Causes and treatment of ventral hernia

What is a ventral hernia? This is a surgical pathology, which is characterized by pathological protrusion of internal organs in the postoperative period. Such a protrusion is formed in the area of ​​​​the scar, which remains after the operation. Ventral hernia after surgery occurs on average in 11-20% of all patients who have recently undergone surgery. In half of the patients, postoperative hernia is observed in the first year after treatment, in the second half - within two to five years.

Often, a ventral hernia forms almost immediately after removal. In this case, they speak of a recurrence of bulging.

There are several features of this bulge, such as a large size, a direct relationship with the size of the scar (the larger the scar, the larger the hernia). The likelihood of a protrusion is higher if the operation was performed urgently.

Causes

There are various factors that contribute to the formation of postoperative hernia.

These include:

1. Heredity . This category includes various diseases of the connective tissues of the body - dysplasia or abnormal development. With congenital weakness of ligaments, tendons and other strengthening systems, the likelihood of developing a hernia increases several times.
2. Ignoring the assigned mode . In the postoperative period, adherence to the mode of stay in the ward and diet are of great importance. It should be remembered that the surgical suture is not only an external skin defect, it is also a tool that contributes to the speedy healing of the wound.
3. Violation of tissue regeneration in the wound area . This phenomenon is facilitated by the layering of the infection, as a result of which inflammatory processes and suppuration of the wound area develop. The wound does not heal, which creates the conditions for re-excretion of the hernia.
4. background diseases. This includes diseases that are accompanied by symptoms such as coughing, sneezing, constipation, or increased gas production. All these points increase intra-abdominal pressure - the main chain in the pathological process of hernia formation.
5. Medical errors during the operation, namely: incorrect implementation of the wound suturing technology.
6. Obesity . Excess body weight has two negative factors: the presence of a large amount of adipose tissue increases intra-abdominal pressure and prevents normal blood flow, which inhibits the supply of nutrients.

Classification of ventral hernias

Types of postoperative hernias are usually divided according to their size.

This classification was introduced by the surgeons Toskin and Zhebrovsky:

1. Small - occupies any area, which practically does not change the configuration of the organs and the affected area. Basically, such hernias are detected by chance during ultrasound or by palpation.
2. Medium - a hernia of medium size can be seen with the naked eye. Outwardly, they stick out a little.
3. Extensive - almost completely occupies the cavity in which it is located, partially deforming it.
4. Giant - such a hernia occupies two or more cavities at once, greatly changing their configuration.

In addition, ventral hernia has several more types:

• the width of the hernia gate is up to 5 cm;
• from 5 to 10cm;
• from 10 to 15cm;
• 15cm or more.

Symptoms of a ventral hernia

The leading sign of a postoperative hernia is the appearance of a tumor-like formation at the site of the scar. In the first time after the operation, the protrusion is completely reducible (in a horizontal position, the hernia can be reduced on its own), and it does not cause pain. Pain at the site of damage appears only with sudden movements, lifting various weights.

If the patient ignores such signs, then with the development of the disease, the hernia becomes painful, sometimes the pain syndrome has a cramping type. In addition to discomfort at the site of the scar, the patient may complain of severe bloating, constipation, belching, nausea and sometimes vomiting - dyspeptic symptoms.

You should know that the clinical picture depends on the location of the hernia.

Postoperative hernia of the anterior abdominal wall suggests the presence of pain in the peritoneum. Most often, the stomach, intestines, large or small omentum are involved in this process. Abdominal hernia is associated with symptoms such as nausea, vomiting, and constipation. A protrusion in the groin area entails disorders of the genitourinary system: difficult urination, pain in the groin area, in men there are erectile dysfunction, decreased libido, in women - violations of menstruation cycles.

In addition to specific symptoms, there are common signs: redness of the skin, fever, irritability, rapid exhaustion, low mood.

Strangulated postoperative ventral hernia

Strangulated ventral hernia is a complication that is characterized by a sudden dysfunction of the organs located in the hernial sac against the background of their strong sudden compression. This condition is associated with a further violation of local blood circulation, which sooner or later leads to tissue necrosis. Any hernia can undergo such a complication: in 60% - inguinal, in 25% - femoral, in 10% - umbilical. The rest - a hernia of the white line of the abdomen, esophagus.

The infringement itself is formed due to a strong increase in pressure in the cavity where the organs are located. The latter, under the influence of the buoyancy force, are driven into the bag. The strangulated organs cannot come out backwards, since the hernial ring does not have the appropriate diameter.

This complication requires immediate surgical intervention. Patients with infringement are urgently delivered to the surgical department, where treatment is carried out. A strangulated hernia is dangerous in itself, as it provokes the development of many complications, such as intestinal obstruction, tissue necrosis. This condition is especially dangerous for older people.

Diagnostics

The study of the disease does not cause difficulties for specialists: the symptoms of a postoperative hernia are visible to the naked eye. Often, a visual examination alone is enough to make a preliminary diagnosis and begin treatment.

However, to clarify the nature of the disease, some diagnostic procedures are still necessary:

• ultrasound , which allows you to evaluate the parameters of the protrusion, its shape and the presence of adhesive processes;
• x-ray diagnostics , allowing doctors to study the state of functioning of the organs of the gastrointestinal tract, genitourinary system;
• magnetic resonance imaging is a method based on the phenomenon of magnetic resonance. It allows you to get detailed high-contrast images of the tissues of a sick person.

After the implementation of all the procedures, the doctors make the final diagnosis and begin therapeutic measures.

Treatment

Treat ventral hernia is necessary only surgical intervention. Without surgery, it is impossible to completely eliminate hernial pathology.

There are several types of surgery:

Tension hernioplasty.

Previously, this method was the only method in the treatment of protrusions. The course of the operation is as follows: the doctor performs a small skin incision, gaining access to the hernial sac. Next, the specialist opens the wall of the bag, examines the organs that are there and adjusts them to their anatomical location. After that, the surgeon successfully puts several sutures on the incision. But this is an old method, which entails a long rehabilitation period. In addition, the recurrence rate is considered high (with ventral hernias, the risk of recurrence is up to 50%). Tension hernioplasty gets its name from fixing the two edges of the wound with surgical sutures.

Tension-free hernioplasty.

The second method is a way to remove a hernia using synthetic implants. Often used for protrusions of the abdomen and groin. Tension-free hernioplasty is known for its low traumatization. During the operation, a polypropylene mesh is used, which over time becomes overgrown with the natural tissue of the patient.

Laparoscopic hernioplasty.

This technique is one of the newest, it is considered minimally invasive due to minimal damage to the body and a short rehabilitation period. The course of the operation: the doctor makes several punctures in the patient's tissues (the intervention is not carried out through a large incision), through which he inserts several thin tubes, on which miniature video cameras and flashlights are located for illumination. Advantages of laparoscopy: no external defect on the skin, low traumatization of internal organs, short recovery period.

Postoperative period

For a full recovery, the patient is advised to follow a diet and perform therapeutic exercises. The diet consists of fractional and frequent meals. The patient should not overeat, as the accumulation of food increases intra-abdominal pressure. Foods that increase gas formation are excluded from the diet. Most of all, it is recommended to take various cereals on the water without spices.

Therapeutic physical training is aimed at restoring the lost tone of the muscle corset, blood circulation. Also, exercise therapy helps to accelerate the regenerative processes in the body. Daily exercise returns the body to its former strength, partially improves immunity.