Treatment of Incarcerated and Strangulated Ventral and Incisional Hernias

Ventral and incisional hernias are commonly encountered in general surgical practice today. These range in complexity and acuity with the incarcerated or strangulated hernia presenting a challenge in management. The true rate of the hernia “accident” with bowel obstruction or ischemia is difficult to ascertain, yet this must be discussed with the patient presenting with a reducible or chronically incarcerated ventral/incisional hernia. The decision making encompasses the timing of repair for the reducible or largely asymptomatic chronically incarcerated ventral hernia, preoperative risk modification, potential for mesh contamination, and the risk of hernia recurrence. The impact of these surgical decisions is amplified in the emergent setting with an acutely ill patient. There are many options for repair at the surgeon’s disposal. Thoughtful consideration of the advantages and disadvantages of each and the patient’s desires and expectations are central to the success of repair.