Ventral Operations

Mesh repairs are considered the standard by most in the surgical community for hernia defects larger than 1-2 cm. In most studies, the use of mesh did not result in a statistically significant increase in chronic pain or complications. The use of mesh however was correlated with a lower recurrence rate (about 1-5%). There are rare cases of well-documented mesh-related illness due to uncommon immune reactions.

Open repair with mesh
Benefits of this repair include not requiring general anesthesia and intubation. Generally, the mesh can be kept away from the bowel by either utilizing the preperitoneal or onlay position. Typical meshes used include Ventralex ST, Prolene, or Bard Soft Mesh.

Robotic repair with mesh (IPOM+)
Benefits of this repair include probably slightly less pain for larger defects. General endotracheal anesthesia is required. Here the mesh is placed intra-peritoneally (though sometimes it is placed pre-peritoneally), but certain modern anti-adhesive barriers appear quite effective at allowing the mesh to re-peritonealize (be covered with peritoneum and thus excluded from the intestine). Typical meshes used include Ventralight ST, Prolene, or Bard Soft Mesh.

Robotic TAR with mesh
This repair is useful for large or recurrent hernias and keeps the mesh away from the peritoneal cavity. This operation is more involved and generally a little longer than other ventral hernia repairs. It is similar to open TARs but leverages the benefits of minimally-invasive surgery in what would otherwise require a large incision. Typical meshes used include light-weight or medium-weight non-coated polypropylene large pore meshes.

Many studies demonstrate that non-mesh repairs are comparable to mesh repairs for small hernias. For larger hernias, alternative techniques must be utilized -- there is no definitive consensus in the surgical community as to which technique is best. Most agree that these repairs should either not be used or used with caution in patients with risk factors for recurrence (e.g. recurrent hernias, obesity, and smoking). 

Open primary repair
This is most appropriate in smaller hernias 1-2 cm in size. This is our preferred technique for small umbilical hernias. An absorbable mesh may or may not be used to buttress the repair -- doing so would likely decrease recurrence rates with no notable increased risk of complications.

Robotic primary repair
This is most appropriate in smaller hernias 1-2 cm in size in obese patients. An absorbable mesh may or may not be used to buttress the repair -- doing so would likely decrease recurrence rates with no notable increased risk of complications.

Open two-layer no mesh repair
This repair is for larger hernia defects and utilizes a muscle plication technique similar to what is done during abdominoplasties. By plicating the rectus muscles above and below the hernia, we are able to close the hernia primarily. Recurrence rates are slightly higher than in mesh repairs. We recommend this technique be performed with permanent sutures and that the repair be buttressed with an absorbable mesh such as Phasix or Phasix ST.