What Is an Ventral Incisional Hernia?

Abdominal wall incision hernias are abdominal wall hernias that result from poor healing of the tendon layer that plays a major supporting role after abdominal surgery. The incidence is 2.0% to 11.0%. The incidence of incisional hernia is higher in patients with incisional infection after major abdominal surgery. Abdominal wall incision hernias can occur for many reasons. Incisional infections, dehiscence of the incision, and severe intracranial pressure increase after surgery can cause incisional hernias.

Basic Information

Visiting department: General Surgery
Common locations: Abdominal surgical incision
Common causes: Incision infection, incision dehiscence, severe cough after operation, etc.

Common symptoms: Acute incarceration can sustain pain with intestinal obstruction; necrosis and strangulation of hernia contents, persistent and severe pain, causing inflammation and edema of the outer cap of the hernia

Causes of abdominal wall incision hernia

The occurrence of incisional hernia involves a variety of factors, which can be divided into local and systemic factors.

Local factor

(1) Incisional infection Incisional infection is the main cause of incisional hernia. Although the infection can be controlled in the end, the myofascial layer of the abdominal wall has a weak defect due to poor healing, and then an abdominal incisional hernia may occur.

(2) Incisional dehiscence Various forms of incisional dehiscence that are not treated in a timely and effective manner will directly lead to incisional hernia.

(3) Incision selection The incision position and direction are also related to the occurrence of incision hernia. The incidence of incision hernia in lower abdominal incision is higher than that in upper abdominal incision. The risk of incision hernia after longitudinal incision is significantly higher than that of lateral incision.

(4) The suture technique may induce incisional hernia if the upper level of suture is not correct, improper mating, too sparse, embedded in other tissues, and gaps in the peritoneum are sutured.

2. Systemic factors

(1) Obese and obese patients have weak muscles and weak abdominal wall laxity, and the incision is easy to tear after surgery, so incision hernia is prone to occur.

(2) Chronic diseases with increased intra-abdominal pressure Elderly patients often have a series of diseases that cause increased intra-abdominal pressure, such as chronic obstructive pulmonary disease (COPD), prostatic hyperplasia, and intractable constipation, which are prone to incision dehiscence and poor healing leading to incisions. The occurrence of a hernia.

(3) Diabetic patients have poor wound healing ability, and the incidence of incisional hernia is 5 times that of normal people.

(4) Malnutrition, the use of adrenocortical hormones and other immunosuppressive drugs hinders the healing process of the incision and leads to incision hernia.

(5) Disturbances in collagen metabolism Some patients with incisional hernias have collagen metabolism disorders, which directly affects the healing of the incision.

Clinical manifestations of abdominal wall incision hernia

Patients with abdominal wall incision hernias have a clear history of abdominal surgery. The clinical manifestations are the abdominal wall mass at the original surgical incision site, which protrudes or increases when the abdominal pressure increases. In most cases, it can be recovered after supine and disappears, and palpation can touch the defect under the incision; sometimes the contents of the hernia and the hernia ring Or hernia sac adhesion is not easy to accept. Acute incarceration can cause persistent pain and can be associated with the appearance of intestinal obstruction. If necrotic strangulation occurs in the contents of the hernia, the pain is persistent and severe, which can cause inflammation and edema of the outer cover of the hernia, flushing the skin, and increasing skin temperature. Strangulation is a very serious complication of an incisional hernia, and it must be operated in time, otherwise it will kill the patient. In addition, huge incisional hernias are often accompanied by trophic ulcers on the skin, and the progress of this ulcer may lead to the rupture of the abdominal wall and intestinal fistula.

Abdominal wall incision hernia

In addition to clearly showing the location and size of hernia defects in the abdominal wall, the contents of the hernia, and its relationship with the internal organs, CT can also help find some hidden hernias, multiple hernias, and incarcerated hernias.

Diagnosis of abdominal wall incision hernia

A typical incisional hernia can be clearly diagnosed by asking a detailed medical history and careful physical examination. Ultrasound, CT and other imaging examinations can be used to assist the diagnosis, evaluate the size of the incisional hernia defect and the contents of the hernia, and provide a reference for further development of the surgical plan. Some patients with acute abdomen should pay attention to the presence of incision hernias or strangulation during physical examination, especially when accompanied by intestinal obstruction.

Abdominal wall incision hernia treatment

Surgery is the only effective way to cure abdominal wall incision hernias. When only conservative treatment of abdominal wall incision hernia is used, the potential risk of incarceration and even strangulation is high. Therefore, after the diagnosis is clear, those who have no contraindications to surgery are advised to perform surgery as soon as possible.

Non-surgical treatment

It is only applicable to patients with abdominal wall incision hernias with other serious diseases and metastasis or recurrence after tumor surgery. For patients with short surgical time and wound infection healing soon, non-surgical treatment can also be used while waiting for surgery.

Non-surgical treatment is mainly the use of elastic abdominal bands. In the course of conservative treatment, if clinical symptoms such as nausea and vomiting, abdominal pain occur, you should check in time for incarceration or strangulation.

2. Surgical treatment

Surgical repair of abdominal wall incision hernia includes two major types: open repair and laparoscopic repair. In addition, it also includes hybrid operation of laparoscopy and open operation. Repair methods include direct suture repair and patch repair. Direct suture repair has a recurrence rate of more than 50% and is only suitable for abdominal wall incision hernias with small defects. At present, patch repair is mainly used in clinical practice, and the recurrence rate is about 5%.

(1) Open incision hernia repair was performed earlier, but the trauma to the abdominal wall and the patient was relatively large. At the same time, it was difficult to place and fix the patch during open surgery.

(2) Laparoscopic incision hernia repair Laparoscopic incision hernia repair is to make 3 to 5 small holes of 5 to 12 mm in the abdominal wall. First, the intra-abdominal adhesion caused by the previous operation is separated, and then the defect is repaired with a patch. Make repairs. Compared with open surgery, it has obvious minimally invasive advantages. At the same time, the placement of the patch can be performed directly under direct vision, and the fixation of the patch is easier. It has become the first choice for repair of abdominal wall incision hernia.

(3) Hybrid repair For some patients with incision hernias with heavy adhesion in the abdominal cavity, the adhesion can be separated in the open state through a small incision in the abdominal wall, and then the patch is placed and fixed under laparoscopic direct vision, the so-called open and abdominal cavity Microscopy combined with hybrid surgery to overcome the respective shortcomings of open and laparoscopic incision hernia repair to achieve the ideal repair.

Abdominal wall incision hernia prevention

Mainly for various causes of abdominal wall incision hernia.

1. Avoid incision infections

By improving the general condition before and after surgery, correcting hypoproteinemia, controlling blood sugar, stopping or adjusting the amount of hormones and immunosuppressants before surgery, the healing ability and anti-infection ability of the incision can be enhanced, combined with strict aseptic operation during the operation, Protect the incision and other measures to reduce the probability of infection of the incision.

2. Avoid splitting the incision

On the one hand, the wound healing ability is enhanced through the above measures, and on the other hand, factors such as severe cough, intestinal palsy, and abdominal distension that increase intra-abdominal pressure after surgery are avoided. In combination with post-operative bandaging, the incision is avoided.

3. Avoid factors of chronic intra-abdominal pressure increase

For patients with chronic obstructive pulmonary disease, prostatic hyperplasia, refractory constipation and other diseases that cause increased intra-abdominal pressure, postoperative management and relief of the above factors can help reduce the incidence of postoperative incisional hernias.

In addition, good incision design and suture techniques, smoking cessation, weight loss, etc. all help reduce the incidence of abdominal wall incision hernias.