Do you fix Ventral Hernias like Inguinal Hernias? Are they the same?

My patients often ask what is the difference between an Inguinal and Ventral hernia, and they are confused that the repair in one is usually laparoscopic while the other is in an open fashion. Let’s start with the difference. A Ventral Hernia is a hernia anywhere on the abdominal wall, and although this may include the inguinal area, usually only best refers to hernias which are above the inguinal area, and usually in the midline of the abdomen. Hernias that fall under this category are umbilical (belly button), upper midline (epigastric), and incisional (hernia that forms from a prior surgical incision; ie you had an appendectomy as a kid, and a hernia formed through the scar). 

Inguinal hernias, due to the specific anatomy and location, are the most common hernias, and mostly seen in males (90%). They are usually fixed best by laparoscopic method, in a preperitoneal fashion (TEPP), for reasons listed in other sections of this website. Ventral hernias are not in the inguinal area, and have a different anatomy, and therefore a different repair. Depending on the hernia, the body habitus, and the forces at work on the abdominal wall, the surgeon may choose either an open repair or a laparoscopic repair, all of which may or may not use mesh. Therefore, where the inguinal hernia repair recommendation is usually straightforward, the ventral hernia repair is not as standard.