What are the other Names for this Condition? (Also known as/Synonyms)

• Hernia of the Anterior Abdominal Wall

What is Ventral Hernia? (Definition/Background Information)

• When a part or whole of an internal organ (or tissues) protrudes through weak areas of the adjoining muscles or connective tissues, the condition is termed as a hernia. Hernia occurs through the weakened area, whenever there is increased pressure or strain on it. They most commonly occur in the abdomen region
• Medically, there are various types of hernia and the most common ones are:
  • Inguinal hernia
  • Incisional hernia
  • Femoral hernia
  • Umbilical hernia
  • Hiatal hernia
• When parts of the abdominal contents, such as the bowel or tissues attached to it (omentum or mesentery), protrude through the weakened anterior abdominal wall (in the belly area), the condition is called Ventral Hernia. These hernia types generally occur along the midline or close to the midline of the abdominal wall
• Ventral Hernia is not classified as one single type of hernia; rather, it is a group of hernias that occur in the anterior abdominal hernia. The most common types of Ventral Hernias include:
  • Incisional Hernia (or Ventral Incisional Hernia) is a hernia that occurs through a previous surgical scar
  • Umbilical hernia, which can occur in both infants and adults, at the belly button
  • Epigastric hernia (or fatty hernia of linea alba) occurs in the midline above the belly button. They are usually small in size, but may be multiple in numbers
  • Spigelian hernia (or Lateral Ventral Hernia or hernia Spiegeli) occurs below the level of the belly button on either side; they are not present in the midline. These type pf hernias usually present with pain or discomfort, rather than a bulge. They need to be repaired surgically most of the times, because of the risk of complications
• Ventral Hernia may develop as a birth defect (incomplete closure of the belly wall during fetal development) or it may be acquired (non-birth defect) such as following a surgery to the area or slow weakening with age. The belly wall may also become weak, due to lifting of heavy objects, chronic coughing, obesity, pregnancy, diabetes, and many other factors
• The most common sign is a bulge in the belly. The bulge may decrease in size while lying down or when it is pushed in (which is not advisable though). The bulge may or may not cause other symptoms, but they usually become bigger with time
• The worrisome complications of Ventral Hernia may include:
  • Incarceration (intestine gets stuck in the hernia defect): It presents with severe pain and irreducible swelling (the intestine or other abdominal contents cannot be pushed back into the abdomen)
  • Incarceration can progress and cause loss of blood supply to the trapped abdominal contents (strangulation), which may eventually lead to death of bowel (gangrene)  
• Either a laparoscopic surgery or an open surgery may be performed to correct the defect. With proper treatment, the prognosis of Ventral Hernia is generally good

Who gets Ventral Hernia? (Age and Sex Distribution)

Ventral Hernia can occur in any individual, irrespective of age, sex, race, and ethnicity. However, the incidence (the rate of occurrence) varies for different types of ventral hernias.

• Umbilical hernias are very common in infants and children, but it can affect adults too, especially adults over the age of 60 years
  • It is equally common in both male and female infants. However, in the case of adults, it is more common in females than males
  • Statistically, it has been observed that African-Americans are more prone to Umbilical Hernias, than individuals of any other race
  • The condition is seen worldwide
• Up to 10% of all belly hernias are due to incisional hernias
  • As incisional hernia occurs following a surgery, it is more common with increasing age due to the fact that the probability of having surgeries increases with age. Moreover, wound healing gets poorer with age. However, individual of any age are prone to incisional hernia
  • Generally, they are 2 times more common in women than men
  • It may occur worldwide, in individuals of all races and ethnicities
• Spigelian hernias are rare types of Ventral Hernia
  • It is slightly more common in women than men
  • It is usually seen in individuals over 40 years of age
  • It may occur worldwide in individuals of all races and ethnicities
• Epigastric hernias account for approximately 1-3% of all abdominal hernias
  • It is slightly more common in women than men
  • It is usually seen in individuals between the ages of 20-50 years
  • It may occur worldwide in individuals of all races and ethnicities

What are the Risk Factors for Ventral Hernia? (Predisposing Factors)

