Ventral Hernia

What is a ventral hernia?

A ventral hernia is a hernia that occurs through your front abdominal muscles. “Ventral” refers to your front or belly area. A hernia is when one of your internal organs or tissues bulges through an opening in the wall of its body cavity. Most (but not all) hernias come through one of your abdominal walls.

Ventral hernia types

Different types of ventral hernias occur in different locations in your front abdominal wall. They include:

• Epigastric hernias: Your epigastric region (epigastrium) is the upper part of your abdomen that lies between your belly button and your breastbone.
• Umbilical hernias: Umbilical hernias occur in the natural weak spot surrounding your belly button. They’re often congenital (present at birth).
• Incisional hernias: An incisional hernia occurs at the site of a former surgical incision through your abdomen. It’s a common side effect of abdominal surgery.

What are the symptoms of a ventral hernia?

The first sign of a ventral hernia is usually a visible bulge that appears somewhere in your front abdominal wall. You may only see it emerge occasionally during certain activities or in certain positions that contract your abdominal muscles. For example, you might see your ventral hernia when you’re:

• Laughing.
• Crying.
• Coughing.
• Sneezing.
• Pooping.
• Bending.
• Lifting.
• Exercising.

Some people, but not all, can also feel their hernia. You might feel it when it pops out, or when some movement pulls it, compresses it or pinches it. It might feel like a tug, a dull ache or a sharper pain. Hernia pain is a sign of a larger hernia that may be at risk of getting stuck (incarcerated) while it’s out.

Other symptoms of a more complicated hernia might include:

• Nausea and vomiting.
• Redness or rash at the site.

What are the common causes of a ventral hernia?

A hernia pushes through a weakness in the muscle or tissue barrier that contains it. Sometimes, the weakness is already there at birth. Other times, a single event, like an injury or surgery, causes it. And sometimes, it happens over time through gradual wear and tear. Often, it’s more than one of these.

Common contributing causes of ventral hernias include:

• A congenital weak spot (birth defect).
• Connective tissue diseases.
• Aging and natural muscle degeneration.
• Chronic obesity.
• Abdominal injury.
• Abdominal surgery.
• Pregnancy and childbirth.
• Chronic coughing.
• Chronic breathing difficulties (such as COPD or emphysema).
• Chronic constipation or straining to poop.
• Jobs involving frequent lifting or pushing.

What are the possible complications of a ventral hernia?

Most hernias can move in and out of their opening, appearing and disappearing. But moving in and out continues to weaken the tissues around it. Over time, the opening gets bigger, and so can the hernia, meaning more of your organ or tissue bulges through. This is when complications can happen.

The bigger a hernia becomes, the more at risk it is of getting stuck or “incarcerated” in the opening. This pinches or compresses the hernia, causing pain and potentially obstructing the organ. You could end up with a blocked intestine, or its blood supply could be cut off (strangulation). This can cause tissue death.

How is a ventral hernia diagnosed?

A healthcare provider will usually find a ventral hernia during a physical exam. If they don’t see it right away, they’ll have you try different positions or actions to make it emerge. In some cases, they might take images to see the hernia more clearly. This might mean an abdominal ultrasound, CT scan or MRI.

If they can see and feel the hernia physically, they’ll examine it up close and check to see if they can gently push it back in. This tells them how serious it is and how soon it might need treatment. They’ll also ask you detailed questions about your symptoms, health history and possible causes, such as:

• When you first noticed it.
• Whether it’s changed over time.
• Whether it causes discomfort.
• Your chronic health conditions.
• Your occupation.
• Your diet, exercise and lifestyle habits.

Should ventral hernias be repaired?

Most ventral hernias should be repaired eventually, but not necessarily right away. A hernia that doesn’t cause you any symptoms and that you can still push back in probably isn’t a serious risk. But hernias do tend to worsen over time, and as they do, they can become more dangerous and more difficult to fix. A ventral hernia that can’t be pushed back in is a potential emergency and should be evaluated in the ER.

When do ventral hernias need surgery?

Healthcare providers recommend ventral hernia repair when:

• It can’t be pushed back in.
• It causes frequent symptoms, like pain.
• It’s large enough to get stuck or cause complications.
• Your overall health condition can handle surgery.

If your child is born with an umbilical hernia, it will usually heal by itself in a few years. If it doesn’t, their provider will recommend umbilical hernia surgery at that time to prevent it from growing bigger.

How do they fix a ventral hernia?

The goal of ventral hernia surgery is to repair the hole in your abdominal wall so the hernia can’t come through it again. Surgery restores the shape and tone of your abdominal wall by closing the hole and bringing the muscles back into position. Surgeons may use surgical mesh to reinforce the wall.

Is ventral hernia repair a major surgery?

Ventral hernia surgery is common and usually simple. General surgeons perform around 350,000 ventral hernia repair operations in the U.S. each year. They can often use minimally invasive methods, which means smaller incisions and a shorter recovery time. But some people need open abdominal surgery.

Your surgeon will decide the best method to use to approach your hernia. The options are:

• Open ventral hernia repair: Open surgery is the traditional approach to hernia repair surgery. A surgeon makes an incision over the hernia to expose the area and repair it directly. This approach might be necessary when your hernia is more complicated than usual.
• Laparoscopic ventral hernia repair: Laparoscopic surgery is a minimally invasive method. A surgeon makes several small, “keyhole” incisions, about a half-inch long, to access the site. Through one incision, they place a small camera called a laparoscope that projects to a screen. Through the others, they operate with long, narrow tools, while watching the screen.
• Robotic ventral hernia repair: Robotic surgery for hernia repair is another minimally invasive method. Robotic surgery also uses small incisions, long tools and a laparoscope. The difference is that the surgeon operates the tools by controlling robotic hands from a computer console.

Do all ventral hernias need to be repaired with mesh?

Not all ventral hernias need to be repaired with mesh, especially if they’re small epigastric or umbilical hernias. But most incisional hernias do because they come through tissue that’s already been cut. Muscle tissue is never quite as strong again after surgery, and hernia repair surgery weakens it again.

Surgeons can choose from several different types of surgical mesh to help repair the hernia:

• Synthetic mesh: Made of permanent, man-made materials, this is the most durable mesh to use for repair. As new tissue grows around it, the mesh becomes embedded within the tissue, providing a strong, permanent layer that won’t deteriorate over time like tissues can.
• Biological mesh: Biological mesh is made of human or animal tissue. It’s less durable than synthetic mesh but also less likely to cause an infection. While the overall risk is low, some people are more at risk from infection than others, so biological mesh may be safer for them.
• Bioabsorbable synthetic mesh: This is a temporary mesh that provides short-term support until the surgery heals. After it absorbs into your body, scar tissue develops to reinforce the wall.

Are there any alternatives to surgery for a ventral hernia?

Surgery is the only way to repair a ventral hernia. But some people can’t have surgery due to other health conditions. If you have a large hernia that can’t be repaired, your healthcare provider may suggest that you wear a special apparatus, like a corset, binder or truss, to hold the hernia in.

How serious is a ventral hernia?

Most aren’t serious, but they can become more serious over time. That’s why healthcare providers recommend fixing them before that happens. Elective surgery to prevent serious complications always has better outcomes than emergency surgery to fix serious complications that are already occurring.

What is the outlook after ventral hernia repair?

Most hernia repairs are simple, and recovery is quick. More complicated hernias might need a more complex operation to fix and a longer recovery. It’s important to take care not to pull or strain the repaired hernia during recovery. An estimated 10% to 20% of ventral hernias may come back after repair.