Overview
When the abdominal wall needs more than a patch.
Ventral hernias are bulges through the front of the abdominal wall — sometimes at the navel, sometimes through the scar of a previous operation. A simple, first-time, small ventral hernia in a healthy patient is often a straightforward repair. The hernias we call complex are different: they are larger, they have recurred after a prior fix, they have multiple defects in the same wall, or they sit in a patient with reasons to heal poorly. These need careful planning.
We approach every complex ventral hernia the same way: review the imaging, understand the patient's anatomy and prior operations, and choose the technique that gives the best long-term result — robotic with intraperitoneal or retromuscular mesh for many cases; open component separation (including transversus abdominis release, or TAR) for the largest defects. There is no single best operation for all ventral hernias.
Who is a candidate?
Most patients with a symptomatic ventral hernia are candidates for repair. Optimization matters: we ask patients who smoke to quit, work with patients whose body-mass index is very high to lose weight when possible, and tighten diabetes control before a planned repair. For patients with very large defects, we use cross-sectional imaging (CT) to measure the defect, plan mesh size, and decide whether component separation is needed. Emergency repair is reserved for patients with strangulated hernias or bowel obstruction.
How we perform it
For small and moderate hernias, we use a robotic approach: small port incisions, retromuscular dissection (eTEP or transabdominal retromuscular), and a wide piece of mesh placed behind the muscle layer. For very large or recurrent hernias, we use an open approach with component separation — releasing one or more layers of the abdominal-wall muscles so the midline can be brought back together over a wide mesh. We measure carefully and use the technique the anatomy calls for. Operations range from 90 minutes to over four hours depending on complexity.
Recovery
Hospital stay varies by complexity — from same-day for a small robotic repair to three or four days for a large open reconstruction. We use abdominal binders, walk patients early, and manage pain with a multimodal regimen that minimizes opioids. At home, light activity is fine in the first 1–2 weeks; heavy lifting is held for at least eight weeks. Follow-up is at two weeks for wound check, six weeks for activity progression, and longer-term to monitor for recurrence.
Why Florida Surgical
Complex hernia work is the difference between a repair that lasts and a repair that re-fails. The decisions that matter most happen before the incision: which technique fits this anatomy, which mesh to use, whether to do a component separation, and which patients need optimization first. Dr. Shaw and Dr. Decio collaborate on these cases — two-surgeon repair for the largest defects — and follow patients through to long-term outcomes. We don't use a template.
Frequently asked questions
My hernia has come back twice. Can it still be fixed?
Almost always, yes. Recurrent hernias are often what we are best at fixing. The key is mapping out the prior repairs, choosing a different plane of dissection, and using the right mesh in the right position. Multiple prior failures is one of the strongest indications for an open component separation with retromuscular mesh.
Do I always need mesh?
For complex ventral hernias, essentially always. Without mesh, recurrence rates after a sutured repair of a larger defect are unacceptably high. Modern meshes are well-studied and used safely in millions of repairs each year.
Is robotic repair an option for me?
Often yes, even for moderately complex hernias. The robotic platform lets us do retromuscular mesh placement through small incisions, which used to require an open operation. Very large or loss-of-domain hernias still require an open approach.
How long until I can do my regular workout again?
Light cardio (walking, stationary bike) starts in week 2. Moderate exercise (lower-body work, light resistance) at 4–6 weeks. Full unrestricted lifting at 8 weeks. We tailor this to the size of your repair.
Will I need a drain after surgery?
Sometimes. Larger repairs with extensive dissection benefit from a small closed drain to prevent fluid collection. Drains stay in for one to two weeks and are removed in the office once output is low.