Ventral Hernia

A bulge in the abdomen wall might seem like a minor inconvenience, but for millions of people living with a ventral hernia, it can significantly impact their daily lives. This condition can cause pain, discomfort during activities like bending or lifting, and digestive issues. This comprehensive guide explores everything patients need to know about ventral hernias, symptoms, types, and ventral hernia side effects. 

What is Ventral Hernia?

A ventral hernia, also known as a vertical hernia, occurs when internal organs or tissues push through an opening in the front abdominal muscles. The term "ventral" specifically refers to the front or belly area of the body, making these hernias distinctly visible through the abdominal wall.

Types of Ventral Hernia

The main types of ventral hernias include:

• Epigastric Hernias: These hernias occur in the upper abdomen between the belly button and breastbone. They typically contain fatty tissue and are often small, making them challenging to diagnose.
• Umbilical Hernias: Located around the belly button, these are among the most common ventral hernias. They often appear as a noticeable bulge at the navel and can be present from birth.
• Incisional Hernias: These develop at the site of previous surgical incisions and affect up to 10% of patients who have undergone abdominal surgery.
• Parastomal Hernias: These hernias occur at the site of a colostomy, ileostomy, or other stoma where the intestines are sutured to the skin. 
• Spigelian Hernias: These appear in the lower quadrants of the abdomen, slightly to either side of the belly button. They present a unique challenge as they don't always penetrate all abdominal wall muscles, making diagnosis more complex.

Symptoms of Ventral Hernia

The most common indicator that patients experience is a visible bulge in their front abdominal wall.

This bulge becomes more noticeable during specific activities that engage the abdominal muscles. Patients might observe or feel the hernia during:

• Laughing or crying
• Coughing or sneezing
• Using the bathroom
• Bending or lifting
• Exercise or physical activity

Other symptoms include: 

• Pain or discomfort that worsens with coughing, lifting, or prolonged standing
• Nausea and vomiting
• Bloating or constipation
• Redness or swelling around the hernia site

Causes and Risk Factors of Ventral Hernia

The development of a ventral hernia can be attributed to various factors, ranging from natural causes to lifestyle influences. 

• Congenital weak spots present from birth
• Previous abdominal surgeries, with up to 30% risk of developing incisional hernias
• Chronic health conditions affecting muscle strength
• Natural muscle degeneration due to aging
• Physical trauma or injury to the abdomen

Several risk factors can raise the likelihood of developing a ventral hernia. These include:

• Chronic coughing or breathing difficulties
• Persistent constipation
• Regular heavy lifting or pushing
• Diabetes and connective tissue diseases
• Pregnancy and childbirth
• Obesity

Complications of Ventral Hernia

The most common complications progress in stages of severity:

• Incarceration: The intestine becomes trapped in the abdominal wall and cannot be pushed back. This condition causes pain, discomfort, and potential bowel obstruction.
• Strangulation: Blood supply to the trapped tissue gets cut off, leading to tissue death. This situation requires immediate emergency surgery.
• Bowel Obstruction: Can occur with incarcerated ventral hernias, causing nausea, vomiting, and severe constipation
• Tissue Death: Without blood flow, affected tissue begins to die, potentially releasing fatal toxins into the body

In cases where a ventral hernia ruptures, the mortality rate increases significantly to 60-80% even after surgical repair. 

Diagnosis

• Physical Assessment: Doctors examine the abdomen for visible signs of herniation. They may ask patients to perform specific actions to make the hernia more apparent, such as standing, coughing, or changing positions. This hands-on examination allows doctors to assess whether they can gently move the hernia back into place, providing crucial information about its severity and urgency for treatment.
• Medical History: The diagnostic process includes several key steps:
  • Detailed discussion about symptom onset and progression
  • Assessment of chronic health conditions
  • Review of occupation and lifestyle habits
  • Evaluation of diet and exercise routines
• Imaging: In cases where physical examination isn't conclusive, healthcare providers may order additional imaging tests. These might include an abdominal ultrasound, CT scan, or MRI to view the hernia better. 

Treatment for Ventral Hernia

While ventral hernia repair surgery remains the only definitive solution, some patients may initially opt for non-surgical approaches.

• Non-surgical Treatment: Non-surgical management typically involves using supportive devices to ease discomfort. Doctors may recommend an abdominal truss, belt, or hernia brief to relieve pressure and pain. 
• Surgery: The main surgical techniques include:
  • Traditional Open Surgery: Doctors repair the ventral hernia by:
    • Herniorrhaphy: Herniorrhaphy involves making an incision in the abdomen above the hernia, pushing the protruding intestine back into the abdomen, and closing the opening.
    • Hernioplasty: This surgical procedure involves repairing and strengthening the weak area with mesh.

