A ventral hernia is a protrusion from the abdominal wall, other than in the groin. They usually originate at the site of an incision from prior surgery. Thus they are also referred to as incisional hernias. Up to 10% of patients who undergo abdominal surgery will develop an incisional hernia, which may develop early postoperatively or several years later.

Several risk factors for the development of these hernias include obesity, wound infection, and premature stress on the incision due to vomiting, coughing or heavy lifting. Other ventral hernias include epigastric (mid-upper abdomen), Spigelian (lower lateral abdominal wall) and peristomal (around the site of an ostomy).

If left untreated, ventral hernias will continue to enlarge and the muscle will spread apart, leaving the patient with loss of abdominal wall strength and function. These large hernias may require complex reconstruction with mesh and tissue flaps.

Ventral hernias produce a bulge which one can feel, especially when coughing or straining. They will continue to enlarge over time, but the rate of increase varies from patient to patient. They can become so large that the intestine is in the hernia sac and this predisposes the patient to incarceration and strangulation. This produces life-threatening gangrene and is a surgical emergency. Thus we recommend repair of all ventral hernias once they are large enough to palpate.

The options for repair are open sutured repair, open mesh repair, and laparoscopic mesh repair. Adding a “relaxing incision” or lateral fascial release has also been popularized recently to allow the surgeon to better pull the muscles together in the midline. This is also known as separation of parts, because the surgeon divides and separates the layers of the abdominal wall to allow better mobilization.

Open sutured repair was once the standard approach but resulted in recurrence rates of 41 to 50%. Prosthetic mesh repairs became popular because the recurrence rates were lower, in the 12-24% range. Reports from large series of laparoscopic mesh repair show < %10 recurrence rates. In addition, we have seen similar low recurrence rates with an open underlay mesh technique that we use. This technique works best for medium to small hernias and is our preferred method for these hernias less than 2 inches across.

For medium to large hernias, we offer patients the laparoscopic mesh repair. This is a modern technique, which we have been doing since 1998. It allows intra-abdominal mesh placement using small incisions. The recovery is shorter and the recurrence rate is generally low. The mesh we use has a non-stick undersurface to prevent adhesions from the intestine to the bowel.

Another new technique we recommend for large defects and loss of abdominal wall support is an open mesh repair using the separation of parts. This technique allows us to mobilize the patient's own abdominal wall to the midline with less tension. This restores more form and function to the patient. We add mesh to this repair to lower the recurrence rate. The lateral fascial release can be performed through a midline incision, separate small incisions or using the laparoscope. We will sometimes do this operation with a plastic surgeon performing a concomitant abdominoplasty.

Ventral hernia operations can be fairly complicated due to the adhesions from prior surgery, the amount of dissection and fact that multiple sutures are required to fixate the mesh. No matter what technique is used, pain and disability is common, sometimes for up to four weeks postoperatively.

We believe we offer the newest proven options to patients who have ventral incisional hernias and will partner with you through the process. For an evaluation of your hernia, and recommendations for treatment, please call to schedule an appointment with one of our surgeons, 847-433-1060.