REVIEW ARTICLE Evolution of ventral hernia repair Jose Macario Faylona Department of Surgery, University of the Philippines College of Medicine, University of the Philippines-Manila, Manila, Philippines Keywords: Hernia; history; ventral Correspondence Jose Macario Faylona, Department of Surgery, Philippine General Hospital, Taft Avenue, Manila 1000, Philippines. Email mackymd@yahoo.com Received 3 March 2017; revised 3 May 2017; accepted 6 May 2017 DOI: 10.1111/ases.12392 Abstract Purpose: The aim of this review was to look at relevant data and research on the evolution of ventral hernia repair. Methods: Resources including books, research, guidelines, and online articles were reviewed to provide a concise history of and data on the evolution of ventral hernia repair. Results: The evolution of ventral hernia repair has a very long history, from the recognition of ventral hernias to its current management, with significant contributions from different authors. Advances in surgery have led to more cases of ventral hernia formation, and this has required the development of new techniques and new materials for ventral hernia management. The biocompatibility of prosthetic materials has been important in mesh development. The functional anatomy and physiology of the abdominal wall has become important in ventral hernia management. New techniques in abdominal wall closure may prevent or reduce the incidence of ventral hernia in the future. Conclusion: The management of ventral hernia is continuously evolving as it responds to new demands and new technology in surgery. Introduction “Ventral hernia” is defined as a protrusion of loops of intestine, fat, or fibrous tissue through a defect or weakened region of the abdominal wall. The protrusion may involve, for example, preperitoneal fat, intestinal contents, or omentum. Ventral hernia may be congenital or acquired (1). Acquired ventral hernia is usually due to a previous laparotomy and is also synonymous with incisional hernia. Patients have a 2%–20% risk of developing an incisional hernia after laparotomy (2–6). Several factors have been identified that may contribute to the development of an incisional hernia. These factors may be divided into surgeon factors and patient factors. Patient factors include high BMI, smoking history, history of malignancy, and medical comorbidities such as diabetes, pulmonary diseases, and connective tissue disorders (7). Surgeon factors pertain to the laparotomy closure technique, the choice of suture material, and the surgeon’s experience. Some of these factors can be controlled and some cannot. History of Ventral Hernia The anterior abdominal wall was first described in the 16th century B. C. E. in the Ebers Papyrus, which discussed the possibility of an epigastric hernia. The treatment was heat applied to the hernia to imprison the illness in the patient’s belly (8). Subsequently, authors proposed several techniques in abdominal wall closure. Celsus 100AD described the technique of closure of the abdomen by layers (9). Galen 200AD described mass closure of the abdominal wall (10). The 17th and 18th centuries brought new developments in ventral hernia repair. Beatus Ignatius La Chausse first defined ventral hernia as any hernia that is not inguinal, umbilical, or femoral (11). The first documented surgery for incisional hernia was performed by Pierre Nicholas Gerdy, who completed the surgery by inverting the Hernial sac through the hernia into the abdominal cavity that includes the skin. He then sutured the edges together and injected ammonia into the sac to cause adhesions (12). During the start of modern era of surgery, Lister and Morton discovered concepts of antisepsis and anesthesia, respectively (13,14). These advances improved survival after surgery, but more cases of incisional hernia were seen (15). Therefore, management of incisional hernia became a concern for surgeons. Management Options in Ventral Hernia As rates of ventral hernia formation increased, different authors proposed several approaches, including a simple Asian J Endosc Surg •• (2017) ••–•• © 2017 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd Asian J Endosc Surg ISSN 1758-5902