Causes  complications and treatment

incisional hernia occur when a weak surgical or traumatic wound allows the protrusion of peritoneal sac the swelling appears which gradually enlarges the hernia may affect the whole wound or just one portion mostly the lower . the content of the hernial sac may become irreducible and attack of subacute intestinal obstruction incarceration and strangulation may follow the overlying skin may become thin atrophic and
ulcerated spontaneous rupture may occasionally occur caesarean and gynecological wounds being particularly prone to this complication incisional hernia complicated 6%of abdominal wounds ay 5 years and 12%at 10 years male to female ratio are nearly equal

 the predisposing factors of incisional hernia can be classified into

pre-operative factor as

patient with weak abdominal musculature

  patient with chronic straining as chronic cough lower urinary tract obstruction which are not treated before operation

often occurs in obese patients malnutrition chronic debilitating diseases as malignancy ,diabetic renal failure jaundice and immunosupression
operative factor as

 type of incision more liable to occur with muscle cutting than with muscle splitting or muscle retracting incision which causes damage to muscles their nerve supply or their blood supply are prone to be weak

 difficulty in closing the peritoneum may occur in emergency operations or distended abdomen in case of intestinal obstruction or general peritonitis improper anaesthesia will add to the difficulty

 damaging muscles by rough manipulations and tight stitches  imperfect hoemostasis =haematoma = infection 
dead space from inefficient closure =seroma = infection

 postoperative factors as

 infection of the wound 

 persistent cough urethral obstruction straining 
 heavy lifting before 3 months 

post operative distension as in acute gastric dilatation or ileus
  poor healing power 

 dehiscence or burst of the wound

 also incisions which more liable to hernia formation are lower midline lateral muscle splitting and subcostal incisions


Conservative treatment as
may be left untreated where symptoms and deformity are minor they may be controlled by the use of a corset or surgical belt 
they may be repaired surgically if the patient have large hernia he may undergo to induction of pnemoperitoneum to enlarge the peritoneal cavity before operation and this facilitated the hernial reduction at operation without impairing respiratory function

Surgical treatment

surgical repair may performed using
 layer to layer anatomical repair where the defect is moderate size with no tissue loss
 the keel repair the old scar is excised but the underlying peritoneum id left intact and reduced by invagination into the abdomen and sutured in this position
 successive layers of peritoneum and aponeurosis are also invaginated and sutured using non absorbable material
  hernioplasty by synthetic mesh this technique is widely used in a lower recurrence rate than the older techniques described above


0 comment:

Post a Comment