A ventral hernia occurs when abdominal contents protrude through a defect in the anterior abdominal wall. These hernias can arise at previous surgical incision sites (incisional hernia) or spontaneously due to weakness in the abdominal muscles. Common symptoms include a noticeable bulge, discomfort, pain during activity, or complications like bowel obstruction in severe cases.

Traditional vs. Laparoscopic Approach

Historically, ventral hernias were repaired through open surgery, which involved large incisions and extensive tissue dissection. This approach, while effective, is associated with higher risks of infection, postoperative pain, longer hospital stay, and delayed recovery.

In contrast, laparoscopic ventral hernia repair is a minimally invasive technique that uses small incisions, a camera, and specialized instruments. This approach offers multiple advantages:

• Reduced postoperative pain

• Faster recovery and shorter hospital stay

• Lower risk of wound infection

• Better cosmetic outcomes

• Ability to identify and repair multiple hernia defects simultaneously

Procedure Overview

1. Preoperative Assessment: Patients undergo imaging studies, usually a CT scan of the abdomen, to evaluate the size, location, and contents of the hernia. Risk factors such as obesity, diabetes, and previous surgeries are assessed.

2. Anesthesia and Access: The procedure is performed under general anesthesia. Small incisions (typically 5–10 mm) are made, through which trocars are inserted to allow laparoscopic instruments and a camera.

3. Hernia Reduction: The herniated abdominal contents are gently pushed back into the abdominal cavity. Adhesions around the hernia site are carefully released using laparoscopic tools.

4. Mesh Placement: A synthetic or biologic mesh is introduced through the ports and positioned to cover the hernia defect with adequate overlap (usually 3–5 cm beyond the edges). The mesh is then fixed in place using tacks, sutures, or a combination.

5. Closure and Recovery: The instruments are removed, and the small incisions are closed. Patients usually resume oral intake within hours and can ambulate the same day. Full return to normal activities typically occurs within 1–2 weeks, depending on individual factors and hernia size.

Outcomes and Considerations

Studies have shown that laparoscopic repair has lower recurrence rates compared to traditional open repair, especially in large or multiple ventral hernias. However, it requires expertise in advanced laparoscopic techniques and careful patient selection. Risks include seroma formation, mesh infection, bowel injury, or chronic pain, though these are generally less frequent than with open surgery.

Conclusion

Laparoscopic management of ventral hernia represents a safe and effective treatment option, combining the principles of hernia repair with the benefits of minimally invasive surgery. It offers patients quicker recovery, less pain, and better cosmetic results, making it the preferred approach for many surgeons worldwide.