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Understanding Incisional Hernia Causes & Treatment

Incisional hernia is an abnormal protrusion of a viscus through an old surgical scar, often caused by pre-operative, operative, and post-operative factors. Symptoms include bulging at the incision site, which may worsen with standing or coughing, and can lead to complications such as obstruction or strangulation. Treatment options include palliative measures like abdominal belts and various surgical techniques, with a focus on correcting underlying factors pre-operatively.

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Kaung Khant
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20 views3 pages

Understanding Incisional Hernia Causes & Treatment

Incisional hernia is an abnormal protrusion of a viscus through an old surgical scar, often caused by pre-operative, operative, and post-operative factors. Symptoms include bulging at the incision site, which may worsen with standing or coughing, and can lead to complications such as obstruction or strangulation. Treatment options include palliative measures like abdominal belts and various surgical techniques, with a focus on correcting underlying factors pre-operatively.

Uploaded by

Kaung Khant
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Surgery Eindra

INCISIONAL HERNIA

( Post-operative Hernia )

DEFINITION

 Abnormal protrusion of a viscus or part of a viscus through an old operation scar

AETIOLOGY
1. Pre-operative factors ( factors which can cause Delayed healing )
 General debility & malnutrition
 Hypo-proteinemia
 Vit C deficiency
 Obesity
 DM, Jaundice, Uremia
 Prolonged steroid therapy
 Increased intra-abdominal pressure ( eg: COPD, BPH, Chronic constipation,
Pregnancy )

2. Operative factors ( Faulty Technique )


 failure to use non-absorble sutures
 failure to control persistent leakage of pancreatic enzymes ( eg : Pancreatitis )
 failure to avoid factors which can predispose wound infections
 type of incision – midline & vertical incisions

3. Post-operative factors
 Persistant post-op factors
 wound haematoma
 wound infection

CLINICAL FEATURES
Symptoms
 history of abdominal operation (+)
 history of precipitating factors (+)
 most cases – asymptomatic
 bulging or swelling in the area of incision
 more marked on standing & coughing , weight lifting
 reduces on lying down
 Features of complications
 obstruction  features of IO ( absolute constipation, abd distension, vomiting )
 strangulation  Pain over the swelling, rapid increase in size

Signs
1. General
 features of ppt factors  pallor, Jaundice, obesity, malnutrition, pregnancy
2. Local

1
Surgery Eindra

 Inspection
 abdominal scar healed by primary or secondary intention
 swelling in the vicinity of scar
 visible cough impulse & visible peristalsis
 Palpation
 palpable defect in the scar
 palpable cough impulse & reducibility
 associated intra-abdominal mass may be present
 Percussion
 shifting dullness (+)ve if ascites (+)

INVESTIGATIONS

To detect the ppt factors

 CXR  for chest infection


 USG abd & pel  for BPH, ascites, intra-abdominal tumor
 Blood for CP  anaemia, infection, bleeding disorder

For Operative Mx

 Hb%, G&M, BCR


 Liver function tests, BT/CT, U&E, Cr, T &DP
 CXR , ECG

TREATMENT
Palliative
 wearing abdominal belt

Operative

1. Pre-operative measures  correction of ppt factors


 correction of anaemia, nutritional deficiencies
 control of DM & metabolic disorders
 Tx of infection , ascites & intra-abdominal tumors

2. Operative methods
a. Simple apposition
 Cattle’s operation/ anatomical repair
 Open the hernia sac
 Remove the redundant peritoneal fold
 Repair layer by layer
b. Complex apposition
 Keel operation
 Hernia sac is NOT opened
 Repair by wide inversion of the sac & rectus sheath
 Mass Closure

2
Surgery Eindra

 Mayo’s operation
 for incisional hernia close to the umbilicus
c. Mesh closure ( using polypropylene mesh )

3. Post-op care
 Gastric decompression , NBM
 IV fluids & nutrional support
 avoid strenuous exercise

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