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Management of ventral hernias

Authors
David C Brooks, MD
John Cone, MD
Section Editors
Michael Rosen, MD
Lillian S Kao, MD, MS
Deputy Editor
Wenliang Chen, MD, PhD

INTRODUCTION

An estimated one-quarter of all individuals are either born with or will develop a ventral hernia in their lifetimes [1]. In the United States, over $3.4 billion a year is spent on repairing ventral hernias [2].

Ventral hernias occur in the anterior abdominal wall and include epigastric, umbilical, spigelian, parastomal, and most incisional hernias [3]. Epigastric and umbilical are primary ventral hernias. Incisional hernias can develop anywhere an incision has been made but most commonly occur at the midline, given that midline incisions are most commonly used during laparotomies. Spigelian and parastomal hernias occur off the midline and are discussed in detail elsewhere. (See "Parastomal hernia".)

The management of ventral hernias, both primary and incisional, will be reviewed here. The clinical features and diagnosis of ventral hernias and the diagnosis and management of other abdominal wall hernias (eg, groin hernia) are reviewed separately. (See "Overview of abdominal wall hernias in adults" and "Overview of treatment for inguinal and femoral hernia in adults" and "Classification, clinical features, and diagnosis of inguinal and femoral hernias in adults".)

ACUTELY INCARCERATED OR STRANGULATED VENTRAL HERNIAS

Patients with an acutely incarcerated or strangulated ventral hernia require emergency repair (algorithm 1). Among the 2.3 million inpatient abdominal hernia repairs performed from 2001 to 2010 in the United States, an estimated 576,000 were performed emergently [4].

The objective of the emergency surgery is to alleviate any acute problems (eg, bowel infarction, bowel obstruction, abdominal pain) without jeopardizing the opportunity for a satisfactory hernia repair. The optimal technique of hernia repair in this situation varies depending on the anatomy, patient stability, patient comorbidities, and the degree of contamination of the operative field [5].

                            

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Literature review current through: Aug 2017. | This topic last updated: Aug 17, 2017.
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