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Overview of abdominal hernias

INTRODUCTION

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 HERNIA

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 [1]. 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 [4]. 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 [4].

                                          

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Literature review current through: May 2013. | This topic last updated: Oct 9, 2012.
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References
Top
  1. George CD, Ellis H. The results of incisional hernia repair: a twelve year review. Ann R Coll Surg Engl 1986; 68:185.
  2. Mudge M, Hughes LE. Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 1985; 72:70.
  3. Kingsnorth A, LeBlanc K. Hernias: inguinal and incisional. Lancet 2003; 362:1561.
  4. Bucknall TE, Cox PJ, Ellis H. Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J (Clin Res Ed) 1982; 284:931.
  5. van Ramshorst GH, Nieuwenhuizen J, Hop WC, et al. Abdominal wound dehiscence in adults: development and validation of a risk model. World J Surg 2010; 34:20.
  6. Fassiadis N, Roidl M, Hennig M, et al. Randomized clinical trial of vertical or transverse laparotomy for abdominal aortic aneurysm repair. Br J Surg 2005; 92:1208.
  7. Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, et al. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA 2006; 295:285.
  8. Ramirez OM, Ruas E, Dellon AL. "Components separation" method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 1990; 86:519.
  9. de Vries Reilingh TS, van Goor H, Rosman C, et al. "Components separation technique" for the repair of large abdominal wall hernias. J Am Coll Surg 2003; 196:32.
  10. Gonzalez R, Rehnke RD, Ramaswamy A, et al. Components separation technique and laparoscopic approach: a review of two evolving strategies for ventral hernia repair. Am Surg 2005; 71:598.
  11. Rosen MJ, Williams C, Jin J, et al. Laparoscopic versus open-component separation: a comparative analysis in a porcine model. Am J Surg 2007; 194:385.
  12. Burger JW, Luijendijk RW, Hop WC, et al. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 2004; 240:578.
  13. Flum DR, Horvath K, Koepsell T. Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg 2003; 237:129.
  14. Luijendijk RW, Hop WC, van den Tol MP, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 2000; 343:392.
  15. Bringman S, Conze J, Cuccurullo D, et al. Hernia repair: the search for ideal meshes. Hernia 2010; 14:81.
  16. Schmidbauer S, Ladurner R, Hallfeldt KK, Mussack T. Heavy-weight versus low-weight polypropylene meshes for open sublay mesh repair of incisional hernia. Eur J Med Res 2005; 10:247.
  17. Matthews BD, Pratt BL, Pollinger HS, et al. Assessment of adhesion formation to intra-abdominal polypropylene mesh and polytetrafluoroethylene mesh. J Surg Res 2003; 114:126.
  18. Bellows CF, Alder A, Helton WS. Abdominal wall reconstruction using biological tissue grafts: present status and future opportunities. Expert Rev Med Devices 2006; 3:657.
  19. Candage R, Jones K, Luchette FA, et al. Use of human acellular dermal matrix for hernia repair: friend or foe? Surgery 2008; 144:703.
  20. Chavarriaga LF, Lin E, Losken A, et al. Management of complex abdominal wall defects using acellular porcine dermal collagen. Am Surg 2010; 76:96.
  21. Gray SH, Hawn MT, Itani KM. Surgical progress in inguinal and ventral incisional hernia repair. Surg Clin North Am 2008; 88:17.
  22. Petersen S, Henke G, Zimmermann L, et al. Ventral rectus fascia closure on top of mesh hernia repair in the sublay technique. Plast Reconstr Surg 2004; 114:1754.
  23. DeMaria EJ, Moss JM, Sugerman HJ. Laparoscopic intraperitoneal polytetrafluoroethylene (PTFE) prosthetic patch repair of ventral hernia. Prospective comparison to open prefascial polypropylene mesh repair. Surg Endosc 2000; 14:326.
  24. Cobb WS, Kercher KW, Heniford BT. Laparoscopic repair of incisional hernias. Surg Clin North Am 2005; 85:91.
