Treatment strategies for ventral hernias

	Patient health state	Quality of life	Hernia complexity	Risk of acute presentation
Expectant management	Irreversible advanced disease state such as advanced cirrhosis or cancer	Oligosymptomatic or asymptomatic	Complicated ventral hernia with multiple prior recurrences or loss of domain	Minimal
Medical optimization	Potentially reversible, such as obesity, current smoker, poorly controlled diabetes	Quality of life impaired by both hernia and modifiable conditions	Active infection such as enterocutaneous fistula or mesh infection	Risk of acute presentation may be present but is outweighed by benefits of optimization
Surgical repair	Risks of surgery acceptable at patient's current state of health	Symptomatic	Varies	Bowel-containing, history of bowel obstruction, or large hernia sac to defect size ratio, defect size 3 to 4 cm^[1]

Reference:

Sneiders D, Yurtkap Y, Kroese LF, et al. Risk factors for incarceration in patients with primary abdominal wall and incisional hernias: A prospective study in 4472 patients. World J Surg 2019; 43:1906.

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