Ventral hernia
The content of the article:
-
Why arises
- Local causes
- Common causes
- Classification
- Clinical manifestations
- How to make a diagnosis
-
How to treat pathology
- Conservative therapy
- Surgical intervention
- Forecast and consequences
- Video
Ventral hernia is the exit of organs outside the abdominal cavity in the area of the postoperative defect. The term "ventral hernia" has recently been used less and less, more often such formations are called postoperative, which more reflects the mechanism of the development of pathology. To get rid of the pathology, an operation (hernioplasty) is required.
Ventral hernia is formed as one of the late postoperative complications
Why arises
Postoperative (ventral) hernia is the exit of the peritoneum and internal organs beyond the boundaries of the abdominal cavity in the area of the postoperative scar. Organs leave not through a natural opening, but through a postoperative defect of the anterior abdominal wall.
This is a common complication of laparotomy operations - removal of the appendix, gallbladder, uterus and other internal organs. In most cases, a protrusion is formed during the recovery period after emergency operations, less often after planned ones.
There is no single reason that would lead to the development of pathology. A combination of local and general factors plays a role.
Local causes
Local factors are associated with changes in the area of the postoperative wound:
- irrational choice of prompt access (large section);
- poor-quality wound closure (insufficient alignment of the edges, excessive tension, wrong choice of suture material);
- draining;
- wound infection;
- decreased regeneration.
Common causes
The development of the disease is also influenced by general factors that are associated with the patient's condition:
- burdened heredity;
- pathological conditions that lead to an increase in intra-abdominal pressure - chronic constipation, prolonged cough, pregnancy;
- obesity;
- diseases in which the regenerative capacity of tissues (healing) decreases - diabetes mellitus, cardiovascular pathology, vitamin deficiency, hypoproteinemia, anemia.
The development of the disease can be influenced by both one factor and several at once. Moreover, a combination of several factors increases the likelihood of suture failure and protrusion formation.
Classification
Ventral hernias are characterized by various sizes, shapes, and localization. The clinical picture differs depending on the presence of complications, the composition of the hernial contents. The presence of such a wide variety of pathologies makes it difficult to create a single classification. There are the following types of pathology:
- By localization: median (lower, upper) and lateral (right and left, lower and upper).
- Largest: small, medium, large, giant.
- According to the composition of the hernial sac: loops of the small intestine, greater omentum, stomach, bladder.
- By the presence of complications: strangulated, perforating, with signs of acute intestinal obstruction.
- By reducibility: reducible, irreducible.
Clinical manifestations
In most cases, the only symptom of pathology is the presence of a protrusion in the postoperative scar on the anterior abdominal wall. Such education has the following characteristics:
- localized at the seam site;
- increases in a standing position;
- increases with coughing, straining, physical exertion;
- decreases or disappears in a horizontal position;
- in an uncomplicated course, it is easily adjusted back.
The second most common symptom of the disease is pain. At first, the pain is aching and pulling in nature, it increases with physical exertion. Over time, the pain can become sharp and constant, especially with irreducibility.
The rest of the symptoms develop less often and depend on which organ is included in the contents of the hernial sac.
| Hernial sac contents | Additional symptoms |
| Bowel loops | The pain is limited, constipation and flatulence appear. With a prolonged course of the disease, signs of intoxication may develop. |
| Stomach |
Characterized by the appearance of heartburn and belching, periodic vomiting, a feeling of heaviness after eating. |
| Big gland | The pain is less intense, extending to the entire front wall of the abdomen. |
| Bladder | In addition to protrusion, dysuric symptoms appear (frequent or painful urination). |
How to make a diagnosis
If a bulge is detected, you need to contact a surgeon. The diagnosis is usually not difficult, the clinical picture and anamnesis (previously performed surgical intervention) are taken into account. During a physical examination, the doctor pays attention to the following changes:
- postoperative scar;
- protrusion - its size, shape, reducibility;
- the condition of the skin around the scar (there may be signs of dermatitis);
- the consistency of the hernial contents, the edges of the hernial orifice and the size of the hernia (on palpation);
- symptom of a cough shock.
In most cases, this is sufficient for a diagnosis.
How to treat pathology
The main method of treatment is surgical removal of the hernia, followed by plastic surgery. If there are contraindications to the operation, conservative treatment is applied. It is aimed not so much at curing the disease as at preventing complications.
Conservative therapy
Conservative treatment is carried out when the patient refuses the operation or there are contraindications. Contraindications to surgical treatment may be pregnancy, severe heart disease, respiratory system, blood clotting disorder.
What is the conservative treatment:
- Wearing a special high bandage.
- Strengthening the muscles of the press (physiotherapy exercises).
- Elimination of heavy physical activity.
- Normalization of body weight in obesity.
- Compliance with a diet aimed at preventing constipation (the use of fiber and cereals, 1.5 liters of water per day).
- Treatment of diseases that are manifested by chronic cough.
Conservative treatment can be used as preparation for surgery.
Surgical intervention
An operation to remove a hernia is indicated for all patients in the absence of contraindications. With an uncomplicated course, planned surgical intervention is prescribed (6–12 months after the development of the pathology).
In case of infringement of a hernia or the development of acute intestinal failure, an urgent operation is performed.
The operation can be open or laparoscopic. The choice of tactics depends on the reducibility of the hernia, its size, and the presence of inflammatory changes. In most cases, surgery is performed under general anesthesia, rarely under local anesthesia (with a small amount of protrusion).
The operation consists of two stages:
- Excision of the hernial sac.
- Closure of the defect with local tissues or a synthetic prosthesis.
Forecast and consequences
Even in the absence of complications, ventral hernias often result in poor quality of life. If the hernia is infringed, the prognosis is poor. Every 10th infringement of the hernia ends in death.
After surgical treatment, the prognosis is generally favorable. Relapse is possible.
Video
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
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