University of California San Francisco

Ventral (Incisional) Hernia

A hernia occurs when part of an internal organ (usually the small intestine) protrudes through a weak point of the abdominal wall, resulting in a bulge.

A ventral or incisional hernia specifically describes a hernia, often in the middle of the abdomen, that occurs after a prior incision was made during a prior operation. The size of the hernia varies considerably from small to gigantic.

There are over 400,000 repairs of ventral hernias performed each year in the U.S.

The UCSF Hernia Center provides the latest treatments for complex ventral hernias, such as the progressive pneumoperitoneum procedure, a specialized approach for treating particularly large ventral hernias. Our patient outcomes far surpass the national average. Patients with complex ventral hernias treated at UCSF have a recurrence rate of approximately 18 percent, compared to a 30 to 40 percent recurrence rate nationally. 

Signs and Symptoms

Symptoms of a ventral hernia include:

  • A small to large bulge at or near an old surgical incision, most commonly along a vertical straight incision on the abdomen

  • Discomfort or sharp pain-especially when straining, lifting, or exercising-that improves when resting

  • A burning, gurgling, or aching feeling at the bulge

  • Intestinal obstructions can occur when the intestines are blocked due to scar tissue

Incidence

Of the 5 million abdominal surgeries performed each year, 11-23% of patients develop ventral hernias. There are 400,000 ventral hernia repairs done per year in the U.S. The average age of patients are in their 5th decade of life. Risk factors include diabetes, obesity, lung disease, smoking, wound infections, and steroids.  

Diagnosis

To diagnose a ventral hernia, the doctor takes a thorough medical history and conducts a physical examination. The person may be asked to stand and cough so the doctor can see and feel the hernia as it protrudes from the abdominal wall. The doctor checks to see if the hernia can be gently massaged back into its proper position in the abdomen.

Treatment

There is currently no universally accepted classification system or evidence-based management guidelines, and there is a wide variation in surgical techniques and strategies for repair. Often patient seek repair when they cause symptoms of discomfort, pain, or cosmesis (disfiguring). Recovery time varies depending on the size of the hernia, the technique used, and the age and health of the patient. There are open and laparoscopic (minimally invasive) repairs, with or without mesh. The two main types of surgery for hernias are:

Open Ventral Hernia Repair

In open hernia repair, also called herniorrhaphy, a person is given general anesthesia to sedate or help the person sleep, and this is often augmented with epidural anesthesia to improve recovery time and pain control. Then the surgeon makes an incision on the abdomen, releases scar tissue, and moves the hernia contents (often bowel or fat) back into the abdomen, and reinforces the muscle wall with stitches. Usually the area of muscle weakness is reinforced with a synthetic or biologic mesh to provide additional support to reduce the likelihood of recurrence.

Laparoscopic Ventral Hernia Repair

Laparoscopic surgery is performed using general anesthesia. The surgeon makes several small incisions in the abdomen and inserts a laparoscope-a thin tube with a tiny video camera attached to one end. The camera projects a magnified image of inside the abdomen to a monitor, giving the surgeon a close-up view of the hernia and surrounding tissue. While viewing the monitor, the surgeon uses instruments to carefully repair the hernia using synthetic mesh.

People who undergo laparoscopic surgery generally experience a somewhat shorter recovery time. However, the doctor may determine laparoscopic surgery is not the best option if the hernia is very large or if there is too much prior scar tissue to perform it safely laparoscopically.

Most adults experience discomfort after surgery and require pain medication. Vigorous activity and heavy lifting are limited for several weeks. The doctor will discuss when a person may safely return to work.

Potential Complications

Surgery to repair a ventral hernia is generally safe and complications are uncommon. Knowing possible risks allows patients to report postoperative symptoms to their doctor as soon as they occur.

  • Risk of general anesthesia. Before surgery, the anesthesiologist-a doctor who administers anesthesia-reviews the risks of anesthesia with the patient and asks about medical history and allergies to medications. Complications most likely occur in older people and those with other medical conditions. Common complications include nausea, vomiting, urinary retention, sore throat, and headache. More serious problems include heart attack, stroke, pneumonia, and blood clots in the legs.

  • Getting out of bed after surgery and moving as soon as the doctor allows will help reduce the risk of complications such as pneumonia and blood clots.

  • Hernia recurrence. A hernia can recur up to several years after repair. Recurrence is the most common complication of inguinal hernia repair, causing patients to undergo a second operation.

  • Bleeding. Bleeding inside the incision is another complication of inguinal hernia repair. It can cause severe swelling and bluish discoloration of the skin around the incision. Surgery may be necessary to open the incision and stop the bleeding. Bleeding is unusual and occurs in less than 2 percent of patients.

  • Wound infection. The risk of wound infection is small-less than 2 percent-and is more likely to occur in older adults and people who undergo more complex hernia repair.2 The person may experience a fever, discharge from the incision, and redness, swelling, or tenderness around the incision. Postoperative infection requires antibiotics and, occasionally, another procedure requiring local anesthesia to make a small opening in the incision and drain the infection.

  • Painful scar. Sometimes people experience sharp, tingling pain in a specific area near the incision after it has healed. The pain usually resolves with time. Medicine may be injected in the area if the pain continues.Injury to internal organs. Although extremely rare, injury to the intestine, bladder, kidneys, nerves and blood vessels leading to the legs, internal female organs, and vas deferens-the tube that carries sperm-can occur during hernia surgery and may lead to more operations.

For More Information

Ventral Hernia Repair (American College of Surgeons)