Ventral hernias result from defects in the abdominal wall. They are typically classified by etiology and location. Ventral hernias can develop as a result of prior surgery (incisional) or spontaneously (umbilical, epigastric, Spigelian, or lumbar hernias).
The etiology, presentation, and treatment options for most abdominal wall hernias will be reviewed here. Wound infections in abdominal wall hernias, inguinal and femoral hernias, and abdominal hernias related to peritoneal dialysis are discussed separately. (See "Wound infections following abdominal wall hernia repair: Epidemiology, pathogenesis, and prevention" and "Classification, clinical features and diagnosis of inguinal and femoral hernias in adults" and "Overview of treatment for inguinal and femoral hernias" and "Abdominal hernias in continuous peritoneal dialysis".)
Incisional hernias, by definition, develop at sites where an incision has been made for some prior abdominal procedure. Hernias are due to failure of fascial tissues to heal and close following laparotomy.
Etiology — Any condition that inhibits natural wound healing will make a patient susceptible to the development of an incisional hernia. Such conditions include: infection, obesity, smoking, medications such as immunosuppressives, excessive wound tension, malnutrition, fractured sutures, poor technique, and connective tissue disorders . Emergency surgery increases the risk of incisional hernia formation.
It is estimated that an incisional hernia will develop in approximately 10 to 15 percent of abdominal incisions [2,3], and in up to 23 percent of patients who develop postoperative wound infection . Such hernias can occur after any type of abdominal wall incision, although the highest incidence is seen with midline incisions, the most common incisions for many abdominal procedures .