Causes and methods of treatment of postoperative abdominal hernia

Postoperative hernia of the abdomen is a pathological protrusion of the abdominal organs in the area of the surgical scar. This pathology can occur immediately after surgery or after several months or even years, as a delayed complication. In each case, removal of a postoperative abdominal hernia is required, followed by a number of preventive measures.

Ventral protrusion is a common consequence of the removal of an umbilical or inguinal hernia, but an ailment can also occur after surgery for any other disease. For the formation of pathology after surgery, certain conditions are needed that could cause a hernia without surgery.

The disease is often combined with other complications, and can be life threatening. Ventral hernias more often than others can reach gigantic proportions, accommodating the stomach, omentum and several intestinal loops.

Why does a ventral hernia appear?

There are two key factors in the development of a hernia of the abdominal cavity after surgery:

1. Seam divergence.

The surgeon during the operation may make a mistake, make a rough seam. Poor-quality suture material causes tissue divergence, and the omentum and part of the intestine exit through the hole formed.

The divergence of the seam can also happen through the fault of the patient.

You need to take care of the postoperative wound, change the dressings so that there is no infection and suppuration. In the early period after surgical treatment, high loads on the muscles of the abdominal wall should not be given, which can provoke a violation of the suture and the appearance of a hernia. Many surgeons believe that such a consequence of the operation as a ventral hernia occurs only in the case of a predisposition that already existed before the surgical intervention.

2. Congenital or acquired muscle weakness.

This factor is especially often observed in overweight people, a sedentary lifestyle and congenital diseases of the musculoskeletal system. With obesity, the muscles are weakened, they are replaced by adipose tissue, which fuses much more slowly after surgery. An increase in pressure and load do not contribute to the normal healing of tissues, therefore there are all conditions for the formation of a postoperative hernia.

Risk factors

Predisposing factors for the appearance of a ventral hernia are:

bloating;
frequent constipation;
chronic cough;
pathology of the respiratory system;
fluctuations in intra-abdominal pressure.

After abdominal surgery, it is important to follow preventive measures, including diet, daily routine and exercise. If, however, immediately after surgery, return to the usual way of life, this can lead to poor healing of the scar, and physical activity and overeating will contribute to the weakening and divergence of the muscles.

Diseases and conditions that provoke the development of a hernia of the abdomen after surgery:

chronic pancreatitis;
intestinal obstruction;
cachexia and obesity;
transferred difficult childbirth;
period of pregnancy;
diabetes;
bronchitis, pneumonia.

Signs of the disease

The first manifestation of the disease is a protrusion in the area of \u200b\u200bthe scar of a round or oval shape. At first it is hardly noticeable, but then more elements appear in the hernial sac, the hernia gradually increases and without treatment can reach gigantic sizes - more than 40 cm.

The symptoms of a postoperative hernia without concomitant disorders do not differ from the usual protrusion, but when there are other complications, the clinical picture is supplemented by a number of specific manifestations.

With ventral hernia, pain in the abdomen of varying intensity always worries. Unpleasant sensations are aggravated during movement, when coughing and increasing the load. This will be an important diagnostic sign when the patient is overweight and the protrusion is not visually determined.

With a hernia, nausea, vomiting, general weakness can be disturbing, but these are non-specific signs that can indicate several diseases at the same time, therefore research is always carried out.

Dangerous symptoms of complications may occur, then you need to urgently consult a doctor:

pallor or blueness of the skin;
nausea with frequent vomiting;
increasing pain in the abdomen;
pre-fainting state.

With a hernia of the abdomen, a complication such as peritonitis can occur. Inflammation of the abdominal cavity occurs due to strong compression of the organs, then necrotic processes begin, the infection spreads to neighboring tissues.

The following symptoms are characteristic of peritonitis:

tension of the abdominal muscles, hardness of the abdominal wall;
diffuse pain in the abdomen;
decrease or complete absence of peristalsis;
strong thirst, dryness of the mucous membrane;
repeated vomiting.

