From the Guidelines
Ventral hernia surgery is generally not considered a high-risk procedure for most patients. It is a common operation with relatively low complication rates when performed on appropriate candidates. However, the risk level varies depending on several factors including the size of the hernia, whether it's an emergency or elective procedure, the surgical technique used (open versus laparoscopic), and the patient's overall health status. Patients with significant comorbidities such as obesity, diabetes, heart disease, or lung problems face higher risks during and after surgery. The procedure typically involves pushing the protruding tissue back into place and reinforcing the abdominal wall with mesh or sutures. Potential complications include infection, bleeding, recurrence of the hernia, mesh-related complications, and anesthesia risks. Recovery usually takes 2-6 weeks depending on the extent of the repair and individual healing factors. Most ventral hernia repairs have good outcomes with proper patient selection, surgical technique, and postoperative care, making it a moderate-risk rather than high-risk procedure for most individuals.
Factors Influencing Risk
- Size of the hernia
- Emergency or elective procedure
- Surgical technique used (open versus laparoscopic)
- Patient's overall health status
- Presence of comorbidities such as obesity, diabetes, heart disease, or lung problems
Potential Complications
- Infection
- Bleeding
- Recurrence of the hernia
- Mesh-related complications
- Anesthesia risks
Recovery and Outcomes
- Recovery time: 2-6 weeks
- Individual healing factors influence recovery time
- Proper patient selection, surgical technique, and postoperative care contribute to good outcomes
- Most ventral hernia repairs are considered moderate-risk rather than high-risk procedures for most individuals, as supported by studies such as 1 and 1.
Recent Guidelines and Recommendations
Recent guidelines, such as those published in the World Journal of Emergency Surgery 1 and the International Journal of Surgery 1, provide recommendations for the use of biological meshes in abdominal hernia repair, highlighting the importance of proper patient selection and surgical technique in minimizing risks and optimizing outcomes.
From the Research
Ventral Hernia Surgery Risks
- Ventral hernia surgery can be considered a high-risk procedure for certain patients, particularly those with co-morbidities such as congestive heart failure, pulmonary circulation disorders, coagulopathy, liver disease, metastatic cancer, neurological disorders, and paralysis 2.
- The risk of complications, including surgical site infection, hernia recurrence, postoperative pain, and mesh-related issues, is higher in patients with certain risk factors, such as obesity, smoking, and high blood sugar levels 3, 4.
- Elective ventral hernia repair is not recommended for patients with a BMI ≥ 50 kg/m, current smokers, or patients with HbA1C ≥ 8.0% due to increased risk of complications 4.
- Minimally invasive techniques, such as laparoscopic surgery, can decrease the risk of surgical-site infections and shorten the duration of hospital stay, but are technically more demanding and take longer to perform 5, 6.
Patient-Related Risk Factors
- Optimizing patient-related risk factors before surgery is important to decrease complication rates 5, 2.
- Patients with high-risk factors, such as age > 50 years, male gender, and certain co-morbidities, are at increased risk of mortality after elective ventral hernia repair 2.
- Individualized interventions to reduce surgical risk are recommended for patients with BMI = 30-50 kg/m or HbA1C = 6.5-8.0% 4.
Surgical Techniques and Complications
- Surgical techniques for ventral hernia repair are constantly evolving, and abdominal wall surgery has turned into a highly specialized field 5.
- The management of postoperative complications, including surgical site infection, hernia recurrence, postoperative pain, and mesh-related issues, is an important aspect of ventral hernia repair 3.
- Mesh reinforcement is recommended for repair of hernias ≥ 2 cm, but there is limited evidence and broad variability in practice patterns for other aspects of ventral hernia management 4.