The risk factors can vary for different types of Ventral Hernias. Common or general factors that increase the risk of Ventral Hernia include:

• History of abdominal surgery, with the risk increasing with multiple surgeries
• Chronic constipation
• Chronic cough
• Prostate gland enlargement, or any condition that constantly increase intra-abdominal (within the belly) pressure
• Family history of hernia
• Activities that put pressure on the abdomen, such as weightlifting or improper lifting techniques
• Malnutrition
• Obesity (or being overweight) puts more strain on the abdomen muscle
• Pregnancy. The risk increases with multiple pregnancies
• Smoking
• Advancing age: The muscle and supporting structures (fascia, connective tissue) weaken with an increasing age
• Use of steroids (corticosteroids) for other medical conditions

In infants, some of the specific risk factors for umbilical hernias are:

• Low birth weight
• Premature or preterm babies
• Children born to African American parents seem to have a higher risk
• Babies born with certain genetic disorders, such as Down syndrome, Edwards syndrome, and Patau syndrome

For an incisional hernia, the most important risk factor is a history of belly surgery. Besides the general factors above, conditions that may increase one’s risk for incisional hernia include:

• Wound infection after belly surgery can increase the risk of acquiring hernia in the future
• Improper surgical techniques used during belly surgeries
• History of previous incisional hernias
• History of or associated ventral hernias that include umbilical or epigastric hernias
• Medical conditions in which there may be poor wound healing such as due to diabetes mellitus
• Elderly adults are more likely to be affected because the healing process slows with aging

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Ventral Hernia? (Etiology)

When an area in the abdominal wall losses its strength, the wall begins to gape (become wide open or separate). When the organs inside the abdominal cavity, such as the bowel or tissues attached to it (omentum or mesentery), protrudes through this hole or tear, the condition is called Ventral Hernia.

The possible causes of Ventral Hernia are:

• Ventral Hernia may develop due to a birth defect (incomplete closure of the belly wall during fetal development)
• The abnormality may develop later in life (acquired form of Ventral Hernia), due to:
  • Weakening of the abdominal wall, which may be due to lifting of heavy objects, chronic coughing, chronic straining, and aging
  • Obesity
  • Pregnancy
  • Diabetes            
  • Following a belly surgery
• A family history can also predispose an individual to Ventral Hernia
• For an individual to get incisional hernia he/she should have had a belly surgery in the past. The following factors may play a role in the development of Incisional Hernia:
  • Weaknesses of surgical wounds may develop due to hematoma, seroma, or an infection
  • Incisional hernia could occur due to inefficient surgical procedure techniques adopted by the surgeon
  • The condition is less common following a laparoscopic belly surgery than due to an open belly surgery       

What are the Signs and Symptoms of Ventral Hernia?

The common signs and symptoms that distinguish Ventral Hernia are:

• The most common symptom is a bulge in the abdominal wall, which may expand when pressure is generated within the abdomen cavity. For example, when an individual strains while coughing
• The abdominal lump may decrease in size, when gentle pressure is applied, or while lying down. The lump may or may not be associated with other symptoms
• The lump or bulge in the abdomen may become painful, cause discomfort, or be painful to the touch. Spigelian hernia usually presents with pain or discomfort rather than a bulge
• The skin over the abdominal lump may become red, if the intestine gets stuck in the hernia defect
• In epigastric hernia, the pain can occur after eating and it may be associated with nausea and/or vomiting

The presence of certain symptoms may be warning sign(s) of life-threatening complications:

• Swelling increases, the skin becomes tight and red in color
• Unable to have bowel movements, unable to pass gas
• High fever
• Low urine output
• Severe pain in the abdomen
• Severe nausea and/or vomiting
• Difficulty in standing-up erect

How is Ventral Hernia Diagnosed?

