Incision, abdominal and epigastric or Umbilical hernias are defects of the anterior abdominal wall. They can be congenital (hernia umbilicalis) or acquired (incision). Incision hernia shape after the operation by the incision site or previous drain sites, or laparoscopic trocar insertion sites.
Incision hernia have been reported in about 4-10% of patients after open surgical procedures. Certain risk factors make patients prone to incision hernia, such as obesity, diabetes, respiratory insufficiency (lung disease), steroids, wound contamination, postoperative wound infection, smoking, hereditary disorders such as Marfan syndrome and Ehlers-Danlos Syndrome Syndrome, as well as a bad development surgical technique. Approximately 90,000-100,000 scar fracture repairs are run annually in the United States.
This hernia is present in much the same way inguinal hernia. That is, they present themselves with a bulge in the neighborhood or a previous incision. Some patients may discomfort, abdominal cramps or complete intestinal obstruction, or incarceration as a result of that hernia.
The principle of surgical repair involves the use of prosthetic mesh for large defects to recover the tension on the repair to minimize. A tension free repair has a lower chance of relapse hernia. Traditionally, the old scar incised and removed, and the entire length of the incision inspected. Generally, there are multiple other flaws than the herniated disc (s) detected by physical examination. The area, which requires coverage is generally large and takes a lot of surgical dissection. A prosthetic mesh is used to the defect (s) cover, and the wound closed. This is a major surgical procedure and often complicated. Infection rates after repair can be as high a 7.0%. Repetition can reach up to 5%, or higher, depending on the patient’s preoperative risk factors. While the use of prosthetic mesh decreased the number of relapses, is also involved in increased infection rates, adhesion or scar formation of the abdominal contents to the anterior abdominal wall lead to bowel obstruction and Fistula formation. However, general recovery is usually excellent and patients to return to normal activity within a matter of weeks.
The laparoscopic ventral hernia repair was meant to minimize operative trauma for the patient. As mentioned, these are often complicated repairs that large incisions and comprehensive dissection of tissue. The principles for a laparoscopic ventral hernia are based on that of open Stoppa ventral hernia. A big piece of the prosthetic mesh is placed under the hernia defect with a wide margin of the meshes outside the defect (see figure). The mesh is anchored in place with eight full thickness sutures and attached to the anterior abdominal wall with a varying number of TACs, laparoscopic placed.
A patient is a candidate for laparoscopic hernia repair scar if they are medically able to undergo general anesthesia. The defect should also “allow” the surgeon the laparoscopic trocars place in such positions, which for repair are ergonomically as possible.
In some very large or large hernias, the abdominal wall is distorted to such an extent that it is impossible to safely place laparoscopic trocars. Additional studies such as CT scan of the abdomen and pelvis are helpful in making this decision. Patients also get a bowel preparation prior to evacuate and decrease of the number of intestinal bacteria to the surgery.
Patients are admitted on the same day of their operation. As a result of the procedure and the recovery of anesthesia, they are transferred to a hospital room where they spend the night. We encourage our patients to move as quickly as possible. It is extremely important to early active in order to stave off a part of the complication after surgery, such as pneumonia, deep vein thrombosis and pulmonary embolism (blood clots in the legs that break down and enter the lungs).
Postoperative pain is variable, and can significantly during the first 24 hours. As such, patients who I.V. drugs as needed, and oral analgesics are changed in the next day. In general, most patients in the hospital stay 1 or 3 days after surgery. Patients are then seen by the surgeon, one to two weeks after dismissal. There is no caloric restriction. Activity level is limited by the comfort of the patient level. However, it is generally not advisable to take part in a heavy physical exertion or heavy lifting for several weeks, so that the hernia to heal.
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