VENTRAL HERNIA

Ventral hernia is the projection and protrusion of part of an intra-abdominal organ or preperitoneal fat, out of its anatomical position through an orifice or gap of the abdominal wall.

Ventral hernia is distinguished according to its location in the abdominal wall in epigastric hernia, white line hernia, umbilical hernia, Spiegel hernia and finally in postoperative ventral hernia when it appears after previous surgery.

The causes vary from patient to patient and the main ones are obesity, heavy manual labor, conditions that increase intra-abdominal pressure (chronic constipation, dysuria, chronic severe cough), multiple births, sudden weight changes and collagen disorders of the connective tissue.

Risk factors for postoperative ventral hernia are good wound suturation technique, use of inappropriate sutures, infection of the wound after surgery, obesity, non-compliance of the patient with the postoperative instructions on weight lifting.

Most patients notice a slight swelling or lump in their abdomen which is more visible when they are standing or after an increase in intra-abdominal pressure (cough, weight lifting).
These hernias cause mild discomfort or local pain where they are located or diffuse abdominal pain. Rarely it can cause ileus (entrapment and obstruction of part of the intestine) due to constriction of its contents.

Usually the diagnosis is easily made only by clinical examination by the doctor and rarely in doubt may require ultrasonogram, computerized axial tomography (CAT) or magnetic resonance imaging (MRI).

Surgical repair, usually with plexus placement, is the only definitive treatment for ventral hernia. The use of a hernial bandage or abdominal band should be avoided because they weaken the muscles and can create adhesions.

Surgical repair can be done either openly or laparoscopically. The laparoscopic technique is superior to the open one in many fields. In the open method, in order to place and fixate the plexus in its correct position, large mobilizations of tissues in the abdominal walls must be made, but this is not done in the laparoscopic method and so it is much less traumatic. Patients undergoing laparoscopic surgery have shorter hospital stay, faster mobilization, less pain, better aesthetic results and faster return to their individual and professional activities.

As there is no ideal plexus (one for all types and sizes) the following parameters must be considered in selecting the appropriate plexus:

• Anatomical placement position (intra-abdominally, preperitoneally, above the denervation)
• Placement method (open, laparoscopic)
• Characteristics of the hernia being repaired (first treatment or relapse)
• Clinical experience