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Ventral Hernia

What is a ventral hernia?

A ventral hernia is a bulge of tissues through an opening of weakness within your abdominal wall muscles. It can occur at any location on your abdominal wall.

Many are called incisional hernias because they form at the healed site of past surgical incisions. Here abdominal wall layers have become weak or thin, allowing for abdominal cavity contents to push through.

In a strangulated ventral hernia, intestinal tissue gets tightly caught within an opening in your abdominal wall. This tissue can’t be pushed back into your abdominal cavity, and its blood flow is cut off. This type of ventral hernia is an emergency requiring surgery.

Hernias can occur in other places of your body and are named after the location where they occur — for example, a femoral hernia occurs in your upper thigh.

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Risk factors

What are the risk factors of a ventral hernia?

Certain people are born with a congenital defect — one existing from birth — that causes their abdominal wall to be abnormally thin. They are at a greater risk for developing a ventral hernia. Other risk factors for a ventral hernia include:

  • pregnancy
  • obesity
  • history of previous hernias
  • history of abdominal surgeries
  • injuries to your bowel area
  • family history of hernias
  • frequently lifting or pushing heavy objects

Causes

What are the causes of a ventral hernia?

According to UCSF, incisional hernias may occur in up to 30 percent of those who’ve had an abdominal surgery. Most occur at the site of a surgical scar. The scar tissue weakens or thins, allowing a bulge to form in the abdomen. This bulge is tissue or organs pushing against the abdominal wall.

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Symptoms

What are the symptoms of this condition?

Ventral hernias can produce an array of symptoms. Symptoms may take weeks or months to appear.

You may feel absolutely no symptoms. Or you could experience discomfort or severe pain in the area of your hernia, which might grow worse when you try to stand or lift heavy objects. You may see or feel a bulging or growth in the area that feels tender to the touch.

If you experience any of the following symptoms, make sure to consult a doctor right away:

  • mild discomfort in your abdominal area
  • pain in your abdomen
  • outward bulging of skin or tissues in your abdominal area
  • nausea
  • vomiting

Diagnosis

How is a ventral hernia diagnosed?

For a complete diagnosis, a doctor will ask you about your symptoms and perform a physical exam. They may need to order imaging tests to look inside your body for signs of a ventral hernia. These may include:

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Treatment

What treatment options are available?

Ventral hernias require surgical correction. If left untreated, they continue to grow slowly until they are able to cause serious complications.

Untreated hernias can grow into enlarged ventral hernias that become progressively more difficult to fix. Swelling can lead to trapping of hernia contents, a process called incarceration. This in turn can lead to reduced or no blood supply to the tissues involved, which is referred to as strangulation.

Options for surgical treatment include:

  • Mesh placement surgery: A surgeon pushes tissue back into place and then sews in a mesh, which serves as a reinforcing patch, to keep it in place. This is considered safe and reliable, and mesh placement has been shown to reduce risk of hernia recurrence.
  • Laparoscopic repair: A surgeon makes multiple small openings and fixes your hernia using guidance with a small camera inside your body to direct the surgery. A mesh may or may not be used.
  • Open surgery (nonlaparoscopic): A surgeon makes an incision adjacent to your hernia, pushes the tissues back into place, and then sews the area shut. A mesh may or may not be used.

Benefits of laparoscopic removal include the following:

  • much smaller cut site, which lowers chance of infection
  • reduced postoperative pain
  • reduced hospital stay — generally able to leave day of or day after procedure
  • absence of a large scar
  • faster overall recovery time

These are a few concerns about open surgery:

  • longer stay in the hospital after surgery
  • greater amount of pain
  • medium to large scar
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Complications

Are there complications?

Massive ventral hernias are those that have a length or width of at least 15 centimeters (cm) or an overall area of 150 cm2, according to the Journal of American Surgery. They pose a serious surgical risk. The giant hernia fills the abdominal cavity, making it difficult to separate from surrounding organs. As the hernia grows in size, the risk of a reoccurrence also becomes higher.

Other complications of untreated hernias include:

  • Incarceration: Your intestine becomes trapped in a weak abdomen wall where it can’t be pushed back inside of your abdominal cavity. This may cause blockage to your intestine or cut off its blood supply.
  • Strangulation: This occurs when blood flow to your intestine is blocked. Part of your intestine may die or begin to decay. Immediate surgery is necessary to restore blood flow and save the intestine.
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Outlook

What is the outlook for a ventral hernia?

In the early stages of a hernia, you may be able to “fix” your own hernia. Some people may feel the bulge in their abdomen and push the organs back inside. This is called reducing the hernia. Reducing often works temporarily until you undergo surgery.

The outlook is generally very good after a surgery with no complications. You may need to rest for a few weeks before resuming daily activities, avoiding any heavy lifting or straining to the abdominal area.

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