In addition to peritonitis, intestinal obstruction may develop, as evidenced by the absence of stools, constant nausea, a sharp deterioration in well-being, acute abdominal pain, and rumbling. Any symptom should be taken into account and serve as a reason for the examination.

Hernia Research

The surgeon is responsible for the diagnosis and treatment of a hernia. The doctor examines the abdominal cavity, sees an asymmetrical protrusion in the area of the surgical scar. When pressed, the formation is reduced into the abdominal cavity, and also disappears in the supine position.

Diagnostics is complex and may include the following methods:

magnetic resonance imaging - allows you to assess in detail the contents of the hernial sac and surrounding tissues, by MRI the size of the formation and the organs affected by the pathological process are determined;
esophagogastroduodenoscopy;
colonoscopy.

How is an incisional hernia treated?

Treatment of ventral hernia is only surgical. Removal of the formation is carried out by the method of tension or tension-free plastics. If other types of hernias can still be maintained for a long time by conservative methods, then the postoperative form of the disease requires prompt surgical treatment.

Removal of a hernia of the abdomen is carried out by several methods:

Plastic surgery with own tissues . Sewing of the hernial orifice is carried out with the patient's tissues without fixing additional implants. This method is used less frequently than others, it has many contraindications and a high risk of relapse.
With the installation of a mesh implant. The defect is sutured using a special mesh, which is sutured to the tissues in the area of the hernial ring. The endoprosthesis grows together with the tissues, protecting the wall of the abdominal cavity from re-protrusion.
Laparoscopic hernioplasty. Access to the hernial sac is created through 3 punctures in the abdomen. Instruments and a camera are inserted through the holes, the abdominal cavity is preliminarily filled with gas. This method allows you to remove the hernia, install a mesh implant with a minimal risk of postoperative complications and without wide scars.

Conservative approach to therapy

Treatment without surgery is appropriate only if there are contraindications to hernia removal and preparation for hernia repair is underway. Conservative therapy includes dieting, wearing a bandage, avoiding physical activity, and taking symptomatic medications.

What to do to prevent complications before surgery:

normalize weight, which reduces the load on the abdominal wall and helps strengthen the muscles by reducing the fat layer;
avoid muscle tension, do not lift weights;
timely treat pathologies of the respiratory system and gastrointestinal tract in order to exclude factors that increase intra-abdominal pressure (cough, constipation, bloating);
wear a support bandage while doing daily activities.

Rehabilitation conditions after removal of a postoperative hernia of the abdomen:

creation of conditions for normal healing of the surgical scar;
prevention of infection of the wound;
exclusion of accidental injuries and increased pressure inside the peritoneum;
regular examination, ultrasound or MRI.

Complications

After any operation there is a risk of complications. The risk group includes patients with complicated hernia and concomitant diseases of the gastrointestinal tract.

What complications are possible after removal of the ventral hernia:

infringement - clamping of organs in the area of the hernial orifice or sac, which is accompanied by ischemia and tissue death, in addition to impaired bowel function, inflammation occurs, there is severe pain, a state of shock develops, immediate medical attention is needed;
coprostasis - stagnation of stool in the part of the intestine contained in the hernial sac, a condition of dangerously slow poisoning of the body, then inflammation occurs, infection of the hernial sac, which is more often observed in older people;
peritonitis - occurs due to perforation of the organ in the hernial sac, manifested by acute pain, nausea, tension in the muscles of the peritoneum, an imaginary relief of the condition for several hours.

The risk of complications will depend on the size of the hernia. There are small, medium, large and giant. In the latter case, the formation reaches more than half a meter and simultaneously occupies several areas of the abdominal cavity.

Postoperative hernia can be reducible and irreducible. The urgency of the operation will depend on this sign. An irreducible hernia has a higher risk of complications, including strangulation. Reducible hernias are not so dangerous, they return to their place in the supine position, while the organs are not compressed, the function is minimally impaired.

Any hernia of the abdomen requires surgical treatment, regardless of the severity of the manifestations and the results of the research. By postponing hernia repair, one can only bring closer the time for the development of complications, when an urgent operation is already required.