What is an incisional (ventral) hernia?
A hernia in the muscles of your abdominal wall happens when tissue from inside the abdomen pushes through a weak spot in the muscle layer, creating a visible bulge that can cause discomfort, pain, or limit your activity. It can start as a hernia that simply enlarges over time, or it can develop at a prior surgical incision — or both.
About 2 out of every 10 people who have had a midline abdominal incision later develop a hernia there. Your risk is higher if you have diabetes, smoke, are overweight, needed emergency surgery, or had a wound infection after a prior abdominal operation.
Why repair it?
Repair is recommended once a hernia causes symptoms, keeps enlarging, or interferes with daily activities. The goal is to restore strength to the abdominal wall and lower your risk of future complications.
What is the robotic eTEP approach?
eTEP stands for "extended totally extraperitoneal" repair. It's a minimally invasive way to rebuild the abdominal wall from a space behind the abdominal muscles, called the retro-rectus space — without entering the main abdominal cavity. Keeping the mesh in this protected space means it doesn't touch your intestines.
The robotic platform gives a 3D view with better depth perception, more precision in tight spaces, and the ability to reconstruct the abdominal wall while sticking to open-surgery principles — every movement is controlled directly by Dr. Rodriguez; the robot does nothing on its own.
Goals of the surgery
- Find and repair every hernia defect, not just the obvious one
- Restore your normal abdominal wall anatomy
- Rebuild the center line of your abdomen (linea alba) without tension
- Reinforce the repair with mesh
How robotic-assisted repair works
Ultrasound marks the muscle borders before any incisions are made, so the small ports are placed accurately and away from the hernia itself. A working space is created behind the abdominal muscles, which are then carefully freed using your CT scan as a roadmap. Once all defects are identified and repaired, the muscles from both sides are brought together at the midline with heavy suture, and mesh is measured, cut to fit, and placed flat in that protected space — sometimes stretching from the bottom of the breastbone to the pelvis.
When is a "TAR" needed?
If the muscles can't be brought together without too much tension, Dr. Rodriguez may perform a transversus abdominis release (TAR) — releasing one specific muscle layer to allow more give when rebuilding the midline. Larger or more complex hernias sometimes need this on both sides, which usually means incisions on both sides of the abdomen (called a "double-dock").
Could this convert to an open operation?
In some cases — heavy scar tissue or unusually complex anatomy — it isn't safe to finish the repair robotically. If that happens, the operation converts to an open repair, which typically means a longer hospital stay and recovery. Even so, the resulting incision is usually smaller than if the case had started as an open operation from the beginning.
Advantages of the robotic eTEP approach
- Smaller incisions, often less pain and a better cosmetic result
- Excellent visualization for precise reconstruction
- Wide mesh coverage for a more durable repair
- Mesh stays outside the main abdominal cavity, lowering the risk it sticks to the bowel
- Restores normal anatomy and function
Risks to know about
- Bleeding or infection
- Injury to the bowel, other organs, or blood vessels (uncommon)
- Injury to intestines, blood vessels, or nerves during initial entry and during the dissection process — this risk is small, but does vary based on anatomy and scar tissue
- Nerve injury or chronic pain
- Fluid or blood collection (seroma or hematoma)
- Hernia recurrence, despite mesh reinforcement
- Temporary breathing or pressure-related symptoms after large repairs
- Extra skin or a midline ridge, which usually improves over time
- Possible conversion to an open operation
Hospital stay and early recovery
- Most patients stay one night in the hospital. If the operation needs to convert from robotic to open during surgery, the hospital stay is often longer than one night.
- A urinary catheter placed during surgery is removed the next morning.
- An abdominal binder is optional — some patients find it helpful, others don't.
- Home medications usually restart on day 1; blood thinners typically resume on day 2, depending on coordination with your other doctors.
- Early fullness or some difficulty taking deep breaths is common and temporary. Walking, sitting upright, and breathing exercises (incentive spirometry) help.
- If drains are placed, they're removed once drainage drops below about 2 tablespoons in 24 hours.
Before going home, you'll need to: have pain controlled with pills, eat and drink adequately, urinate on your own after the catheter is removed, and walk safely (physical therapy may help assess this).
Pain control
An abdominal wall nerve block before surgery can last up to 72 hours. For the first 3 days: scheduled Tylenol (acetaminophen), Celebrex (celecoxib), and Robaxin (methocarbamol), with narcotics available only for breakthrough pain. A bowel regimen is provided too, since constipation is common after surgery and narcotics.
Wound care & activity limits
- Incisions are closed with dissolvable stitches and a purple waterproof glue (Dermabond). You can shower the day of surgery — let water run over the incisions and pat dry. Do not submerge incisions in a pool, tub, or other body of water for at least 4 weeks.
- If present, remove the umbilical dressing the Sunday after surgery.
- Avoid sun exposure on incisions for 6 months to prevent permanent discoloration.
- Walking is encouraged starting the day of surgery.
- Avoid pushing, pulling, or lifting more than 10 pounds, and avoid core exercise, for 4 weeks.
- You can resume driving when no longer taking narcotic / sedating medications and you can quickly go from gas to brake pedal without pain inhibiting your movement.
- Fever over 101°F
- Increasing redness, warmth, swelling, or drainage
- Pain that's getting worse rather than better
- Persistent nausea or vomiting
- Increasing swelling or a new bulge
If it's after hours, your call will be routed to our answering service. The on-call surgeon or PA will receive your message and contact you.
For uncontrolled pain, shortness of breath, chest pain, or inability to keep fluids down, seek urgent medical attention right away rather than waiting for office hours.
Recovery is gradual over several weeks — some temporary swelling, firmness, or change in your abdominal shape is normal and improves with time.