Ventral/Incisional Hernia · Repair Approach

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Emergency? + defect size/complexity
   Incarceration/strangulation? Defect size/recurrent?
   • Incarceration/strangulation (bowel obstruction/peritonitis) → Incarceration/strangulation → emergency surgery
   • Small defect (<2–4 cm), asymptomatic or mild → Small defect → observe/mesh
   • Medium defect → Medium → mesh repair
   • Large/complex (wide defect, recurrent, loss of abdominal domain) → Large/complex → component separation + mesh
2. [End] Incarceration/strangulation → emergency surgery
   Incarceration/strangulation → emergency surgery, assess bowel viability (resect if needed); in a contaminated field choose mesh carefully (biologic/absorbable mesh or delayed repair).
3. [End] Small defect → observe/mesh
   Small defect/asymptomatic umbilical hernia → observe (if asymptomatic) or elective repair; small defects usually use mesh (better than suture alone, lowers recurrence), very small may have suture repair.
4. [End] Medium → mesh repair
   Medium defect → mesh repair (open or laparoscopic/robotic); retromuscular/preperitoneal mesh placement (Rives-Stoppa) is durable with fewer infectious complications.
5. [End] Large/complex → component separation + mesh
   Large/complex/recurrent/abdominal wall insufficiency → component separation + mesh (retromuscular/bridging); preoperative weight loss, smoking cessation, glycemic control; for giant hernias, botulinum toxin/progressive pneumoperitoneum may help.

Source guidelines & references

• Ventral/incisional hernia repair (EHS guidelines; Rives-Stoppa retromuscular mesh; component separation)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

Other pathways