ABSTRACT
This chapter reviews the evolution of ventral hernia surgery over the last 150 years, describes its impact on patients and explains why they should be repaired in the context of a worldwide increasing prevalence. It discusses the concepts around hernia aetiology including herniosis, taxonomy and classification and the difficulties with the concept of complexity. Larger ventral hernias, often with multiple abdominal wall defects, are presenting to the general surgery clinic. If patients do not undergo repair, the hernia enlarges either resulting in an emergency operation due to bowel strangulation or obstruction, or leading to chronic morbidity. Ventral hernia repair is becoming increasingly complex, due in part to the rising prevalence of obesity, advancing age and the high recurrence rates after repair, as each subsequent hernia repair becomes increasingly challenging. If the hernia is reduced in the emergency department it can be managed in the standard fashion with a scheduled repair.
