Ventral and Incisional Hernia

A ventral hernia is a protrusion through a defect in the anterior abdominal wall, encompassing primary midline hernias (such as umbilical and epigastric) and incisional hernias that arise at the site of a previous surgical incision. Incisional hernia is a common late complication of laparotomy and a major driver of reoperation in abdominal surgery.

Definition

A ventral hernia is a protrusion of peritoneum and/or abdominal contents through a defect in the anterior abdominal wall; an incisional hernia is a ventral hernia occurring at the site of a prior surgical incision where fascial closure has failed, while primary ventral hernias (umbilical, epigastric, spigelian) arise without prior surgery.

Scope

This topic covers the distinction between primary and incisional ventral hernias, the European Hernia Society classification by location and defect width, the principles of suture versus mesh repair, and the guidelines on abdominal wall incision closure that aim to prevent incisional hernia. It is reference-educational and does not provide operative or treatment instructions.

Core questions

• How are primary ventral and incisional hernias distinguished and classified?
• How does mesh repair compare with suture repair for incisional hernia recurrence?
• Which fascial-closure techniques reduce the incidence of incisional hernia?
• How do defect location and width influence repair planning?

Key concepts

• Primary versus incisional ventral hernia
• European Hernia Society classification (location and width)
• Suture versus mesh repair
• Mesh position (onlay, sublay/retromuscular, intraperitoneal)
• Fascial closure technique (small-bites)
• Recurrence after repair
• Umbilical, epigastric, and spigelian hernias

Mechanisms

Primary ventral hernias arise at congenital points of midline weakness, whereas incisional hernias develop when a laparotomy wound fails to heal with durable fascial strength, allowing the wound edges to separate under intra-abdominal pressure. The European Hernia Society classification standardizes description by anatomical location and defect width to enable comparison. Repair reduces recurrence chiefly through prosthetic mesh reinforcement, with randomized evidence showing lower long-term recurrence for mesh than for primary suture repair of incisional hernias; closure guidelines further address the surgical-technique factors that influence whether an incisional hernia forms at all.

Clinical relevance

Incisional hernia is one of the commonest long-term complications of abdominal surgery, so its classification and prevention are central to surgical quality. This entry explains how these hernias are categorized and how repair and prevention strategies are compared in the literature; it is educational reference material and not a basis for individual operative decisions.

Epidemiology

Incisional hernia develops in a substantial proportion of patients after midline laparotomy, with risk influenced by wound complications and closure technique; primary ventral hernias such as umbilical hernias are also common in the general population, as reflected in the European Hernia Society classification and incision-closure guidelines.

History

Recognition that suture repair of incisional hernia carried high recurrence led to randomized trials in the 1990s and 2000s establishing the superiority of mesh, while the European Hernia Society's 2009 classification standardized reporting and its 2015 incision-closure guideline consolidated evidence on preventing incisional hernia through technique.

Debates

Optimal mesh position for ventral hernia repair

Whether mesh is best placed as onlay, retromuscular/sublay, or intraperitoneal is debated, trading off recurrence, wound complications, and adhesion risk; classification by location and width helps frame these comparisons.

Suture versus mesh repair

Long-term randomized follow-up showed mesh repair substantially lowers recurrence compared with suture repair of incisional hernia, shifting practice toward routine mesh use even for smaller defects.

Key figures

• Filip Muysoms
• Johannes Jeekel
• Roland Luijendijk

Seminal works

• muysoms-2009
• burger-2004
• muysoms-2015

Frequently asked questions

What is the difference between a ventral hernia and an incisional hernia?

Ventral hernia is the umbrella term for any defect in the anterior abdominal wall; an incisional hernia is the subtype that occurs at the site of a previous surgical incision, while primary ventral hernias (such as umbilical) arise without prior surgery.

Does mesh reduce recurrence after incisional hernia repair?

Long-term randomized follow-up reported substantially lower recurrence with mesh repair than with suture repair of incisional hernia, which is why mesh reinforcement is widely used.