Doctors may use different types of surgical mesh to strengthen the repair during surgery. Synthetic mesh is the most durable, while biological mesh offers a lower infection risk. The choice of mesh depends on individual patient factors and the surgeon's assessment.

• Laparoscopic Repair: During this minimally invasive surgical procedure, the surgeon makes several small incisions in the lower abdomen and inserts tubelike instruments, such as a laparoscope and surgical instruments, to repair the hernia with synthetic mesh and sutures.
• Robotic-assisted Procedures: Robotic-assisted surgery is similar to laparoscopy, but the surgeon controls robotic arms from a console and performs ventral hernia repair.

When to See a Doctor

Emergencies requiring immediate ER evaluation include:

• Severe abdominal pain around the hernia
• Profuse sweating with a rapid heartbeat
• High fever with nausea and vomiting
• Severe nausea accompanied by constipation
• Redness or discoloration at the hernia site

These symptoms could indicate a strangulated hernia, where the supply of blood to the herniated bowel is compromised, potentially leading to tissue death.

Prevention

Essential preventive measures include maintaining a healthy weight through proper diet and exercise. Obesity significantly increases the risk of developing ventral hernias by putting extra pressure on the abdominal wall.

People can reduce their risk of ventral hernia by following these key practices:

• Exercising regularly to strengthen core muscles while avoiding high-strain activities
• Using proper lifting techniques if handling heavy objects
• Managing chronic conditions like diabetes effectively
• Treating persistent coughs promptly
• Maintaining good posture, especially during desk work
• Quitting smoking, as smokers are four times more likely to experience recurring hernias
• For those who exercise regularly, it is essential to choose appropriate activities. Low-impact exercises like swimming, walking, and biking are generally safe options. However, individuals should avoid exercises that strain the abdomen excessively, such as traditional sit-ups and heavy weightlifting.
• Dietary considerations play a vital role in prevention. A balanced fibre-rich diet helps prevent constipation, which can strain the abdominal wall. Fibre-rich foods include vegetables, whole grains, nuts, seeds, and legumes. 
• Additionally, maintaining proper hydration and avoiding alcohol supports overall tissue health.

Conclusion

Ventral hernias represent a serious medical condition that requires proper attention and care. Though common, these hernias can lead to severe complications when left untreated, ranging from chronic pain to life-threatening emergencies. Medical intervention remains the only path to recovery, making early detection and treatment essential for better outcomes.

Patients should stay alert to warning signs and seek immediate medical attention if they notice unusual symptoms or changes in their hernia. Simple lifestyle changes like maintaining an optimal weight, proper lifting techniques, and regular exercise can help prevent ventral hernias or reduce complications for those already diagnosed. Regular check-ups with doctors ensure proper monitoring and timely intervention when needed.

FAQs

1. What is the difference between ventral and umbilical hernias?

An umbilical hernia is actually a specific type of ventral hernia. While ventral hernias can occur anywhere in the front abdominal wall, umbilical hernias specifically develop around the belly button area. The main difference lies in their location - ventral hernias encompass a broader category that includes epigastric, incisional, and umbilical hernias.

2. Which surgery is best for ventral hernia?

The optimal surgical approach depends on individual factors, but three main options are available. Laparoscopic repair involves small incisions, typically resulting in shorter hospital stays and lower infection rates. Open surgery might be necessary for larger hernias, while robotic-assisted repair offers precise control during the procedure.

3. How to reduce a ventral hernia?

Reducing a ventral hernia requires careful techniques. Doctors may attempt manual reduction by:

• Placing the patient in a supine position
• Applying cold compresses to reduce swelling
• Using gentle pressure around the hernia

4. Is walking good for ventral hernia?

Walking is generally considered safe and beneficial after hernia repair. Patients can typically walk immediately after surgery, though they should avoid strenuous activities for 3-4 weeks. Regular walking helps maintain good circulation and promotes healing without putting excessive strain on the repair site.

5. How serious is a ventral hernia?

Ventral hernias can range from mild to severe. While some may cause minimal discomfort, others can lead to serious complications if left untreated. The condition becomes particularly dangerous if the hernia becomes strangulated, cutting off the supply of the blood to the trapped tissue - a situation requiring emergency surgery.

6. Can a ventral hernia come back?

Yes, ventral hernias can recur. Studies show approximately 85% of recurrences after laparoscopic repairs, and 77% after open repairs occur within two years of surgery. The risk of recurrence can be minimised through proper surgical technique and post-operative care, including maintaining a healthy weight and avoiding heavy lifting during recovery.

Dr. Prashant Bhowate

CARE Medical Team