Diagnosing Ventral Hernia? What tests should a doctor preform?

A hernia is a true defect of the abdominal wall typically with very discreet edges often associated with an incision. The diastasis is more broad based.

In most cases, it is relatively straight forward to differentiate between a diastasis and a true hernia based on physical examination. Exceptions are patients who are significantly overweight or have had multiple prior surgeries. In those cases a CT scan is the best way to identify a ventral hernia.

Usually hernias can be diagnosed on physical exam.  In heavier patients, or those with prior abdominal surgeries I will often obtain a CT scan of the abdomen as a "roadmap" for surgery and also to define the extent of the defect and reveal any other areas of weakness that may also exist.

A rectus diastasis is simply separation of the rectus abdominis muscles away from the midline- the 'bridge' between the two muscle bundles is a thin band of connective tissue which can bulge. This is not a true hernia, since there is no 'hole' in the connective tissue of the abdominal wall. Such a hole can allow abdominal contents (fat, bowel etc) and  to enter- this is a hernia sac. The contents of a hernia sac can be entrapped, strangulated, or can just progressively enlarge over time. A rectus diastasis poses no risk of entrapment, and is therefore not considered a diagnosis covered by insurance companies.

Mr. Glass

The best way to diagnose a ventral hernia is through physical exam.  The surgeon can feel the edges of the ventral fascial defect.  Another way to make this diagnosis is through a CT or MRI scan of the abdomen - demonstrating a herniaton of abdominal contents through the ventral fascia.

A hernia is an actual hole in the fascia and muscle. I examine my patients for a hernia, while they stand. Also, sometimes a CT scan is helpful to measure the size of the hernia and evaluate the muscles.

In our practice, we perform tummy tucks in patients of all shapes, sizes, and walks of life. Many of our patients have a separation between their abdominal muscles or even a ventral hernia. During the initial consultation, we carefully examine the abdominal wall of every patient to look for separations, weaknesses, or defects in the abdominal wall such as a hernia. If the patient has a large hernia or if this hernia has recurred, it may be necessary to obtain the advice of a general surgeon who can repair this hernia at the same time that we perform a tummy tuck. It is essential to plan ahead for this as this may change the operative plan and the management of the umbilicus as well. Be sure that you are only working with a plastic surgeon that is board-certified by the American Board of Plastic Surgery and has a great deal of experience in abdominoplasty, liposuction, and body contouring.

A physical exam can usually differentiate a rectus diastasis from a hernia but in some cases, it is hard to tell. An ultrasound is one easy way to evaluate the abdominal wall. A CT scan may also be done but does involve radiation exposure (more of a concern in a woman of childbearing age and less so in a man).


If you are asking this to see if insurance will cover the repair, then documentation of a hernia may be needed. If you are going to have an abdominoplasty anyway, then you may not need to undergo the tests as a hernia would be obvious at the time of a tummy tuck and could be repaired by a Board Certified plastic surgeon. In such a situation, you may want to get an insurance prior authorization first so that the hernia repair (if found at the time of surgery) would be covered.
 

If you are looking to undergo a body contouring procedure (tummy tuck or body lift) in combination with a ventral hernia repair, your plastic surgeon can often detect a sizeable hernia on physical exam.  If you have a very thick abdominal wall, a CT scan may help determine the presence, size, and location of the hernia.   However, It is not uncommon to encounter a small (<5 cm) ventral hernia during a tummy tuck or body contouring procedure.  This can be safely repaired by the plastic surgeon during your contouring procedure.

If you are simply looking for ventral hernia repair without a body contouring procedure, I would recommend a laparoscopic surgeon to evaluate and work you up for a minimally invasive ventral hernia repair, which will allow for a quicker recovery with less downtime.

All the best in a safe recovery.

 

Paul S. Gill, M.D.

Gill Plastic Surgery

Houston Double Board Certified Plastic Surgeon

A hernia is a defect in the abdominal wall that allows passage of  the contents of the abdomen to pass. If bowel or omental fat get in the hernia it can cause pain. If the contents of the hernia do not go back in they can lose their blood supply and cause a surgical emergency.

Frequently defects in the abdominal wall are repaired at the time of abdominoplasty. It is very common in body contouring after massive weight loss.

Insurance will not cover your abdominoplasty because of a hernia but I do not charge extra if I repair it in the course of an abdominoplasty simply because it needs to be done. They may pay a general surgeon to repair a hernia separately if it is done at the time of abdominoplasty but I would check with your insurance carrier first.