Chapter 64 - Ventral hernia repair

Summary

Ventral hernias encompass a wide variety of abdominal wall defects, including incisional, epigastric, umbilical, and spigelian types; for the purposes of this chapter, the term ventral hernia is restricted to the incisional type. A ventral hernia with a small ring predisposes patients to incarceration and possible strangulation of a segment of small or large intestine. Patients with significant ascites are at risk for rupture of a ventral hernia if there is only skin covering the defect. Patients with large ventral hernias have difficulty wearing regular clothing and are often embarrassed by their appearance. Not infrequently, these hernias can be associated with abdominal pain; however this is not universally true. It is also possible for patients to suffer obstructive symptoms such as abdominal distension, nausea, or vomiting if there is involvement of the intestinal loops in the hernia defect. In patients with very large incisional hernias, there is lateral displacement of the abdominal wall muscles which leads to very poor function of the abdominal wall and resultant issues with back pain, difficulty with mobility, and loss of intra-abdominal domain. For these reasons, elective repair of ventral hernias is indicated in patients who are healthy enough to undergo mechanical bowel cleaning and general anesthesia.

Over 100,000 ventral hernia repairs are performed in the USA each year. Hernias are a complication that can occur in up to 5% of patients undergoing abdominal surgery; these rates are potentially much higher in obese patients, those taking steroids, or smokers. Patients who suffer a wound infection at the time of the initial operation are also at greatly increased risk of developing incisional hernias since the entire fascial closure often heals improperly and, in many cases, the hernia can be quite large. The finding of an incisional hernia is one of the most common reasons for consultation in general surgical clinics.