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What is Ventral Hernia?
A ventral hernia is a bulge protruding through an opening in the abdominal wall, typically as a result of a tear or division in the muscles or fascia. Based on where they occur, ventral hernias can be classified into different subtypes:
Primary Abdominal Hernias – Ventral hernias that appear somewhere along the abdominal midline
Epigastric Hernias – Ventral hernias located in the upper abdominal midline below the breastbone or sternum
Incisional Hernias – Ventral hernias that occur at the site of a previous incision
Umbilical Hernias – Ventral hernias that are located at the umbilicus
What Are the Most Common Causes of Abdominal / Ventral Hernias?
When the abdominal muscles and fascia lose integrity, hernias may form. The abdomen is subjected to normal pressures and forces that allow us to walk upright, lift, and carry, as well as maintain proper placement of our internal organs. When such forces occur over areas of inherent weakness—such as the umbilicus or a prior incision—damage in the thin muscle fibers may accumulate over time. When enough of the fibers are torn, a hole can form. Our normal abdominal pressure then pushes our internal contents out the hole, through the path of least resistance. This is similar to a pressurized pipe that springs a leak. Your internal organs, however, cannot completely leave your body because the skin, fat, and other surrounding structures prevent their expansion. Over time, these tissues can stretch and the hernia can increase in size. This results in an abdominal hernia. This process occurs more rapidly when the body is subjected to more excessive forces such as those that occur with heavy lifting and straining. In some circumstances, the tissues are weaker than normal, and hernias develop sooner. This can occur in smokers or with certain genetic conditions.
Conditions that put excessive tension on the abdominal wall:
Industrial or athletic lifting and straining
Conditions that weaken the integrity of tissues:
Connective tissue disorders
What Are the Symptoms of an Abdominal / Ventral Hernia?
An abdominal / ventral hernia can be asymptomatic (meaning there are no obvious symptoms), but the most common reason that people seek treatment is because they develop discomfort at or around the affected area. The discomfort is usually worsened when there is an increase in intra-abdominal pressure. This occurs with heavy lifting, straining, or prolonged standing. Pain tends to worsen by the end of the day, especially after a full day of strenuous activity. Surrounding muscular inflammation may also result in pain near the site of the hernia. The pain is usually made better with rest. Pain levels can vary from minor intermittent discomfort to more significant constant pain.
In some circumstances, the pain is unrelenting and severe. In those instances, emergent evaluation at a hospital is recommended, as there is a possibility of hernia incarceration. An incarcerated hernia may be associated with nausea, vomiting, and non-reducible firmness over the area.
Other secondary symptoms that may be associated with abdominal / ventral hernias include:
Constipation or abdominal bloating
Difficulties with urination
Muscular pain and discomfort (this could include back pain, leg pain, and pain with sitting and/or prolonged standing)
Are There Possible Complications if an Abdominal / Ventral Hernia Isn’t Repaired?
Since the hernia is the result of a physical tear or hole in the muscles and fascia of the abdomen, it cannot heal on its own. In most cases, the greatest risk of delaying repair is worsening symptoms and increasing hernia size. Occasionally ventral / abdominal hernias become incarcerated. This occurs when the contents that push through the hernia exceed what can freely fit through the defect. When this occurs, the hernia cannot be easily reduced and becomes incarcerated. The increased pressure may reduce blood flow to the trapped hernia contents, posing risk for strangulation—also known as lack of oxygenated blood flow—or intestinal obstruction. Both situations need to be addressed emergently by either manual reduction or surgery. When strangulation occurs, if manual reduction does not occur in a matter of hours, then emergency surgery may be the only option due to a greater likelihood of tissue death of the trapped contents.
How Is an Abdominal / Ventral Hernia Diagnosed?
An abdominal / ventral hernia can be diagnosed by a physician during physical examination. The hallmark is the presence of a bulge on the abdominal wall that may or may not be reducible. Radiographic imaging is not always necessary to diagnose an abdominal / ventral hernia. If the diagnosis is uncertain, then an ultrasound, CT scan, or MRI may be performed. If you have been diagnosed with an abdominal / ventral hernia, you should consult a hernia specialist.
How Is Abdominal / Ventral Hernia Treatment Performed?
Abdominal / ventral hernia repair can be performed by Open and Laparoscopic procedures
1. Open Sublay Repair
2. MiLOS (Mini / Less open Sublay Repair)
3. Posterior Component Separation (Sublay with TAR)
1. IPOM (Intra Peritoneal Onlay Mesh Repair)
2. TARM (Trans Abdominal Retro Muscular Repair)
3. TEP (Totally Extra Peritoneal Repair)
4. TAPP (Trans Abdominal Pre Peritoneal Repair)
During abdominal / ventral hernia repair, the mesh is placed behind the weakness or hole in the abdominal wall. The mesh is tailored to extend past the edges of the hernia. This ensures the mesh will act as a sturdy platform for all new tissue growth, as well as supports the existing abdominal wall muscle. Muscles are never cut, and nothing is sutured together to cause tension. The polypropylene mesh is thin and incredibly flexible throughout the healing process to incorporate safely into the muscle wall.
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