Surgery for abdominal hernia

The anterior abdominal wall has several anatomically weak areas: the inguinal region, the umbilical ring and the white line of the abdomen. In these zones, one can observe such a pathological process as a hernia. The protrusion of the internal organs under the skin and into the adjacent cavity occurs under the action of high pressure against the background of muscle weakness.

These factors are the main causes of ventral hernias in young children, adults and the elderly. Education on the abdomen requires surgical treatment, otherwise the pathology is complicated by conditions such as inflammation, infringement, necrosis, coprostasis.

The operation on the abdominal hernia is performed as planned, surgery offers an open method and laparoscopy for this, and the choice of technique will depend on the severity of the disease and the patient's condition. The postoperative period is even more important for recovery, and after the abdominal wall defect has been removed, the treatment is just beginning.

All operations to remove a hernia have their own contraindications and risks, therefore, before choosing a technique, the surgeon prescribes a comprehensive examination and thorough preparation is carried out, including the sanitation of foci of infections, bowel cleansing and the selection of conservative therapy options in the postoperative period.

Why do you need surgery for a hernia

An operation to remove an abdominal hernia is prescribed for everyone without exception, because no method of non-surgical treatment can lead to the closure of an abdominal wall defect. It is important to operate the patient in order to return the organs to their place, followed by suturing the hernial ring, which can be closed by the patient's own tissues or a mesh implant.

Gymnastics, diet, bandage and medications are already a measure after the removal of the hernia, when the body is restored.

Even useful physical activity will not contribute to the elimination of a hernia, but on the contrary, it can become a factor in the infringement of organs. Exercise therapy will be prescribed after surgery to remove the formation to strengthen muscles in order to prevent relapse. As for the bandage, it also harms with a hernia, but it is needed as a restraint to prevent even more of the organ from coming out under the skin.

A special belt does not heal, it helps to reduce the load on the abdominal muscles before and after the operation. Dietary nutrition is important at any period of the disease, because the state of the gastrointestinal tract depends on the quality of the products and the frequency of food intake, and this directly affects the symptoms of a hernia. It is important to prevent bloating, constipation and diarrhea, all those phenomena that increase pressure inside the abdominal cavity and affect well-being.

Only after removal of the hernia of the abdomen, the risk of complications from the stomach and intestines is reduced, because being in the hernial sac, these organs can be infringed at any time, which will lead to their death with the need for urgent excision of the affected tissues.

How is the removal of a hernia of the abdomen

There are several hundred methods of hernia repair, but all of them can be grouped into three groups:

1. Plastic surgery with own tissues.
2. Laparoscopic plasty.
3. Stretch-free plastic.

Plasty with the patient's own tissues involves suturing the hernial orifice with muscles, fascia, and aponeurosis. Access to the hernia is made through a wide incision - 8-10 cm, therefore, after the operation, a cosmetic defect remains in the form of a scar. This variant of hernia repair has many disadvantages. Recovery after stretch plastic surgery lasts several months, and the entire period of rehabilitation is prohibited from increasing the load.

The operation in 3-15% of cases ends with a recurrence or the development of a postoperative hernia, which is also associated with a wide scar, which can become a hernial ring.

Laparoscopic hernioplasty is performed under general anesthesia with constant video monitoring. The operation is performed from inside the abdominal cavity, and access is created through small punctures (2 cm). Three incisions on the abdominal wall are needed to insert the camera and special instruments for excision of tissues, their suturing and fixation of the mesh implant. Such an operation can only be carried out as planned, when there are no contraindications to general anesthesia. The main advantage of the technique is the ability to simultaneously eliminate concomitant pathologies of the abdominal cavity.

The postoperative period after laparoscopic surgery is relatively short, the wounds heal quickly, there are no wide scars, the risk of recurrence is almost completely excluded.

Tension-free plastic surgery or Lichtenstein surgery is a way to close a hernial ring with the installation of a synthetic implant. Due to the absence of tension during the rehabilitation period, the pain syndrome is weak, the risk of recurrence is lower than when the defect is sutured with natural tissues. This operation can be performed both under local anesthesia and under general anesthesia. Elective hernioplasty is performed on an outpatient basis, the patient returns home the very next day, and can return to physical labor in a few weeks.

