What type of specialist repairs large ventral hernias?

Specialist for Large Ventral Hernia Repair

General surgeons are the primary specialists who repair large ventral hernias, though plastic surgeons also perform these procedures with comparable outcomes, particularly in complex cases requiring component separation or panniculectomy. 1

Types of Surgeons Who Perform Ventral Hernia Repair

• General surgeons perform the vast majority (99.1%) of open ventral hernia repairs according to National Surgical Quality Improvement Program data 1
• Plastic surgeons perform a smaller percentage (0.9%) but are often involved in more complex cases requiring additional procedures such as component separation (24.8% of plastic surgeon cases vs 5.3% of general surgeon cases) 1
• Both specialties have comparable outcomes after adjusting for case complexity and patient factors 1

Surgical Approaches for Large Ventral Hernias

• Laparoscopic repair may be performed for incarcerated hernias without strangulation or need for bowel resection 2
• Open pre-peritoneal approach is preferred when strangulation is suspected or bowel resection is needed 2
• Component separation technique is a useful and low-cost option specifically for large midline abdominal wall hernias 2
• Conventional component separation with retromuscular mesh repair is considered the "workhorse" operation for giant ventral hernias 3

Defining Large/Giant Ventral Hernias

• Giant ventral hernias are typically defined as those larger than 10 cm with loss of domain (hernia contents can no longer be accommodated within the abdominal cavity) 4
• A hernia volume greater than 30% of abdominal volume is considered a defining characteristic by most surgeons 4
• These large defects require specialized management and surgical expertise 3, 4

Complexity and Considerations for Large Ventral Hernias

• Large ventral hernia repairs are technically challenging and should be performed by experienced surgeons in centers accustomed to caring for patients with significant comorbidities 3
• Preoperative assessment should include abdominal CT scan (98% of surgeons recommend), functional respiratory testing (71%), and cardiology consultation (50%) 4
• Preoperative medical optimization is crucial for successful outcomes in these complex cases 3
• Recurrence rates range from 10-30% and wound complication rates can be as high as 40-50% even in experienced centers 3

Mesh Selection Based on Surgical Field

• In clean surgical fields, prosthetic repair with synthetic mesh is recommended for better outcomes and lower recurrence rates 2
• For contaminated or dirty fields (bowel necrosis/perforation), primary repair is recommended for small defects (<3 cm), while biological mesh may be used for larger defects 2
• The choice between cross-linked and non-cross-linked biological mesh should be based on defect size and degree of contamination 2

Complications and Long-Term Outcomes

• With each subsequent hernia repair, complications increase, creating a cycle of repair, complications, reoperation, and re-repair 5
• At 140 months follow-up, 37% of primary ventral hernias and 64% of incisional hernias recur, with the highest recurrence rates (73%) seen after third or more repairs 5
• Careful patient selection and optimization are essential to minimize complications and improve outcomes 6