Ventral Hernia (incisional) - Causes, Symptoms And Treatment Of A Ventral Hernia

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Ventral hernia (postoperative)

A ventral hernia is a postoperative defect in the muscles and tendons of the abdominal wall. It forms in the overgrowth of a scar that remains after surgery. This type of bulging is post-traumatic.

As for the statistical data, the ventral hernia is formed in 11-19% of patients who underwent surgery. 50% of patients detect a protrusion already in the first year after the intervention. In the remaining 50%, a hernia appears within a five-year period after surgery. It happens that a protrusion appears after surgery to remove a hernia. In this case, we are talking about a recurrent ventral hernia. The risk of its occurrence is higher if the operation was unplanned and was carried out urgently.

The functions of the anterior wall of the peritoneum are diverse, it has several layers. The bulge appears in the most durable, but not elastic layer - in the muscle-tendon layer.

The ventral type of protrusion, like other hernias, has a gate, a sac and the contents of the sac. Most often they are formed after surgical interventions to get rid of uterine fibroids, ovarian cysts, intestinal obstruction, stomach ulcers, appendicitis, cholecystitis, umbilical hernia and some others.

Content:

• Causes of ventral hernia
• Ventral hernia symptoms
• Diagnostics of the ventral hernia
• Ventral hernia treatment

Causes of ventral hernia

• The fact of heredity. Systemic dysplasia or impaired connective tissue development is a genetically determined pathology that can lead to the formation of a hernia. If a patient who has undergone surgery has congenital weakness of the connective tissue, tendons and ligaments, then the risk of ventral protrusion is significantly increased. The fact that the patient has hereditary dysplasia can be indirectly indicated by thin skin on which stretch marks are easily formed, high growth, hernias in other areas, increased joint mobility and asthenic body type. If the patient has two or more signs indicating dysplasia, then the hernia treatment will be effective only with the imposition of a synthetic prosthesis.
• Non-compliance with the regimen prescribed to the patient after surgery. Failure to follow medical recommendations leads to the formation of a hernia. It is necessary to understand that the postoperative suture is not only an external defect. The healing of a skin wound does not mean complete recovery and the ability to start full-fledged physical labor. The tendon plate (aponeurotic part of the wound), which is responsible for the integrity of the peritoneal wall, will heal for the longest time. If in young patients this period takes up to 4 months, then elderly people can wait for healing only after six months or more. If a person has concomitant diseases, then the process of complete scarring can take up to a year. That is why it is so important to follow all the recommendations of the surgeon, and, if necessary, wear a bandage.

• Failure of the postoperative wound healing process. It happens that even in conditions of the strictest sterility, wound infection occurs. As a result, the suppuration process starts, which affects the healing time and the formation of a full-fledged scar. As a result, it becomes not as strong as it should be. An infection in the wound does not indicate the inevitable formation of a hernia, but significantly increases the risks of its formation. In some cases, there is an individual intolerance to the material used for suturing. As a result, it is rejected and the non-fused edges diverge.

• The presence of concomitant diseases. Any diseases that provoke an increase in intra-abdominal pressure can increase the risk of bulging. These are bronchitis, asthma, chronic constipation. In addition, excess weight, prostate adenoma and other diseases have an effect. As a result, the edges of the postoperative wound are constantly subject to tension. Their blood circulation and supply of nerves are disturbed - as a result, a loose scar is formed. In addition, normal blood supply can be affected by: atherosclerosis, hypertension, ischemia, diabetes mellitus.

  Moreover, the risks increase even in the presence of one of the listed diseases. To reduce them, you should try to get rid of the existing problems before starting the operation. If the diseases are chronic, then it is necessary to wait for their stable remission.

  Dangerous overweight in terms of hernia formation. If the protrusion has been operated on repeatedly, if it has impressive dimensions, then the body weight should be reduced and only after that the surgical intervention should be performed.
• A doctor's mistake in terms of performing the suturing technique. This reason is the least common. Nevertheless, sometimes the surgeon chooses the wrong technique and method of wound closure, sometimes too tightly, or too weakly tightens its edges. As a result, a defect is formed.

