Postoperative hernia
The content of the article:
- What it is
- Why arises
- Kinds
- Symptoms of a postoperative abdominal hernia
- Diagnostic methods
-
How to treat
- What to do for a patient at home
- Surgery
- Prognosis and complications
- Video
Incisional hernia (ventral, cicatricial) is one of the most frequent complications of abdominal surgery. It can form after the removal of the appendix, gallbladder, uterus in women, or during other surgical interventions. In most cases, the only symptom is the presence of a protrusion in the area of the postoperative suture, less often other manifestations develop. You can get rid of protrusion with the help of hernioplasty.
Large incisional hernia appears as a bulge in the area of the incisional scar
What it is
Postoperative (ventral) hernia of the anterior abdominal wall is a condition in which the internal organs (intestines, omentum) extend outside the abdominal cavity in the area of the postoperative scar. In the photo, the hernia looks like a tumor-like protrusion. Its development is always preceded by surgical intervention.
Why arises
The reason for the formation of a ventral hernia is always a defect in the anterior abdominal wall, which is formed as a result of a previous surgical intervention. However, the pathology is not formed after all operations; this can be influenced by both general factors and the peculiarities of the operation.
| Group of factors | Explanation |
| Operation-related |
There are a number of factors associated with surgery: · Postoperative wound infection; · Excessive tension of the tissues of the anterior abdominal wall; · Long cut; · Poor quality wound closure; · Allergic reaction to suture material. |
| General patient-dependent factors |
The following factors increase the risk: Obesity; Diabetes mellitus (with the disease, the blood supply to the tissues worsens); · Diseases of the cardiovascular system, impaired blood coagulation; · Prolonged cough, chronic constipation (increased intra-abdominal pressure); · Old age (reparative properties worsen with age). |
There is no unambiguous explanation why a hernia forms in the postoperative period. This can be influenced by one factor or several at once. Some factors can be influenced and the likelihood of the formation of pathology can be reduced. For example, non-compliance with bed rest, lifting heavy weights, inadequate care of the postoperative wound are those that the patient can eliminate on their own.
Kinds
All incisional hernias are divided, depending on the place of origin, into two large groups - medial and lateral.
| View | What is characterized | Subspecies |
| Medial | Located in the midline of the abdomen (from the xiphoid process to the pubic bone). |
· Epigastric; Umbilical; Paraumbilical; Suprapubic. |
| Side | Located on the right or left side of the lateral edge of the rectus abdominis muscle. |
· Subcostal; Ileal; Lumbar. |
Pathology is classified according to other characteristics:
By the size of the hernial opening: small, medium, large, giant.
By reducibility: reducible, irreducible.
By the presence of clinical manifestations: asymptomatic, symptomatic.
The variety affects the clinical symptoms and treatment tactics.
Symptoms of a postoperative abdominal hernia
The main sign of pathology is the presence of a tumor-like formation in the area of the postoperative scar. Localization and size may vary depending on the access performed during the operation.
At first, the protrusion does not bother the patient in any way, there are no additional symptoms. Over time, pain appears in the area of exit of the hernial contents. Pain syndrome has the following characteristics:
- localized in the area of the scar;
- aggravated by coughing, straining, physical exertion;
- decreases at rest.
When the intestines are pinched in the hernial orifice, symptoms of acute intestinal obstruction may appear:
- intense pain;
- nausea, vomiting;
- stool and gas retention.
Diagnostic methods
In most cases, the diagnosis is straightforward. Two points are important - the presence of a protrusion in the area of the scar and a history of abdominal surgery.
Next, the doctor conducts a physical examination - palpation of the hernial protrusion, the symptom of a cough shock is determined. Sometimes, to clarify the diagnosis, additional diagnostic methods are required - ultrasound (ultrasound) or computed tomography (CT). With the help of ultrasound or CT, you can determine:
- parameters of the hernia gate;
- the contents of the hernial sac;
- additional hernial openings.
Less commonly, a survey radiography of the abdominal organs may be prescribed (when symptoms of acute intestinal obstruction appear).
Before the operation, a number of general clinical studies are usually prescribed - a general blood and urine test, a coagulogram, an electrocardiogram. The test results do not affect the diagnosis; these studies are necessary to assess the general condition of the patient before the operation.
How to treat
The only effective treatment is surgery (hernioplasty). Before its implementation, conservative therapy may be prescribed, which is aimed at preventing complications. It is impossible to get rid of protrusion with the help of medications or folk remedies.
What to do for a patient at home
It is impossible to get rid of bulging at home. However, adherence to some recommendations will avoid the development of complications. What you can do at home:
- Wear a special bandage.
- Eliminate heavy physical activity, especially heavy lifting.
- Follow a diet aimed at preventing constipation - eat more fiber, cereals, drink 1.5 liters of clean water daily.
- Timely treat diseases of the respiratory system, which are manifested by coughing.
It should be understood that adherence to these recommendations does not negate the hernioplasty.
Surgery
Hernioplasty is the only effective treatment. Usually, surgery is performed 6–12 months after the appearance of the protrusion, the operation in this case is planned. If complications develop, an emergency operation is performed.
The operation consists of two main stages - hernia repair (excision of the hernial sac) and plasty (closing the defect). There are two types of hernioplasty:
- Plastic surgery with local tissues. The defect is sutured without using prostheses. Such an operation is possible if the size of the defect does not exceed 5 cm.
- Radical plastic (using prostheses). The aponeurosis defect is covered with a synthetic prosthesis. The operation is used when the size of the defect is more than 5 cm.
In most cases, the operation is performed under anesthesia, but if the defect is small, it is possible to perform surgery under local anesthesia.
Prognosis and complications
With timely hernioplasty, the prognosis is favorable. If radical plasty is used, relapses are extremely rare.
With the development of complications, the prognosis is less favorable. The following complications are more common:
- infringement;
- inflammation;
- coprostasis;
- irreducibility.
With the development of complications, emergency medical care is required. Usually, treatment consists of an urgent operation.
Video
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
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