Ventral/Incisional Hernia

What is a Ventral Hernia?

A hernia occurs when an organ or abdominal tissue protrudes through a cavity in the fascia or abdominal muscle.  A ventral hernia occurs along the vertical center of the abdominal wall.

What are the Types of Ventral Hernias?

Incisional hernias, umbilical hernias, and epigastric hernias are all considered unique types of ventral hernias.

  • An incisional hernia is a protrusion that occurs where a surgical scar exists. Studies suggest that 15 to 20% of all ventral hernias are incisional hernias.
  • An umbilical hernia is a protrusion of fat or intestinal tissue through or around the belly button. It may cause the appearance of an "outie" belly button.
  • An epigastric hernia is one located somewhere midline between the belly button and the chest bones.

What are the Symptoms of a Ventral Hernia?

The symptoms of a ventral hernia relate to the location of the protrusion in the abdomen. General symptoms may include vomiting, constipation, and sharp pain that may occur or worsen during physical activity.

What Causes a Ventral Hernia?

Ventral hernias may develop for a number of different reasons. The direct cause is a weakness in the abdominal wall. This weakness could result from injury, pregnancy, heavy lifting, prior surgery, disease, diabetes, chronic or severe vomiting, or chronic coughing.

Should All Ventral Hernias Be Repaired?

Even the smallest ventral hernias should eventually be repaired. While taking a watch-and-wait approach to small, non-symptomatic hernias may be a good starting point, ventral hernias can become medical emergencies if they become incarcerated or strangulated.

How is a Ventral Hernia Diagnosed?

Dr. Brian Jacob is an internationally recognized hernia, chronic pain, and weight loss surgeon in New York City. Over the past decade, he has performed thousands of hernia procedures, and he has devoted the majority of his career to treating hernias and groin pain. He is extraordinarily familiar with the signs and symptoms of the various types of ventral hernias and may use multiple diagnostic techniques to accurately name the hernia. During the history and physical, the doctor asks about symptoms such as constipation, "thin" stools, nausea, vomiting, and other symptoms. He examines the abdomen and may ask the patient to cough, which increases abdominal pressure and may make the hernia more pronounced. To confirm the diagnosis, diagnostic imaging such as ultrasound, CT, or MRI may be ordered.

Are Some Ventral Hernias More Serious than Others?

Most ventral hernias are not considered excessively dangerous. The concern about these types of hernias is that tissue will become incarcerated or strangulated. The term incarceration indicates that the protruding tissue is trapped and cannot be put back into a normal position. A strangulated hernia indicates that the tissue is not receiving the necessary blood flow to sustain it. Strangulated tissue necroses, dies, if the hernia is not repaired. Surgery is necessary to repair incarcerated and strangulated ventral hernias, sometimes on an emergency basis. Signs of a complicated ventral hernia include severe abdominal pain, fever, nausea, vomiting, and an abdominal or bladder blockage that prevent urination, bowel movement, or passing gas.

What Are The Risks Factors for Ventral Hernias?

Anyone can develop a ventral hernia. However, some people may be more susceptible due to certain genetic and lifestyle factors. Some of the most prevalent ones are:

  • Family history of hernias.
  • Obesity.
  • A previous history of hernias.
  • Previous surgeries of the abdomen or bowel.
  • Frequent pushing or lifting of heavy objects at work.

How are Ventral Hernias Treated?

Dr. Jacob may recommend laparoscopic, open, or robotic surgery to repair a ventral hernia. The doctor repairs the weakness in the abdominal muscle and closes the incision. Laparoscopic or robotic hernia repair involves several small incisions versus one long one. The doctor inserts a laparoscope, a narrow tube with a camera on the end, into an incision. This displays the surgical field around the hernia on a monitor to guide the operation. Small instruments inserted through other incisions are used to reposition tissue and, in some cases,  repair the hernia using sutures and/or synthetic mesh.

What Are the Complications of a Ventral Hernia?

Large ventral hernias, ones that are over 15 centimeters, are dangerous before and during surgical intervention. Since these are considered giant hernias, it can be difficult to separate them from the abdominal cavity. In addition, as the hernia continues to increase in size, so does the risk of recurrence once removed.

Other possible complications include strangulation and incarceration. When a ventral hernia becomes strangulated, part of your intestine may die if the hernia is not repaired. If the hernia is incarcerated, the organs or tissue that is pushed against the abdominal wall cannot be pushed back into the abdomen. If not repaired, an incarcerated ventral hernia may cut off blood flow to the intestines.

How Long Does it Take to Recover After the Surgical Repair of a Ventral Hernia?

One of the reasons that laparoscopic surgery is preferred is because it incurs a relatively short recovery period. Depending on the extent of repair performed, recovery usually 1 to 4 weeks. Generally, patients' symptoms are significantly improved within three to four weeks of their procedure. Upon discharge, patients receive specific instructions for wound care. An outer bandage is applied after surgery and should remain on the skin for two days. Beneath the outer dressing, there may be glue or tape that needs to stay in place for seven to 10 days. Patients should walk every day and can even climb stairs. However, it is necessary to avoid strenuous exercise and lifting for approximately two weeks or as otherwise instructed by the doctor. Patients may shower the day after surgery but must avoid immersing the body in water for five days. No swimming or baths. It is possible to return to work as soon as physical comfort allows. This can take three to seven days. Patients whose jobs are more physically demanding may need more time off work to fully recover.

What Should I Eat to Avoid Aggravating My Ventral Hernia?

Ventral hernias can cause several uncomfortable symptoms that worsen after eating certain foods. Patients with any type of ventral hernia are encouraged to pay close attention to their symptoms and how they may relate to their diet. If necessary, modifications can be made to avoid worsening pain, nausea, or other symptoms. Generally, experts recommend:

  • Avoiding foods with saturated or trans fats. Examples include processed food and red meat. Hydrogenated vegetable oil should be strictly avoided. Since many packaged foods contain hydrogenated oil, labels must be checked carefully.
  • Consuming healthy fats like olive oil, avocado oil, canola oil, nuts, and salmon.
  • Trading pasta, instant rice, and white bread for whole grains, legumes, and sweet potatoes, all of which offer healthy forms of fiber.
  • Avoiding foods high in hydrochloric acid, such as caffeinated beverages and orange juice.
  • Consuming healthier acidic foods such as pineapples and pineapple juice, apples, and tomatoes.
  • Reducing sugar intake as a way to avoid abdominal weight gain.

Schedule a Consultation

If you would like more information regarding the diagnosis and treatment of a ventral hernia, contact our NYC office at 212-879-6677 or book a visit online.

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