Ventral hernia describes any hernia that occurs on the abdominal wall, exclusive of inguinal or groin hernias. Although most ventral hernias occur as a complication after abdominal surgery some, such as epigastric or umbilical hernias, develop without antecedent surgery. Many people use the terms "ventral" and "incisional" hernias synonymously. Here are the most common complications of ventral hernia repair.
Recurrence
Despite the best efforts of surgeons, recurrence rates following ventral hernia repair are high, ranging from 10 to 50 percent. Often the fact that the initial operative procedure resulted in a ventral hernia means that the patient's native tissues are inherently weak. This leads to breakdown of subsequent repairs. Over the last decade or so, the majority of ventral hernia repairs have been performed by reinforcing the abdominal wall with artificial materials known as mesh such as polypropylene, expanded polytetrafluorethylene (Gore-Tex) or combinations of the two. Risk factors for recurrence include obesity, prior wound infection, smoking, steroid use and technical error such as implanting a piece of mesh that is too small or failing to anchor the mesh securely.
Infection
Reoperation through a previous incision has a higher rate of wound infection than operating on virgin tissue. If an infection occurs after ventral hernia repair the hernia almost always recurs. If mesh was implanted it usually must be removed because the foreign material serves as a sanctuary for bacteria. The infection frequently will not resolve until the mesh is removed.
Bowel Injury
Because intestine is often present in the ventral hernia sac and the previous surgery has resulted in the formation of adhesions (bowel is adherent to the abdominal wall, hernia sac or other loops of bowel), the dissection of the contents of the sac may be quite difficult. In the course of the surgery injury to the serosal (outer lining) of the bowel or a full-thickness opening in the bowel wall may be created. The serosal injury may not heal well and even if the full-thickness injury is closed, a leak might occur. At worst this could cause an abscess, a fistula (connection between the contents of the intestine and the wound) or a wound infection.
Bowel Obstruction
When the abdominal cavity is entered for any operation, adhesions are likely to form. Since ventral hernia repair involves at least a second opening of the abdomen the chance that adhesions will result is great. If these create a kink or twist in the bowel the patient may suffer a bowel obstruction. The obstruction may occur any time from the immediate post-operative period to years later. While most obstructions resolve with conservative management with intravenous fluids and bowel rest some require re-exploration to relieve the kink or twist. This potential generates the opportunity for more adhesions to form and for the hernia to recur.