In the last decade, tension-free hernioplasty has gained great popularity, which is due to a number of advantages: rapid recovery, absence of pain, minimal risk of recurrence.

Indications and contraindications

A hernia of the abdomen is dangerous not only for health, but also for life. Protrusion of organs under the skin in adults and children can be asymptomatic for a long time, and only a slight swelling in the abdominal wall is visible, which does not bother. A latent disease is even more dangerous, because at any time under the influence of a high load, infringement can occur.

A hernia is an indication for a planned operation, but there are conditions in which the immediate help of a surgeon is needed.

Emergency surgery is performed for complications, for which the following symptoms are typical:

• sharp pain in the abdomen, hardness and tension of the abdominal wall;
• nausea with vomiting, discharge of blood with vomit;
• lack of bowel movements or diarrhea with blood in the stool;
• absence of a cough impulse, non-reduction of protrusion;
• a sharp deterioration in well-being, pallor of the skin, tachycardia;
• general malaise, intense thirst, increased sweating.

Each operating technique has relative contraindications. When the hernia becomes complicated, the surgeon correlates the degree of danger of the condition and the potential harm of the operation, making a decision to save the patient's life.

Planned hernia repair requires preparation:

• abstaining from alcohol a week before surgery;
• refusal of medicines for 2 weeks;
• refusal to eat from the evening before the operation;
• treatment of associated pathologies of the gastrointestinal tract;
• vitamin therapy 2 weeks before surgery.

Hernia repair is tolerated in case of a cold, with infectious diseases in the acute stage, during pregnancy. The operation can be carried out 14 days after recovery, except for emergency indications.

Complications

After removal of the hernia, there is mild soreness for several days. The patient is concerned about discomfort during movement, there are difficulties when walking, bending over and squatting. Unpleasant sensations completely disappear after 7-14 days, subject to the rehabilitation regimen. Residual symptoms can bother up to two months, which is also the norm.

If after the operation there is pain for a long time, inflammation of the wound occurs, the condition worsens, this indicates the addition of complications.

Possible complications after surgery and their prevention:

1. Local - inflammation, necrosis, abscess, ischemia, phlegmon, hematoma. Prevention - compliance with the rules of asepsis during the operation, planned treatment of the wound after hernia repair, the use of antiseptics.
2. Common - thromboembolism, pneumonia, compartment syndrome. Prevention - a comprehensive examination before surgery, treatment of infectious pathologies, restorative therapy, taking antibacterial agents.

Postoperative rehabilitation

In the early period after surgery (the first 2 weeks) there are a number of restrictions and rules:

• before removing the stitches, you need to go for dressings and follow all appointments;
• it is important to take laxatives to prevent constipation;
• a strict diet and diet are observed;
• physical activity, weight lifting, forward bending are excluded;
• you need to maintain weight after surgery for six months, otherwise there is a risk of suture divergence.

The first weeks after hernia repair are the most difficult, because there are many factors that can lead to increased intra-abdominal pressure and suture divergence. To minimize risks, it is important to exclude respiratory tract damage, stop smoking, and avoid inhaling dust, pollen and other irritants.

After a planned operation, bed rest is not needed.

The patient is discharged from the hospital the next day and can move independently, take care of himself, eat and drink as usual with only minor changes. Already on the 3rd day after hernia repair, you can leave the house, take walks, do light physical work, but only in a postoperative bandage.

Diet

The diet after surgery is selected to eliminate bloating and constipation. You need to eat in the early period of rehabilitation in small portions several times a day. Particular attention should be paid to the diet with excess weight, because obesity is a risk factor for the development of abdominal hernia.

The goal of dietary nutrition will also be to reduce the load on the intestines, which puts more pressure on the area of ​​​​the operation than other organs. The main emphasis in nutrition is on boiled and steamed dishes.

Heavy foods should be excluded: fatty meat, mushrooms, legumes, cabbage. Portions should be small, but you need to eat at least 5 times a day.

After hernia repair, low-fat soups, vegetable purees, milk porridges, vegetable salads are recommended. From the liquid it is better to drink clean water, and do this half an hour before eating. Compotes, weak green tea with honey, jelly will be useful. In no case should you drink sweet carbonated drinks, strong coffee, alcohol. A therapeutic diet is prescribed by a doctor, and it must be strictly followed, regardless of how you feel.