Johns Hopkins Surgery
April 9, 2015

Complex ventral hernias, which occur in about 15 percent of patients who have had abdominal surgery, can be difficult to treat in a timely manner. Often, symptoms are not severe enough for patients to seek help. They may wait until they feel more discomfort, or until the hernia grows larger. In these cases, patients are at risk for serious complications, such as bowel strangulation or obstruction. In addition, the size of their hernia can become so large that amore complex operation is necessary to repair.

For the right candidates, says Hien Nguyen, who directs the Comprehensive Hernia Center at Johns
Hopkins, endoscopic component separation with mesh reinforcement not only provides a durable repair for these large hernias occurring at the incision, but it can decrease the recovery time as well, allowing patients to leave the hospital and return to their activities earlier.

The traditional open repair requires a 20- to 30-centimeter incision from the sternum to the pelvis and the creation of large tissue flaps to fix the hernia. These tissue flaps can lead to further risk of skin breakdown and wound infections. Endoscopic component separation, says Nguyen, avoids many of the complications of this approach because it can be performed with 1-centimeter incisions, and without creating large tissue flaps. This minimally invasive technique allows Nguyen to cut the external oblique muscle, the outermost layer of the three anterior abdominal muscles, to decrease tension as the hernia defect is closed. He then places mesh underneath the tissue repair, with margins of 3 to 5 centimeters, to protect the mended area and reinforce the abdominal wall structure. He uses a variety of different meshes, and, he says, the operation provides a durable repair that decreases the risk of recurrence.

“Not all ventral hernias need to be fixed immediately, but it is better to refer patients for surgical consults before the hernia requires a complex repair,” says Nguyen. “Patients then have more choices for surgical repair, and can potentially be a candidate for a minimally invasive procedure and fewer complications.”

Nguyen adds that not all patients with ventral hernias are good candidates for endoscopic component separation. Those who have unusually large hernias or who have a great deal of scar tissue from other procedures may need to have an open procedure. Patients with heart or bleeding issues may not be able to tolerate the operation.

But for those who are good candidates, the procedure can potentially enhance quality of life, reduce hospital stays, decrease the risk of wound infection and improve healing compared with open repair technique.

“The level of relief and increased function patients experience after the endoscopic component separation is incredible,” says Nguyen, who has performed more than 50 of the procedures. “Many of my patients tell me that they can do things they were hesitant to do for a long time, such as exercise or travel.”

To refer a patient: 443-997-1508

To see a brief animation on complex hernia repair, please visit bit.ly/complex_hernia_repair.