Postoperative hernia on the abdomen: consequences and treatment
Complications after open surgicalinterventions are infrequent. Nevertheless, sometimes they occur. Often this is due to improper care of the patient, increased physical exertion, failure to follow the doctor's recommendations. One of the complications that develops against the backdrop of surgical intervention is postoperative hernia on the abdomen. It is formed at the site where the laparotomy was performed. In most cases, a hernia after surgery appears on the white line of the abdomen. Nevertheless, it can develop in any area. Typical localizations are scars after cholecystectomy, removal of the liver cyst, surgical intervention on the pelvic organs.
Hernia postoperative abdominal abdominal wall - what is it?
Virtually everyone knows that the hernia representsa protrusion over the surface of the body. It has several components. They include: a gate, a hernial sac and its contents. Such protrusion can have different localizations. The most common are inguinal, umbilical and femoral hernias. They can also be in the spine. Any internal organs can be localized in the cavity of the hernial sac. In most cases, it is an intestinal loops (if protrusion is located on the abdomen). With other types of hernia, the contents can be spinal cord, male genitalia, liver, etc.
The differences between protrusions formed aftersurgical procedures? The main difference is the cause of the occurrence, it is always an operation. Postoperative hernia of the abdomen can be recognized by localization and appearance time. The contents of the bag can be the same as in other types of this pathology. Hernial portal is the site on which the surgical incision was made. In most cases, this is the white line of the abdomen, the scar after append, cholecystectomy. The hernial sac itself is represented by the tissues of the anterior abdominal wall - skin, muscles and fascia. Most often, protrusion appears after some time from the time of surgery.
Types of postoperative hernias
Depending on the size of the hernial protrusion andits localization on the anterior abdominal wall distinguish several types of this pathology. Nevertheless, they all have the same reasons for development. Regardless of the type, protrusions develop in the postoperative period. Hernia in most cases is surgically removed. This is a diagnostic criterion for ventral (postoperative) defects. Depending on the location, the following types of hernias are distinguished:
- The medial.
In the first case hernial protrusion is locatedon the middle line of the abdomen. It can be higher, lower and at the level of the umbilical ring. The lateral hernia is located on the lateral side of the abdominal wall. In addition, there is a unit for left- and right-sided protrusions.
Depending on the size distinguish small,medium, large and very large hernias. In the first case, the configuration of the abdomen is not broken. Medium and extensive hernias are visible to the unaided eye. They occupy a large part of the anterior abdominal wall. Very large protrusions may contain several internal organs in the hernial sac (intestine, omentum). They occupy 2/3 of the area of the anterior abdominal wall.
What is the difference between a postoperative hernia of the white abdominal line?
Postoperative hernia often occupies a medialposition on the anterior abdominal wall. In this case, it is in the region of the white line of the abdomen. This arrangement of hernial protrusion occurs after massive surgical interventions. In some cases, a midline incision is made to diagnose surgical pathologies that can not be detected by other methods.
Medial postoperative hernia on the abdomenarises from the weakness of the anterior abdominal wall. In this area there are straight muscles. When carrying out surgical interventions on the white line, a cut of the skin and fat is produced. Straight abdominal muscles are pushed in different directions. Therefore, healing after laparotomy takes quite a long time. It is necessary to achieve not only the formation of a formed scar, but also the restoration (closing) of the straight muscles.
Causes of a hernia on the abdomen after surgery
Normally, after surgicalmanipulation should not form hernial protrusions. Their appearance indicates the non-observance of the technique of the operation, the wrong way of life after the intervention (lifting weights, excessive physical load). In addition, the ventral hernia can appear independently. Usually this is facilitated by various diseases in which wounds heal more slowly than in healthy people. Postoperative hernia on the abdomen may appear due to the following reasons:
- Prolonged tamponade of the abdominal cavity.It is used for complex surgical interventions, as well as for complications. Among the operations after which ventral hernias develop, one can distinguish: removal of appendix and gallbladder, resection of the liver. Also, long-term healing of the tissues is observed due to the interventions on the stomach (bleeding, perforation of the ulcer) and intestines (obstruction), pelvic organs, kidneys.
