We refer to all other hernias, other than groin hernias, as ventral (abdominal) hernias. Two common ventral hernias are umbilical and epigastric. They are commonly associated with diastasis recti, or abnormal separation of recti muscles (straight muscles of the abdomen, or simply “abs”). Normally, recti muscles are about 2 centimeters apart and the connective tissue (fascia) between them (linea alba) is thick and robust. With multiple pregnancies, weight gain and age, straight muscles may spread apart, sometimes as wide as 5-6 centimeters. Patients with diastasis may feel a “ridge” when lifting up their head while lying down. When the linea alba becomes thin and weak it can form multiple defects. A similar situation occurs with midline incisional hernias. These hernias require plication and reinforcement of the weakened diastasis with mesh, which can be done robotically. In the case of a small umbilical hernia associated with diastasis, we offer laparoscopic subcutaneous repair (SCOLA) which takes care of the hernia and diastasis.
Umbilical (belly button) hernias are very common. If the umbilical hernia is small, and in an average-risk patient, it can be repaired using the sutures only without mesh. An umbilical hernia larger than 2-3 centimeter needs mesh reinforcement for a durable repair. Many complex recurrent ventral hernias start as a small simple umbilical hernia. Treating such complex hernias requires meticulous planning with preoperative imaging and patient preparation. Repair of complex hernias may require abdominal wall reconstruction techniques including myofascial release. This can often be done robotically but will need to be repaired using an open approach (larger incision). Some of the rarer hernias, for instance, Spigelian and lumbar, can also often be repaired robotically.
If you have a large scar or excessive skin and soft tissues, abdominal wall reconstruction (complex hernia repair) is often performed with formal abdominoplasty or panniculectomy (tummy tuck). Our plastic surgeons perform these body recontouring procedures.
A CT scan is necessary for proper planning and choosing the best surgical approach (open or robotic). A routine non-contrast CT scan of the abdomen and pelvis is sufficient for these purposes. * Such scans can be ordered during your office visit, or by your primary care doctor or referring provider ahead of your office visit.
* Please obtain and bring your CD disk of your CT scan with you to your appointment. Your doctor will need to review the actual images and not just the CT report.