Ventral & Incisional Hernia Repair in Johannesburg

What it involves

The repair strengthens the abdominal wall, usually with mesh reinforcement. For smaller defects Dr Marais uses a laparoscopic approach; larger or complex incisional hernias may require an open reconstruction with component separation.

Umbilical hernias appear at the navel and are often noticed after pregnancy or significant weight change. Epigastric hernias sit between the navel and breastbone. Incisional hernias develop in the scar of a previous abdominal operation and are typically larger and more complex.

Small defects (under 2 cm) can sometimes be repaired with sutures alone, but for anything larger a mesh reinforcement dramatically reduces recurrence. Placement can be onlay (above the muscle), sublay (behind the muscle — usually best), or intraperitoneal for laparoscopic repairs.

Complex incisional hernias — particularly those wider than 10 cm or with loss of abdominal domain — may need component separation, a technique that relaxes lateral abdominal wall muscles so the midline can be closed without tension.

Ventral and incisional hernias are a particularly strong indication for robotic (da Vinci) repair. Wristed instruments make it easier to place mesh precisely in the retro-rectus plane and to suture-close the defect — see the robotic surgery page for detail on when this approach is preferred.

Ventral and incisional hernias are especially common — and technically demanding — in overweight and obese patients. A thick abdominal wall, higher intra-abdominal pressure, larger defects and previous scars all raise the recurrence and wound-infection risk of a standard open repair. This is where minimally invasive surgery earns its place: laparoscopic and, in particular, robotic (da Vinci) ventral hernia repair avoids a long midline incision, allows mesh to be placed in the retro-rectus (Rives-Stoppa) plane, and — for larger defects — makes robotic transversus abdominis release (TAR) component separation possible through small ports. Dr Marais will discuss preoperative optimisation for elective cases: realistic weight loss, glycaemic control if you're diabetic, and smoking cessation all measurably lower the risk of the repair failing.

When it's indicated

Any bulge that appears on the abdominal wall, especially one that worsens with straining, warrants assessment. Repair prevents progression and — importantly — prevents bowel from becoming trapped.

The approach

The technique is matched to the hernia, not the other way round. That means the recovery plan is honest about what each approach realistically involves.

Recovery

Small umbilical or epigastric repairs: same-day or one-night stay, back to desk work in one week. Large incisional or component-separation repairs: two to four nights in hospital, six weeks off heavy lifting, and a binder worn during the day for four to six weeks.