Ventral Hernia: Causes, Symptoms, Diagnosis, and Treatment Options
Understanding Ventral Hernias
A ventral hernia is a protrusion of abdominal contents (intestine, omentum) through a defect in the anterior abdominal wall fascia. It includes umbilical, epigastric, incisional (post-surgical), and Spigelian hernias. Note: Inguinal and femoral hernias are groin hernias, not typically classified as ventral.
Risk Factors and Etiology
- Increased intra-abdominal pressure: Obesity, chronic cough, constipation, ascites, pregnancy, heavy lifting.
- Fascial weakness: Prior incisions (incisional hernia rate 10–20%), congenital defects, aging, collagen disorders.
- Impaired healing: Smoking, steroids, malnutrition, infection, immunosuppression.
Clinical Presentation
- Visible or palpable bulge: Often reducible, more prominent with Valsalva or standing.
- Pain or discomfort: Aching, burning, or pressure at site; worsens with activity.
- Incarceration or strangulation (emergency): Irreducible, tender, erythematous bulge; nausea/vomiting, obstipation, peritoneal signs—urgent surgery required.
Dysphagia, heartburn, nausea, and vomiting are atypical for ventral hernia and suggest comorbid GERD or hiatal hernia.
Diagnostic Workup
- Physical exam: Inspect and palpate supine and upright, with Valsalva.
- Imaging: CT abdomen/pelvis with Valsalva (gold standard for size, contents, defect); ultrasound for superficial hernias; MRI if radiation contraindicated.
Management Strategies
| Approach | Indication | Details |
|---|---|---|
| Watchful waiting | Small, asymptomatic, low-risk | Monitor for enlargement or symptoms; avoid heavy lifting |
| Open repair | Large, complex, contaminated fields | Mesh (synthetic or biologic) reinforcement; component separation for loss of domain |
| Laparoscopic/robotic (IPOM, TAPP, eTEP) | Elective, reducible, defects <10 cm | Less pain, faster recovery, lower wound infection; intraperitoneal mesh |