What is a large or giant ventral hernia?
A large ventral hernia is characterized by a significant hernia defect in the front abdominal wall.
Giant hernias may involve:
- significant separation of the rectus abdominis muscles
- muscle atrophy and retraction
- multiple hernia defects
- marked diastasis
- a large volume of hernia contents
- loss of domain
- previous unsuccessful operations
- recurrence after hernia repair
When a hernia has existed for a long time, the abdominal wall adapts to the new position of the organs, so simply closing the defect is not always enough.
Our approach
Treatment of large and giant hernias begins with a detailed analysis of the anatomy of the front abdominal wall.
Before surgery, the following are assessed:
- the size and location of the hernia defect
- the number of defects
- the condition of the muscles and aponeuroses
- the width of the diastasis
- the volume of the hernia sac
- the ratio of the hernia contents to the volume of the abdominal cavity
- the presence of loss of domain
- previous operations
- the presence and position of mesh implants
- the extent of adhesions
For planning a complex reconstruction, the main imaging method is *CT of the abdominal wall and abdominal cavity*.
If necessary, special preoperative preparation may be carried out to gradually increase the functional volume of the abdominal cavity and reduce the risk of postoperative complications.
When is surgery needed?
Surgical treatment may be recommended for:
- large and giant ventral hernias
- progressive enlargement of the defect
- pain or discomfort
- significantly impaired abdominal wall function
- marked abdominal deformity
- an irreducible hernia
- recurrence after previous hernia repair
- limited physical activity
- a complicated hernia
Indications for surgery
Reconstruction of the front abdominal wall is indicated for patients in whom the hernia defect cannot be reliably repaired with a simple local repair.
Particularly complex cases include those:
- with wide separation of the rectus abdominis muscles
- with loss of domain
- after several previous operations
- with recurrent hernias
- with multiple defects
- with marked muscle atrophy and retraction
- with significantly impaired function of the front abdominal wall
How is the operation performed?
The procedure is performed under general anesthesia.
The extent of the operation depends on the anatomy and complexity of the hernia.
During the operation, the following may be performed:
- access to the hernia defect
- division of adhesions
- reduction of the hernia contents
- dissection and assessment of the hernia sac
- mobilization of the musculoaponeurotic structures
- closure of the hernia defect
- restoration of the midline
- correction of diastasis
- reconstruction of the front abdominal wall
- placement of a mesh implant
- reliable reinforcement of the reconstructed area
For large defects, *abdominal wall component separation techniques* may be used, which mobilize the musculoaponeurotic structures and allow the defect to be closed with less tension.
Reconstruction of the front abdominal wall
The main goal of the operation is not simply to close the hernia opening but to restore the normal anatomy and function of the abdominal wall.
During reconstruction, we aim to:
- restore the midline
- return the rectus abdominis muscles to their anatomical position
- close the hernia defect
- correct the diastasis
- restore abdominal wall function
- ensure reliable reinforcement with a mesh implant
- minimize tissue tension
- reduce the risk of recurrence
Hernias with loss of domain
In giant ventral hernias, part of the abdominal organs may remain outside the abdominal cavity for a long time.
This condition is called *loss of domain*.
Returning a large volume of organs into the abdominal cavity during surgery can cause a sharp rise in intra-abdominal pressure and breathing problems.
That is why such operations require especially careful planning and, if necessary, special preoperative preparation.
The strategy is determined individually depending on the size of the hernia, the volume of the hernia sac, the condition of the abdominal wall, and the patient's general condition.
Use of a mesh implant
In large and giant ventral hernias, a mesh implant is often an important part of the reconstruction.
It provides additional reinforcement of the restored abdominal wall and distributes the load over a larger area of tissue.
The type, size, and placement plane of the implant are determined individually according to the patient's anatomy.
Advantages of modern reconstruction
- Restoration of the anatomy of the front abdominal wall
- Restoration of abdominal muscle function
- Closure of large hernia defects
- Correction of diastasis
- Reliable reinforcement of the reconstructed area
- Less tissue tension
- Lower risk of another recurrence
- Treatment of complex and recurrent hernias
The surgical technique is determined individually after a detailed examination.
Recovery after surgery
After major reconstructive operations, the recovery period is usually longer than after standard hernia repair.
Postoperative care includes:
- early mobilization
- effective pain control
- prevention of thromboembolic and infectious complications
- a gradual return to eating
- monitoring of the surgical wound
- a gradual increase in physical exertion
The return to full physical activity is gradual and depends on the extent of the reconstruction.
Patient care follows the principles of *ERAS (Enhanced Recovery After Surgery)*.
Our advantages
- Experience in treating large and giant ventral hernias
- Comprehensive assessment of the anatomy of the front abdominal wall
- CT-based surgical planning
- Reconstruction of the front abdominal wall
- Treatment of recurrent and complex hernias
- Correction of diastasis
- Use of modern component separation techniques
- Individual choice of mesh implant and its placement plane
- Individual planning of preoperative preparation for loss of domain
- Modern enhanced recovery protocols (ERAS)
Frequently Asked Questions
In many cases, simple suturing is not enough. Large defects require reconstruction of the front abdominal wall and additional reinforcement.
In large and giant hernias, mesh reinforcement is often an important part of the reconstruction. The final decision depends on the specific anatomical situation.
It is a condition in which a large part of the abdominal organs has been in the hernia sac for a long time, and the volume of the abdominal cavity may not be sufficient to return them safely without special planning.
Yes. For large and giant hernias, CT is an important method for assessing the size of the defect, the condition of the muscles, and the hernia contents, and for planning the reconstruction.
In some cases, minimally invasive technology can be used. However, giant and complex hernias may require open reconstructive surgery.
Yes. When a large ventral hernia is combined with diastasis, the correction can be performed as part of the same reconstruction.
Recovery time is individual and depends on the size of the hernia, the complexity of the reconstruction, the condition of the tissues, and the patient's general condition. After major reconstructive operations, a return to full physical exertion takes more time.