A ventral hernia is a bulge (of tissues) through an opening, or defect, within the abdominal wall muscles. It can occur at any location on the abdominal wall. Many are called incisional hernias because they often form at the healed site of past surgical incisions where the skin has become weak or thin. A strangulated ventral hernia refers to intestinal tissue getting caught (this is a surgical emergency) within a ventral hernia.
Hernias can occur in other places of the body and are named after the location where they occur (e.g., a femoral hernia occurs in the upper thigh).
Certain people are born with a congenital defect (existing from birth) that causes the 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:
- history of previous hernias
- history of abdominal surgeries
- injuries to the bowel area
- family history of hernias
- constantly lifting or pushing heavy objects
A 2011 study found that ventral hernias are common complications in approximately 10 percent of open abdominal procedures. 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 the tissue or organs pushing against the abdominal wall.
Ventral hernias can produce an array of symptoms. Some patients feel absolutely no symptoms, while others are in severe pain. Symptoms may take weeks or months to appear. Doctors often diagnose a ventral hernia by observing the patient’s symptoms and examining imaging tests to look for the presence of a ventral hernia. Oftentimes patients have no symptoms. Other times, symptoms include discomfort or pain in the area of the 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 the abdominal area
- pain in the abdomen
- outward bulging of skin or tissues in the abdominal area
For a complete diagnosis, a doctor will perform a physical exam. They may need to look inside the body for confirmation.
Diagnostic tests to look for signs of a ventral hernia may include:
- ultrasound of the abdomen area in question
- computerized tomography (CT) scan
- magnetic resonance imaging (MRI)
Ventral hernias require treatment unless the patient can’t undergo surgery or refuses it. If left untreated, they continue to grow slowly until they are able to cause serious complications. Treatment for a hernia requires surgical correction. Untreated hernias can grow into enlarged ventral hernias that become progressively more difficult to fix. Swelling can lead to entrapment of the hernia contents. Entrapment can lead to reduced blood supply to the tissues involved, causing “strangulation.”
Options for surgical treatment include:
- Mesh placement surgery: A surgeon pushes tissue back into place and then sews in a wire mesh (like a reinforcing patch) to keep it in place. This is considered safe and reliable.
- Laparoscopic removal: A surgeon makes multiple small openings and fixes the hernia using a small camera inside the body to direct the surgery.
- Open surgery (nonlaparoscopic): A surgeon makes a large opening and enters the body to push the tissue back into place and then sew it.
Benefits of laparoscopic removal include:
- much smaller cut site (lowers chance of infection)
- reduced postoperative pain
- reduced hospital stay (generally able to leave day of or day after procedure)
- absence of large scar
- faster overall recovery time
Some concerns of open surgery include:
- longer stay in the hospital after surgery
- greater amount of pain
- medium to large scarring
Giant ventral hernias are those that have grown beyond 10 centimeters. They pose a serious surgical risk. The giant hernia fills the abdominal cavity, making it difficult to separate from the surrounding organs. As the hernia grows in size, the risk of a reoccurrence also becomes higher.
Other complications of untreated hernias include:
- Incarceration: The intestines become trapped outside the abdomen. This may cause blockage to the intestines or stop blood supply.
- Strangulation: This occurs when blood to the intestines is blocked. Part of the intestines may die or begin to decay. Immediate surgery is necessary as the bowel may also become blocked off.
In the early stages of a hernia, a person may be able to “fix” their own hernia. Some people may feel the bulge in the abdomen and push the organs back inside. This is called reducing the hernia. Reducing often works temporarily until the patient undergoes surgery.
The outlook is generally very good after a surgery with no complications. Patients may need to rest for a few weeks before resuming daily activities.