have been informed as to the complications associated with Ventral (or Spigelian) Hernia Repair. I understand the nature of my problem, based on the discussion with my physicians and the above information. Additional questions have been answered. Being therefore fully informed, I consent to the surgery as explained and planned.