Ventral hernia symptoms

• A bulge formed in the area of the postoperative wound on the anterior wall of the peritoneum. It is localized along the line of the existing scar.
• If the hernia has appeared recently, then it can be corrected, the person does not experience pain in the early stages.
• Pain in the protrusion area appears as the pathology progresses. They can occur at the moments of heavy lifting, straining and making sudden movements.
• If the hernia is not treated, the pain becomes constant, its character is cramping.
• If a hernia forms in the suprapubic region, then there may be violations of the process of urination.
• Hyperemia of the skin, fever, gastrointestinal disturbances (nausea, vomiting, increased gas formation), the appearance of blood in the stool - these symptoms appear when the ventral protrusion is impaired or with the development of other complications.

Diagnostics of the ventral hernia

Diagnosticians do not have any difficulties in identifying pathology. As a rule, a visual examination of the patient is sufficient to see the ventral protrusion of the hernia. The patient is asked to push or cough to assess the true size of the hernia.

• Ultrasound examination allows you to assess the size and shape of the protrusion, as well as the presence of adhesions.
• Various variations of X-ray examination allow us to assess the functioning of the gastrointestinal tract, determine the presence of adhesions and the relation of internal organs to the protrusion that has arisen.

To clarify the parameters important for the doctor, the patient is sometimes referred to MSCT or MRI. In some cases, colonoscopy is done.

Ventral hernia treatment

It will not be possible to get rid of the protrusion of the ventral hernia without surgery. Treatment and correction of the peritoneal wall with removal of the formed sac and subsequent plastic surgery will be required.

Tension plastic

The protrusion is sutured with sutures. This procedure can only be performed in young patients whose hernia size is small. In addition, the absence of concomitant diseases is important. The fact is that this method of intervention has a high relapse rate, which reaches 30%.

Of the advantages of the stretching method:

• ease of implementation from a technical point of view;
• low price for materials and equipment used.

Among the disadvantages of the stretching method:

• the risk of recurrence is up to 30%;
• respiratory dysfunction due to too strong tension on the wound;
• the occurrence of pain due to strong tension.

Non-tension hernioplasty

The place where the protrusion was is closed with a synthetic prosthesis. It is made from polypropylene mesh and is inserted directly under the skin or along the fascia.

Of the advantages of this technique:

• Low relapse rate.
• Absence of pain syndrome after surgery or its slight severity.
• Absence of respiratory disturbances.
• With the addition of the tension-free method with abdominoplasty, it becomes possible to restore the peritoneal wall plastic even with a giant protrusion.

Cons of the tension-free method:

• High price category of the operation.
• Increased risk of complications - seroma, hematoma, suppuration.
• In theory - rejection of the implanted mesh, the appearance of a feeling of the presence of a foreign body.
• If adhesions occur between the mesh and the intestine, intestinal obstruction may develop. (Read also: Causes and Symptoms of Intestinal Obstruction)

Hernioplasty prosthetic using a laparoscope

This method of surgical intervention is the least traumatic and most modern. A mesh implant is also inserted into the abdominal cavity, but this does not require making incisions in the area of the hernia itself. As a result, there is no risk of suppuration.

Advantages of this method:

• The patient's abdominal cavity is practically not injured.
• There is no pain, or it is minimal.
• Extremely low relapse rate.
• No wound complications.
• A short recovery phase and an early opportunity to return to work.

Disadvantages of the method:

• The cost of the operation is extremely high.
• The training process for surgeons is laborious and lengthy.
• It is required to equip a medical institution with expensive equipment, which is not always possible.

Conclusions on the management of ventral hernia

It is possible to make a choice in favor of this or that method of surgical intervention only taking into account the recommendations of the attending doctor. For this, it is necessary to undergo a comprehensive examination to obtain complete data on the patient's condition.

In addition, the choice of technique is based on the patient's ability to endure general anesthesia.

As for conservative therapy, it is possible only if there are serious contraindications to the operation. In this case, the patient is advised to adhere to a dietary diet, give up physical exertion, prevent constipation and flatulence, and wear an individually selected bandage.

To avoid or minimize the risk of relapse, the patient will need to strictly follow all the doctor's recommendations, adhere to proper nutrition, normalize weight and achieve regular bowel movements.

The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist

Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.