Complications after open surgery are rare. However, sometimes they occur. Often this is due to improper patient care, increased physical exertion, failure to comply with the doctor's recommendations. One of the complications that develops during surgery is a postoperative abdominal hernia. It forms 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 field. Typical localizations are scars after cholecystectomy, removal of a liver cyst, and surgery on the pelvic organs.
Postoperative hernia of the anterior abdominal wall of the abdomen - what is it?
Almost everyone knows that a hernia is a protrusion above the surface of the body. It has several components. These include: the gate, hernial sac and its contents. Such protrusion can have various localizations. Inguinal, umbilical and femoral hernias are most common. They can also be located in the spine. Any internal organs can be localized in the cavity of the hernial sac . In most cases, these are loops of the intestine (if the protrusion is located on the stomach). In other types of hernia, the contents may be the spinal cord, male genital organs, liver, etc.
What is the difference between protrusions formed after surgical procedures? The main difference is the cause of the occurrence, it is always an operation. A postoperative abdominal hernia can be recognized by location and time of occurrence. The contents of the bag may be the same as with other types of this pathology. The hernia gate is the area where the surgical incision was made. In most cases, this is the white line of the abdomen, a scar after appendic, cholecystectomy. The hernial sac itself is represented by tissues of the anterior abdominal wall - skin, muscles and fascia. Most often, a protrusion appears after some time from the moment of surgical intervention.
Varieties of postoperative hernias
Several types of this pathology are distinguished depending on the size of the hernial protrusion and its localization on the anterior abdominal wall. Nevertheless, they all have the same reasons for development. Regardless of the type, protrusions develop in the postoperative period. In most cases, a hernia of the abdomen is removed surgically. This is a diagnostic criterion for ventral (postoperative) defects. Depending on the location, the following types of hernias are distinguished:
- Medial.
- Lateral.
In the first case, the hernial protrusion is located in the midline of the abdomen. It can be higher, lower and at the level of the umbilical ring. A lateral hernia is located on the lateral side of the abdominal wall. In addition, there is a division into left- and right-handed protrusions.
Small, medium, large and very large hernias are distinguished by size. In the first case, the configuration of the abdomen is not broken. Medium and extensive hernias are visible to the naked eye. They occupy a significant part of the anterior abdominal wall. Very large protrusions may contain several internal organs (intestine, omentum) in the hernial sac at once. They occupy 2/3 of the anterior abdominal wall.
What is the difference between postoperative hernia of the white line of the abdomen?
Postoperative hernia often occupies a medial position on the anterior abdominal wall. In this case, it is located 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 cannot be detected by other methods.
Medial postoperative hernia on the abdomen occurs due to weakness of the anterior abdominal wall. The rectus muscles are located in this area. During surgical interventions along the white line, an incision is made in the skin and fatty tissue. The rectus abdominis muscles move apart. 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 (closure) of the rectus muscles.
Causes of a hernia on the abdomen after surgery
Normally, after surgical procedures, hernial protrusions should not form. Their appearance indicates non-compliance with the technique of the operation, an improper lifestyle after the intervention (weight lifting, excessive physical exertion). In addition, a ventral hernia may appear on its own. Usually, various diseases contribute to this, in which wounds heal more slowly than in healthy people. Postoperative hernia on the abdomen may appear due to the following reasons:
- Long abdominal tamponade. They resort to it during complex surgical interventions, as well as if complications arise. Among the operations after which ventral hernias develop, one can distinguish: removal of the appendix and gall bladder, liver resection. Long-term tissue healing is also observed due to interventions on the stomach (bleeding, perforation of the ulcer) and intestines (obstruction), pelvic organs, and kidneys.
- A history of diabetes. Patients suffering from this disease often have vascular complications. As a result, any wound surfaces heal much longer and harder, unlike healthy people.
- Violation of surgical technique. A hernia can occur with poor-quality overlay of suture material, strong thread tension, lack of preparation for surgery.
- Wound infection. It occurs when a bacterial infection is attached due to non-compliance with hygiene rules, lack of proper treatment of the suture with antiseptics.
- Overweight in the patient.
- Refusal to wear a bandage after surgery.
Ventral hernia can form at different times. In some, it appears a few days after the operation. In other cases, it develops within months.
The clinical picture with postoperative hernia
Postoperative abdominal hernia often does not bother patients, since it does not affect the general condition. Nevertheless, when it appears, you should seek medical help. Indeed, regardless of the type and location 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:
- The appearance of protrusion (tubercle), rising above the surface of the anterior abdominal wall. It can have a different size and shape (usually round, oval). The consistency of the hernia is usually soft.
- Independent reduction of protrusion. With a small size, the hernia disappears when you change the position of the body or press on it with your finger.
- The appearance of protrusion with muscle tension, coughing.
- Sore friction on clothing.
- In some cases, nausea and vomiting.
- Disruption of the intestines (constipation or diarrhea).
When infringement of hernial protrusion develops a clinical picture of "acute abdomen." This is due to compression of the intestinal loop and their ischemia. In severe cases, the restrained organs undergo necrosis. This is accompanied by severe pain, fever, intoxication.
Diagnosis of a hernia of the abdomen
Diagnosis of ventral hernias is based on examination and interrogation of the patient. It is necessary to find out how long the surgery was performed, how long the scar healed. If the patient complains of a painful formation, which is self-correcting, you can make a diagnosis: postoperative hernia on the abdomen. Photos of such protrusions can be found in the medical literature. In appearance, hernias can resemble various neoplasms. Therefore, if any protrusion occurs, you should consult a surgeon. Only he can correctly conduct differential diagnosis.
Treatment of postoperative hernias at home
Removal of postoperative abdominal hernia can only be done by a qualified specialist. Nevertheless, in some cases, surgical intervention can be avoided. Conservative hernia treatment is carried out at home. It includes: adhering to a diet, combating constipation, limiting physical activity and wearing a special bandage or slimming underwear.
Surgical removal of postoperative hernia
In most cases, surgical treatment of a postoperative abdominal hernia is indicated. It is used for the ineffectiveness of conservative therapy, large protrusions. Indication for emergency surgery is infringement of the hernia. In this case, detoxification and symptomatic therapy, necrectomy, plastic hernia gate are performed. In uncomplicated course, planned surgical treatment is indicated.
Types of abdominal hernia surgery
The choice of surgical treatment depends on the size of the hernia. With a slight protrusion of the organs, autoplasty is performed. It involves the closure of the defect with the patient's own tissues. If the hernia is large, then the operation is performed under general anesthesia. In order to restore the aponeurosis of the anterior abdominal wall, special implants are used - synthetic nets. They help strengthen muscles and reduce the likelihood of a recurrence of a hernia. Currently, this technique is common in all countries.
Prevention of postoperative abdominal hernias
Preventive measures should be taken not only by the doctors conducting the surgical intervention, but also by the patients. For 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 should follow a diet, if necessary, take laxatives. After a laparotomy, you must wear a bandage. It helps to restore the abdominal muscles to their previous state.