A ventral hernia is a type of abdominal hernia, a condition in which an organ, the fascia surrounding an organ or muscle, or other tissue protrudes through a weak spot in the abdominal wall, leading to a noticeable bulge. Also known as an incisional hernia, a ventral hernia is distinguished by the fact that the weak spot is the result of an incompletely or improperly healed surgical wound in the abdomen. In addition to the existence of a protrusion where scar tissue is found, this type of hernia can grow quite painful, particularly on straining movements, typically requires surgery to repair, and has a high rate of recurrence in multiple locations along the scar’s length.
Identifiable as a lump beneath the skin at or around the area of the surgical scar, the hernia can push through wounds both small, as from an appendectomy, and large, as from a major abdominal surgery. As long as the surgical opening did not heal correctly, as from an infection, any weak spot no matter the size is vulnerable to an incisional hernia. They are particularly common along the linea alba, the vertical midline of the abdomen that extends from the xiphoid process at the bottom tip of the sternum, or breastbone, to the pubic bone at the base of the pelvis. The pain resulting from a hernia at this site may be amplified with straining movements, such as laughing, coughing, or lifting, and can range from mild to extreme depending on the severity of the hernia.
Surgeons often access the abdominal cavity to perform such procedures as intestinal repair by cutting along the linea alba. As the incision heals, a post-operative complication like an infection can mar the healing process, and a ventral hernia can form along the scar tissue that forms here. One example would be the intestines pushing forward against a weakened segment of the linea alba in the lower abdomen, presenting as a protrusion under the skin as the intestines are forced toward the surface. An additional surgery would then be required to re-open the previous incision and repair the hernia.
The method chosen to close this incision following the second surgery can determine the risk of recurrence of a ventral hernia. If the incision is closed using sutures alone, which creates a great deal of tension along the length of the wound, a hernia is more likely to recur. It is instead recommended that surgeons repair the wound using mesh situated beneath the abdominal muscles, which places less tension on the opening. Due to the high risk of infection from the size of the incision required, however, many surgeons prefer to repair a ventral hernia using a method that inserts the mesh into the abdomen laparoscopically. This calls for significantly smaller surgical incisions, eliminates the need to re-open the original surgical incision where the tissue is already weakened, and shortens the recovery time from surgery as well as reduces post-operative pain.
