A ventral hernia is a bulging of the abdominal wall, often at the midline. However, 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.
Hernias are named after the location in the body they occur. Other types of hernias include:
- femoral hernia: a bulge in the upper thigh, just below the pelvic area
- hiatal hernia: in the upper part of the stomach
- incisional hernia: through a scar from a previous abdominal surgery
- inguinal hernia: a bulge in the groin area
- umbilical hernia: around the belly button
Symptoms may take weeks or months to appear. The diagnosis is often made from the patient’s symptoms and imaging tests that show the presence of a ventral hernia. Sometimes 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.
Treatment for a hernia requires surgical removal. Untreated hernias can grow into enlarged ventral hernias that become surgically difficult to remove. Swelling can lead to entrapment of the hernia contents. If not properly addressed, this can lead to a reduced blood supply to the tissues involved, causing“strangulation.”
Tissue strangulation is typically accompanied by intense pain, and constitutes a medical emergency that requires immediate treatment to prevent tissue death (necrosis).The success rate for hernia surgery is very good. According to the National Institutes of Health (NIH), only about one to three percent of hernias return after surgery (NIH, 2011).
Certain people are born with a congenital defect (existing from birth), causing the abdominal wall to be unnaturally thin. They are at a greater risk for developing a ventral hernia. Other risk factors for a ventral hernia include:
- history of previous hernias
- injuries to the bowel area
- family history of hernias
- constant lifting/pushing heavy objects
Ventral hernias are common complications in approximately 10 percent of open abdominal procedures (Akkary et al., 2011). 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.
- mild discomfort in the abdominal area
- pain in the abdomen
For a complete diagnosis, a doctor will perform a physical exam. He or she 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
- computed tomography (CT) scan
- magnetic resonance imaging (MRI)
Ventral hernias should be fixed unless the patient cannot undergo surgery or refuses it. If left untreated, they continue to grow slowly until they are able to cause serious complications.
Options for surgical treatment include:
- mesh placement surgery: a surgeon pushes tissue back into place and then sews in a wire mesh to keep it in place; this is considered safe and reliable
- laparoscopic removal: multiple small openings are made and the hernia is fixed using a small camera inside the body to direct the surgery
- open surgery (nonlaparoscopic): large opening is made so surgeon can enter the body to push the tissue back into place and then sew it
Benefits of laparoscopic removal include:
- a 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
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 remove 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 of the abdomen; this may cause blockage to the intestines or stop blood supply
- strangulation: occurs when blood is cut off to the intestines. Part of the intestines may die or begin to decay. Immediate surgery is required 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 surgery is performed.
Outlook is generally very good after a surgery with no complications. Patients may need to rest for a few weeks before resuming daily activities.