Introduction
A Ventral Hernia is defect in the anterior abdominal wall.
Types of Ventral Hernias
Ventral hernias comprise primary and acquired subtypes. Primary hernias commonly include umbilical and epigastric with secondary hernias including traumatic or incisional.
Pathogenesis
Primary hernias may be congenital especially at the level of the umbilicus where there is a defect from the umbilical cord. Incisional hernias are believed to be the failure of laparotomy closure with risks factors for hernia formation including wound infection, diabetes, increased intra-abdominal pressure, obesity, malnutrition, comorbid conditions, and medications such as steroids. There is also probably a genetic component with "hernia formers" which still has to be studied.
Symptoms
Patients complain of a bulge or pain related to the protrusion. Some patients complain of vague abdominal symptoms. In an acute situation, a ventral hernia may present with a bowel obstruction from incarcerated or strangulated bowel.
Preop Operative Considerations
Imaging including CT scan may be invaluable in assessing a morbidly obese patient without clear evidence of a palpable defect on exam. Imaging in other cases may not be necessary. Preoperative preparation of the patient should include medical optimization, and lifestyle modification if necessary, such as smoking cessation and weight loss.More
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