  25. Aufenacker TJ, Koelemay MJ, Gouma DJ, Simons MP. Systematic review and meta-analysis of the effectiveness of antibiotic prophylaxis in prevention of wound infection after mesh repair of abdominal wall hernia. Br J Surg 2006; 93:5.
  26. Berger D, Bientzle M, Müller A. Postoperative complications after laparoscopic incisional hernia repair. Incidence and treatment. Surg Endosc 2002; 16:1720.
  27. Heniford BT, Park A, Ramshaw BJ, Voeller G. Laparoscopic repair of ventral hernias: nine years' experience with 850 consecutive hernias. Ann Surg 2003; 238:391.
  28. Ujiki MB, Weinberger J, Varghese TK, et al. One hundred consecutive laparoscopic ventral hernia repairs. Am J Surg 2004; 188:593.
  29. Cassar K, Munro A. Surgical treatment of incisional hernia. Br J Surg 2002; 89:534.
  30. Bingener J, Buck L, Richards M, et al. Long-term outcomes in laparoscopic vs open ventral hernia repair. Arch Surg 2007; 142:562.
  31. Novitsky YW, Cobb WS, Kercher KW, et al. Laparoscopic ventral hernia repair in obese patients: a new standard of care. Arch Surg 2006; 141:57.
  32. Carbajo MA, Martín del Olmo JC, Blanco JI, et al. Laparoscopic treatment vs open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc 1999; 13:250.
  33. Itani KM, Neumayer L, Reda D, et al. Repair of ventral incisional hernia: the design of a randomized trial to compare open and laparoscopic surgical techniques. Am J Surg 2004; 188:22S.
  34. Hodgson NC, Malthaner RA, Ostbye T. The search for an ideal method of abdominal fascial closure: a meta-analysis. Ann Surg 2000; 231:436.
  35. van 't Riet M, Steyerberg EW, Nellensteyn J, et al. Meta-analysis of techniques for closure of midline abdominal incisions. Br J Surg 2002; 89:1350.
  36. Meier DE, OlaOlorun DA, Omodele RA, et al. Incidence of umbilical hernia in African children: redefinition of "normal" and reevaluation of indications for repair. World J Surg 2001; 25:645.
  37. Ameh EA. Incarceration of umbilical hernia in children: is the trend increasing? Eur J Pediatr Surg 2004; 14:218.
  38. Kurzer M, Belsham PA, Kark AE. Tension-free mesh repair of umbilical hernia as a day case using local anaesthesia. Hernia 2004; 8:104.
  39. Halm JA, Heisterkamp J, Veen HF, Weidema WF. Long-term follow-up after umbilical hernia repair: are there risk factors for recurrence after simple and mesh repair. Hernia 2005; 9:334.
  40. Steinke W, Zellweger R. Richter's hernia and Sir Frederick Treves: an original clinical experience, review, and historical overview. Ann Surg 2000; 232:710.
  41. Kadirov S, Sayfan J, Friedman S, Orda R. Richter's hernia--a surgical pitfall. J Am Coll Surg 1996; 182:60.
  42. Lang B, Lau H, Lee F. Epigastric hernia and its etiology. Hernia 2002; 6:148.
  43. Skandalakis PN, Zoras O, Skandalakis JE, Mirilas P. Spigelian hernia: surgical anatomy, embryology, and technique of repair. Am Surg 2006; 72:42.
  44. Mufid MM, Abu-Yousef MM, Kakish ME, et al. Spigelian hernia: diagnosis by high-resolution real-time sonography. J Ultrasound Med 1997; 16:183.
  45. Shenouda NF, Hyams BB, Rosenbloom MB. Evaluation of Spigelian hernia by CT. J Comput Assist Tomogr 1990; 14:777.
  46. Larson DW, Farley DR. Spigelian hernias: repair and outcome for 81 patients. World J Surg 2002; 26:1277.
  47. Moreno-Egea A, Carrasco L, Girela E, et al. Open vs laparoscopic repair of spigelian hernia: a prospective randomized trial. Arch Surg 2002; 137:1266.
  48. Moreno-Egea A, Baena EG, Calle MC, et al. Controversies in the current management of lumbar hernias. Arch Surg 2007; 142:82.
  49. Orcutt TW. Hernia of the superior lumbar triangle. Ann Surg 1971; 173:294.
  50. Ranney B. Diastasis recti and umbilical hernia causes, recognition and repair. S D J Med 1990; 43:5.
  51. Williams TC, Hardaway M, Altuna B. Ambulatory abdominoplasty tailored to patients with an appropriate body mass index. Aesthet Surg J 2005; 25:132.
  52. Nahas FX, Augusto SM, Ghelfond C. Should diastasis recti be corrected? Aesthetic Plast Surg 1997; 21:285.
  53. Losanoff JE, Basson MD, Gruber SA, Weaver DW. Sciatic hernia: a comprehensive review of the world literature (1900-2008). Am J Surg 2010; 199:52.