A Ventral Hernia may be diagnosed through:

• A thorough evaluation of medical history
• A physical examination by the healthcare provider is sufficient enough to diagnose this condition, in many cases. However, it may be difficult to examine the hernia in some obese individuals
• The physician may ask the patient to cough, while examining the abdomen, to visual examine the bulge
• Imaging tests may be undertaken, if the physical examination is not sufficient to arrive at a diagnosis, or to rule-out other conditions
  • Abdominal ultrasound may be done to visualize the hernia and organs of the abdomen
  • A CT scan may give more information and details than an ultrasound in certain select individuals
• If surgery is planned, then additional tests, such as imaging, blood tests, and urine exam, may be performed

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Ventral Hernia?

The possible complications arising out of Ventral Hernia could be:

• Intestinal obstruction: The contents within the bowel may not be able to move, if the bowel gets kinked (sharp twist or bend) in the defect. The obstruction may be partial or complete
• Incarceration (intestine gets stuck in the umbilical hernia defect): It presents with severe pain and irreducible swelling (it is not possible to slowly push back the intestine or other contents into the abdomen)
• Incarceration can progress and cause loss of blood supply to the trapped abdominal contents (strangulation), which may eventually lead to death of the bowel (gangrene)
• Gangrene can lead to infection in the abdominal cavity (peritonitis) and sepsis (infection of blood)
• Septic shock (whole body infection causing decreased blood supply to the organs) and multi-organ failure, as a consequence of strangulated hernia and/or gangrene
• Recurrence of the hernias despite surgical therapy

How is Ventral Hernia Treated?

Generally, hernias that cause symptoms other than bulging need to be treated. The treatment options depend on the type of Ventral Hernia. They may include:

• Regular medical consultation with the physician to monitor and manage its progression may be required in asymptomatic, small hernias. However, this varies from one individual to another, and depends upon the type of the Ventral Hernia
• Use of truss (binder), which is a garment (very much like a weight belt or girdle) to hold the organs in place may be tried in some individual. However, this does not correct the anatomical defect
• Epigastric, Spigelian, and umbilical hernias in the adult require surgery most of the times, because complications are more common with these type of hernias

The most definitive treatment of Ventral Hernias is surgical repair of the defect. The surgical options include:

• Laparoscopic surgery:
  • Small surgical openings (incisions) are made in the abdomen
  • Through this hole, the surgeon inserts a scope, which is a long bendable tube with camera on its end
  • Using this instrument, the surgeon performs the hernia repair
• Open surgery:
  • The abdomen is opened to fix the hernia
  • During the surgery, the organs that protrude are kept back in its original place
  • The abdominal wall is then closed with the help of sutures alone, or with sutures and a mesh, so that the hernia does not come back    

Usually, umbilical hernias in children disappear on their own, within the first 12-18 months. The physician may recommend a surgery, when:

• The swelling becomes bigger during the period of 1-2 years (age of child)
• The swelling does not disappear by the age of 4 years
• If any complication (such as tender to touch, vomiting, or severe pain) develops

How can Ventral Hernia be Prevented?

Ventral Hernia that occurs due to a birth defect cannot be prevented, as the child is born with the defect. Not all acquired hernias can be prevented from taking place.

However, the following preventive measures can be adopted to minimize the occurrence or prevent further complications of a Ventral Hernia:

• Treatment for chronic constipation so as to avoid straining during bowel movements
• Treatment for chronic cough
• Treatment for prostate conditions
• Smoking should be completely stopped because it can cause cough and also be a reason for poor wound healing
• Avoid improper lifting of heavy objects (especially in individuals with a history of hernia)
• Avoiding physical over-exertion
• Maintain age and height appropriate body weight
• Enroll or participate in weight loss programs if you are overweight or obese
• The incidence of incisional hernias can be decreased, if a surgeon adopts appropriate surgical techniques and treats wound infection promptly with antibiotics (and drainage)
• Follow the recovery instructions very carefully, after abdominal surgery
• Follow a healthy diet: A proper diet before and after surgery can also help with good wound healing

What is the Prognosis of Ventral Hernia? (Outcomes/Resolutions)

• The overall prognosis for Ventral Hernia is generally good with prompt diagnosis and appropriate surgery
• Ventral Hernias may recur (come back) in some individuals despite surgical treatment

Additional and Relevant Useful Information for Ventral Hernia:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/digestive-center/