INCISIONAL HERNIA
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
Treatment
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
tags:incisional,hernia
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
Treatment
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
tags:incisional,hernia
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