MedClinic > Blog > Plastic > Abdominal hernia repair

Abdominal hernia repair

A hernia is the protuberance of an organ or its part out through acquired in operations or injuries or natural openings (umbilical ring, white line of the abdomen). The constituent elements of a hernia are the hernia gate (the opening through which the hernia passes under the skin), the hernia sac (skin, peritoneum, muscles, aponeurosis) and hernia contents (intestinal loops).

Abdominal hernias are usually divided by location into:

– Internal (formed inside the abdominal cavity and located in natural pockets and folds)

– External (go out through natural or acquired holes to the outside).

By aetiology, there are:

– Congenital (appear immediately after the birth of the baby).

– Acquired (appear throughout life).

According to the clinical classification:

– Reducible

– Irreducible

Why does a hernia form?

– Tension of the abdominal muscles (physical activity, constipation, cough, etc.)

– Stretching of the anterior abdominal wall (pregnancy, tumor)

– Operation, injury

– Weakness of the anatomical structures on the anterior abdominal wall (white line of the abdomen, umbilical ring)

– Obesity

– Frequent tension and weight lifting

Indications for plastic repair of abdominal hernia:

– Umbilical hernia (protrusion in the navel or near it)

– Postoperative hernia of the abdomen (occurs at the site of postoperative scarring)

– A hernia of the white line of the abdomen (the white line of the abdomen is a weak spot on the anterior abdominal wall, as it consists of fibers and holds 6 muscles on itself, there are holes in which arteries, veins and nerves pass, these holes can serve as a place for the exit of hernias )

Today, the treatment of abdominal hernias is exclusively surgical, because:

– this problem does not have the properties of regression and self-resolution, hernias alone do not pass and do not disappear anywhere.

– The use of alternative treatments has shown to be ineffective.

It is necessary to operate the hernia in the abdomen as quickly as possible, because it has the property of causing a number of complications, such as:

– acute intestinal obstruction,

  • coprostasis,
  • bloating

– necrosis of tissues that are in the hernia gate due to constant ischemia,

– intoxication,

– hernia inflammation,

– mechanical damage to the hernia,

– incarceration.

Symptoms that indicate incarceration of a hernia:

– Blood in the faeces

– No bowel movement

– No gas discharge

– Strong cutting pain at the site of hernia, which rapidly increases

– Inability to independently reposit a hernia in a supine position.

All of the above symptoms indicate that it is necessary to immediately call an ambulance!

The reason for immediately contacting a specialist is:

– Changes in the size of hernia

– Painful hernia

– Changes in skin color over a hernia

– Earlier in the anamnesis there was an incarceration of hernia

– The formation did not disappear until the age of 6 (in children)

– A hernia causes severe discomfort and inconvenience

As in all operations, there are a number of contraindications to hernia repair:

– The presence of severe concomitant diseases against the background of senile age

– Acute inflammatory process

– Pregnancy, breastfeeding

– Oncological diseases

– Obesity in 3-4 stages

Before performing hernia repair, it is necessary to consult your doctor, since each method has its own indications and contraindications. It is necessary to inform the doctor about taking any medications or vitamins, and about the presence of allergies. Pass a series of clinical examinations:

Laboratory: Complete blood count, general fecal analysis, blood glucose, determination of blood group and Rh factor, biochemical blood analysis (bilirubin, ALT, AST, total protein, creatinine, etc.), blood test for syphilis, hepatitis and HIV, coagulation tests.

Instrumental: ECG with decoding, ultrasound of the abdominal organs, chest radiography with a description and others.

Hernia repair is performed under general anaesthesia, the method of administration is determined by the attending physician.

How is the operation performed?

The hernia operation involves placing the hernial contents back into the abdominal cavity. Plastic surgery of the abdomen is performed and, often, a special mesh is applied, which is a protection against the re-occurrence of a hernia.

Plastic repair can be carried out in different approaches:

  1. Open access involves a 4 cm long incision through which the mesh is fixed. The advantage of this method is that visibility for the surgeon during the operation increases significantly.
  2. Laparoscopic access. It is carried out using special video equipment and special tools. It is less traumatic, rehabilitation after this type of hernia repair is much faster.
  3. Preperitoneal access. A similar method to laparoscopic in the technique of execution and the presence of punctures. But there is a significant minus in these procedures: mesh fixation is absent, which subsequently leads to undesirable movement.
  4. Repair with tissue stretching. Previously, this method was the most commonly used in hernia surgery. It is carried out as follows: the skin over the hernia is dissected, the contents are pushed into the abdominal cavity, the wound edges are sutured with local tissues. The disadvantage of this type was a long rehabilitation period and frequent recurrence of hernias. Currently, this method is used only for hernias of small size.
  5. Repair without tissue stretching. To date, this method is used most often, and most likely your doctor will suggest this method. The rehabilitation period is minimised, there is practically no pain, the chance of hernia recurrence is minimal.

Postoperative period:

– It is necessary to postpone sports for some time, as well as any physical activity

– Do not lift heavy objects

– In the first six months it is forbidden to pump abs

– Carefully monitor the diet, do not overeat and prevent constipation.

What is the rehabilitation like?

The time spent in the hospital after hernia repair does not exceed 3 days.

At home, you must adhere to stay calm and have bed rest, and lie solely on your stomach.

After 3-4 days of bed rest, you can begin to roll over in bed and get up.

On the 7-10th day, the stitches are removed. The speed of removal of stitches depends on the characteristics of the body.

In the rehabilitation period, the wearing of a special bandage is a prerequisite.

After the stitches are removed the bandage must be worn for up to 2 months. It helps the front abdominal wall to quickly tone up, and the stitches will not diverge and will not be injured. The bandage helps reduce the risk of relapse, accelerate the healing and recovery process, and get rid of fear of movement and soreness.