Treatment and prevention of postoperative hernia
Surgery on the abdominal organs in 25% of cases ends with the occurrence of a ventral hernia. This is a pathological condition in which there is a violation of the anatomical position of the abdominal organs. The latter move through the muscle defect under the skin. Postoperative hernia is a frequent phenomenon, and is associated with a violation of the integrity of the muscle aponeurosis.
Each patient tolerates surgery differently, and many factors affect the likelihood of a hernia, including the type of surgery.
Everyone can experience a postoperative hernia, including young children. Various complications and consequences of the operation may appear in the first days after the intervention or after several years. The divergence of the seams, the lack of a postoperative regimen, the violation of technique are some of the many factors in the appearance of a hernia after surgery to remove or debride the internal organs.
A hernia after surgery often occurs during an open intervention, but laparoscopic and endoscopic techniques almost completely eliminate the risk of such a complication.
If pathology occurs in the early and late period after the operation, the removal of the postoperative hernia is prescribed, and this is the only treatment option. Surgeons agree that such a violation as protrusion of organs is dangerous and is treated only by removal.
Symptoms of postoperative hernia may be absent for a long time, especially when the patient is overweight. Pathology occurs, regardless of the operated organ, whether it is an intervention for cholelithiasis, cholecystitis, peritonitis, ulcers and any other surgical disease, the consequences of the operation in 90% of cases are the same.
Often, a hernia appears after removal of the gallbladder, bile ducts and urgent intervention for protrusion of the abdominal organs.
Why does a hernia appear after surgery
The main cause of ventral hernia after surgery is the divergence of the tissues of the abdominal cavity and the violation of the surgical suture. This complication is almost always combined with other unpleasant consequences of the operation.
Risk factors in the appearance of postoperative hernia:
- rough seam, use of low-quality material;
- increased load on the abdominal muscles during the rehabilitation period;
- overeating, sports, frequent muscle tension;
- overweight, pregnancy;
- pathology of the gastrointestinal tract with constipation and bloating;
- respiratory diseases with frequent cough;
- decrease in body resistance, infectious diseases;
- atrophy of the muscles and ligaments of the anterior abdominal wall;
- suppuration of the postoperative wound;
- technical errors during the operation;
- non-compliance by the patient with the postoperative regimen.
Of great importance in the appearance of a hernia of the abdomen is a hereditary factor. Predisposing factors in this case will be connective tissue dysplasia and congenital muscle weakness. With such violations, the formation of a hernia after surgery occurs in almost everyone. When the patient has signs of dysplasia, the operation is performed only with the subsequent installation of a mesh implant.
Postoperative hernia occurs only in the area of the scar, that is, its normal healing is crucial in the appearance of the disease.
Violation of the scarring process is an equally common cause of a defect on the abdominal wall. Infection of the wound can occur with insufficient preparation of the patient for surgery or through the fault of the surgeon already during the operation. The inflammatory process and suppuration at times increase the risk of postoperative hernia.
Symptoms of a ventral hernia
It is not difficult to determine the ventral hernia, because it is manifested by a protrusion in the area of the scar. On the abdomen, a round formation up to 10 cm or more can be seen when it comes to large and giant ventral hernias.
Common symptoms of ventral hernia:
- pain in the area of education on the abdomen;
- reducibility of protrusion;
- reddening of the skin and a local increase in temperature.
An important symptom of a complication after surgery in adults is abdominal pain. It can be of different intensity and intensify during movement and when straining.
The patient is often concerned about constipation and bloating, less often nausea, vomiting, diarrhea, dyspeptic symptoms in the form of heartburn and belching occur.
A painful formation is palpated in the area of the scar. In the supine position, the protrusion may disappear, but it is especially clearly visible when the patient is standing. A hernia of the abdomen can be infringed, and in this case, all the symptoms increase, and the formation itself ceases to be reduced. Such a complication requires an immediate operation, but even after it the reappearance of the disease is not ruled out.
Types of ventral hernias
Clinical manifestations will also depend on the form of the ventral protrusion.
Classification of postoperative hernias:
| Classification criterion | Kinds |
| Localization | Middle and side |
| Size | Small - up to 4 cm; medium - up to 15 cm; large - up to 35 cm; giant - more than 35 cm. |
| Origin | Primary and recurrent |
| signs | Reducible, irreducible, single and multi-chamber, single and multiple, uncomplicated, restrained, perforated. |
Complications
Postoperative hernia is complicated by infringement and obstruction of the intestine. Coprostasis or stagnation of stool appears due to compression of the intestinal loop in the hernial sac. This complication ends with perforation of the mucosa and the release of the contents of the intestine into the abdominal cavity. This phenomenon leads to peritonitis, which, without timely help, is fatal.
Strangulation is a common consequence of a ventral mass that occurs suddenly and requires immediate surgery. This complication is accompanied by organ compression, ischemia occurs, necrotic and inflammatory processes begin.
Without exception, all patients with complications need radical elimination of the protrusion.
Treatment - surgical removal
Surgery is the only way to remove a ventral hernia. Conservative methods in this case will only be a waste of time. Hernia repair is performed by open or laparoscopic hernioplasty.
Tension plasty is performed with a slight protrusion of the organs, when the hernia is not complicated by other pathologies of the gastrointestinal tract. During the operation, the doctor sutures the defect with the patient's own tissues, sewing them together over the protrusion. This technique is used extremely rarely, because after such an operation the risk of recurrence of the disease is high.
The operation with the installation of a mesh implant is performed for defects of any size.
This is the most optimal variant of hernia repair with reliable fixation of organs in their place. The mesh implant is made of polypropylene, and it grows together with the tissues over time, protecting the abdominal wall from protrusion. The operation is performed with the removal of the hernial sac, and then the endoprosthesis is fixed, which is not fixed by anything, but is held by pressure.
Laparoscopic surgery to remove an incisional hernia is suitable for uncomplicated pathology. Access to the hernial sac is created through punctures in the abdomen. Instruments and a camera are inserted into the abdominal cavity. During the operation, the surgeon can remove pathological tissues and install a mesh implant. Once laparoscopy has been done, the risk of complications is minimized.
Preventive measures
The primary prevention of ventral formation is the proper care of the scar and compliance with the postoperative regimen. The latter includes a therapeutic diet, a sparing regimen of physical activity, and the exclusion of bad habits. After the operation, a bandage is necessarily prescribed, which will prevent a sharp increase in intra-abdominal pressure.
When an incisional hernia has already occurred, it is important to stop its development until the moment of removal. To do this, it is enough to adhere to all the same preventive measures: wear a bandage, observe a therapeutic diet, and exclude stress on the muscles of the anterior abdominal wall.
When there is a predisposition to a hernia, the doctor prescribes prophylactic arthroplasty, that is, the installation of a mesh implant immediately after performing an operation on the abdominal organs. During the rehabilitation period, the surgeon will already be able to say exactly what to do to prevent delayed complications that can happen even after a few years.
