Ventral is a word used by doctors to mean “the front”. Therefore, a ventral hernia is a defect in the front part of the abdominal wall. This defect or hole allows the protrusion of the internal organs of the abdominal cavity through the defect. Such internal organs may include abdominal fat or even a loop of bowel. When this protrusion is through a previous surgical scar over the abdominal wall, it is called an incisional hernia. For example, if a person has a previous operation to remove the appendix, or a previous Caesarian Section, and now has a hole along the scar – that is an incisional hernia.
It is often first noticed as a painless lump over the abdomen that is more apparent in an upright position and disappears on lying down. It is usually not painful; at most a mild ache may be felt. However, when the pain is severe, this may indicate a serious complication of the condition whereby the bowel loop that protrudes through the defect becomes deprived of blood supply. Equally ominous is distension of the abdomen accompanied by vomiting, as this may represent another complication of the condition whereby the bowel loop that protrudes through the defect becomes blocked.
It is advisable to seek medical attention whenever a ventral hernia/ incisional hernia is suspected or found. Though the person may not experience much discomfort, surgery is usually recommended to prevent the serious complications of the condition from happening.
The doctor is usually able to clinch the diagnosis with physical examination. The lump will typically protrude out on standing or on coughing. It will reduce on lying down. The surgeon will also try to measure the size of the defect – this will help him in his surgical planning.
Sometimes, especially if the person is obese, the defect or the lump may not be very apparent. In such cases, the doctor may order a scan to confirm the diagnosis and also to measure the size of the defect.
The definitive treatment for ventral/ incisional hernia is surgery. This can either be performed through an incision over the previous surgical scar, or directly over the hernia; or with keyhole surgery using much smaller incisions. The aim is to close the defect. This is usually achieved by placing a mesh to cover the defect.
In some cases, however, surgery may not be offered if the risk of recurrence is deemed to be high and outweighs the risk of complications arising from the hernia itself (for example when the patient is overweight and the hernia defect is wide).
This is caused by the weakening of the layers of muscle and tough fibrous tissues that form the abdominal wall. A surgical wound can never recover complete strength compared to before surgery. If the degree of weakening is severe enough, this may lead to the formation of an incisional hernia.
Whilst not completely preventable, constipation, straining when passing urine, carrying heavy weights or a chronic cough may aggravate the condition. In all these situations, there is an increase in the pressure within the abdomen, especially when the person strains. This increase in pressure will slowly enlarge the defect and worsen the condition.
For incisional hernia specifically, complications of the surgical wound, such as wound infection, will predispose to the subsequent development of an incisional hernia. Also, if the person’s nutrition is poor, the wound will heal poorly too.
Another thing to note, especially if a person has had a recent operation in the abdominal area, is not to carry heavy things for about 6 months, so as not to cause unnecessary strain on the wound. However, simple aerobic exercises like cycling, jogging and swimming are safe. Do consult your doctor for more details.