Management of Ventral Hernias

Emergency vs. Elective Repair Decision

Patients with suspected intestinal strangulation require immediate emergency hernia repair, as the timing of intervention directly impacts mortality and morbidity, according to the World Journal of Emergency Surgery 1
Immediate repair is mandatory when intestinal strangulation is suspected, systemic inflammatory response syndrome (SIRS) is present, or there are signs of bowel compromise, as stated by the World Journal of Emergency Surgery 1
Elevated white blood cell count with fibrinogen elevation is independently predictive of strangulation and associated with higher morbidity, as reported by the World Journal of Emergency Surgery 2

Laparoscopic repair is the preferred approach for ventral hernias in stable patients without signs of strangulation or need for bowel resection, representing the gold standard with superior outcomes, according to the World Journal of Emergency Surgery 2 and the World Journal of Emergency Surgery 1
The American College of Surgeons recommends laparoscopic repair for incarcerated hernias without strangulation, as stated by the World Journal of Emergency Surgery 2 and the World Journal of Emergency Surgery 1

Synthetic mesh repair is strongly recommended for all ventral hernia repairs in clean surgical fields, providing the lowest recurrence rates without increasing infection risk, as stated by the World Journal of Emergency Surgery 1
Synthetic mesh can be safely used in patients with intestinal strangulation and/or bowel resection without gross enteric spillage, significantly lowering recurrence risk without increasing 30-day wound-related morbidity, according to the World Journal of Emergency Surgery 1
Primary repair is recommended when defect size is small (<3 cm); biological mesh should be used when direct suture is not feasible, as reported by the World Journal of Emergency Surgery 1 and the World Journal of Emergency Surgery 5

Open management is mandatory for unstable patients with severe sepsis or septic shock to prevent abdominal compartment syndrome, as stated by the World Journal of Emergency Surgery 1 and the World Journal of Emergency Surgery 5
Intra-abdominal pressure should be measured intraoperatively in unstable patients, according to the World Journal of Emergency Surgery 1 and the World Journal of Emergency Surgery 5

Local anesthesia can be safely used for emergency inguinal hernia repair in stable patients, providing less cardiac complications, fewer respiratory complications, shorter ICU and hospital stays, lower costs, and faster recovery compared to general anesthesia, as reported by the World Journal of Emergency Surgery 1
General anesthesia is mandatory when bowel gangrene is suspected, intestinal resection is needed, or peritonitis is present, according to the World Journal of Emergency Surgery 1

All patients should undergo medical optimization before elective surgery to minimize perioperative risk, as stated by Praxis Medical Insights 3
Optimizing patient-related risk factors (obesity, diabetes, smoking, immunosuppression) is essential to decrease complication rates, according to the World Journal of Emergency Surgery 5

Never use mesh in dirty fields with unstable patients, as this leads to catastrophic complications, as reported by the World Journal of Emergency Surgery 1 and the World Journal of Emergency Surgery 5
Never delay emergency repair when strangulation is suspected, as mortality increases exponentially with delay, according to the World Journal of Emergency Surgery 1