- Diabetes mellitus in the anamnesis.Patients suffering from this disease often have vascular complications. As a result, any wound surfaces heal much longer and heavier, unlike healthy people.
- Violation of surgical technique. Hernia can occur with poor quality suture material, strong tension of the thread, lack of preparation for surgery.
- Infection of the wound. Occurs when bacterial infection is attached due to non-compliance with hygiene rules, lack of adequate treatment of the seam with antiseptics.
- Excess body weight in the patient.
- Refusal to wear the bandage after surgery.
Ventral hernia can be formed at different times. In some, it appears several days after the operation. In other cases, it develops within months.
Clinical picture in postoperative hernia
Postoperative hernia on the abdomen is often notworries patients, since it does not affect the general condition. Nevertheless, when it appears, you should seek medical help. After all, regardless of the variety and localization of the hernia, serious complications can develop. The most common and dangerous of them is the infringement of internal organs. The main symptoms of uncomplicated hernia are:
- Appearance of protrusion (tubercle), which rises above the surface of the anterior abdominal wall. It can have a different size and shape (more often round, oval). The consistency of the hernia is usually mild.
- Self-directed protrusion. With a small amount of hernia disappears when the position of the body changes or pressing on it with your finger.
- Appearance of protrusion at tension of the muscles of the press, coughing.
- Soreness when rubbed against clothing.
- In some cases - nausea and vomiting.
- Disruption of the intestine (constipation or diarrhea).
When infringement of the hernial protrusion developsclinical picture of the "acute abdomen". This is due to the compression of the bowel loop and their ischemia. In severe cases, injured organs undergo necrosis. This is accompanied by a strong pain syndrome, fever, intoxication.
Diagnosis of a hernia of the abdomen
The diagnosis of ventral hernia is based on dataexamination and questioning of the patient. It is necessary to find out how long a surgical procedure has been performed, how long the scar has healed. If a patient complains of a painful education that self-corrects, you can diagnose: a post-operative hernia on the abdomen. Photos of such protrusions can be found in medical literature. In appearance, the hernia can resemble various neoplasms. Therefore, when any protrusion appears, you should consult a surgeon. Only he can correctly carry out differential diagnostics.
Treatment of postoperative hernias in the home
Removal of a postoperative hernia on the abdomen canproduce only a qualified technician. Nevertheless, in some cases it is possible to avoid surgical intervention. Conservative treatment of hernia is carried out at home. This includes: diet, fighting with constipation, limiting physical exertion and wearing a special bandage or pulling underwear.
Surgical removal of postoperative hernia
In most cases, a surgicaltreatment of postoperative hernia of the stomach. It is used when ineffective conservative therapy, large size protrusion. Indication for emergency surgery is the infringement of the hernia. In this case, detoxification and symptomatic therapy, necrotomy, plastic surgery of the hernia gates are carried out. In uncomplicated course, scheduled surgical treatment is indicated.
Types of operations to remove a hernia on the stomach
The choice of surgical treatment depends on the sizehernia. With a slight protrusion of organs, autoplasty is performed. It involves closing the defect with the patient's own tissues. If the hernia is large, the operation is performed under general anesthesia. In order to restore aponeurosis of the anterior abdominal wall, use special implants - synthetic nets. They help strengthen the muscles and reduce the chance of a re-emergence of a hernia. Currently, this technique is common in all countries.
Prevention of postoperative hernias on the abdomen
Preventive measures should not only takedoctors, who conduct surgery, but also patients. During one month after surgery, you can not lift heavy objects and exercise. It is also recommended to avoid the development of constipation. To do this, you must follow a diet, if necessary - take laxatives. After laparotomy, be sure to wear a bandage. It helps to bring the abdominal muscles into their previous state.