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Wall Hernia Surgery
Wall hernias or ventral hernias are defects of the aponeurosis and abdominal muscles through which intra-abdominal or pre-peritoneal contents may protrude.
What happens if surgery is not performed?
They can become very painful, especially after lifting something heavy. The complications of these hernias are because the abdominal contents, either fat or intestine, can get stuck in the ring and not return to their place, causing pain. In the case of the intestine, the blood supply may be compromised and cause a surgical emergency.
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These are some of the FAQs about wall hernia surgery
Wall hernias or ventral hernias are defects of the aponeurosis and abdominal muscles through which intra-abdominal or pre-peritoneal contents can protrude.
When they occur after surgery, they are called incisional hernias; the risk of developing hernias is up to 20%. The factors that contribute to their development are obesity, scarring defects, the previous practice of multiple surgeries, smoking, among others.
Es común una masa o abultamiento en el sitio de la cicatriz; pueden ser asintomáticas o provocar gran molestia y a menudo crecen con el tiempo.
A mass or lump at the scar site is common; they may be asymptomatic or cause significant discomfort and often grow over time.
En hernias grandes o pacientes con obesidad se solicitará tomografía computarizada que nos permite delimitar con seguridad los bordes de la hernia y estimar el tamaño de malla que se utilizará.
If you are over 40 years old or have any chronic disease such as diabetes mellitus, hypertension, heart disease, or others, you will require blood tests such as blood biometry, blood chemistry with glucose, creatinine, serum electrolytes, electrocardiogram, and chest X-ray.
These studies should be evaluated by an internist or cardiologist and the anesthesiologist in search of any alteration that needs to be alleviated before surgery. It is recommended to lose weight in case of obesity since this favors better results. Fasting for 6 to 8 hours on the day of surgery is indicated, and if you are taking medication for blood pressure or diabetes mellitus, these will not be suspended.If the patient takes aspirin, it should be suspended for at least 7 days, in any surgery that is performed, due to the bleeding that can be generated since acetylsalicylic acid alters the function of platelets, favoring alterations in coagulation.
Abdominal wall hernia surgery involves closing the defect with the placement of a particular mesh. It is usually done laparoscopically with excellent results. This unique mesh has two different sides; one of them contains a polypropylene fabric called the common mesh material. It adheres to the abdominal wall, creating an excellent fixation.
This material is used in inguinal hernia repair because it is located outside the abdominal wall. Polypropylene cannot come in direct contact with the intestine. Therefore, it is combined with the other side of the mesh made of a cellulose or polytetrafluoroethylene material that can contact the intestines without adhesions or complications.
This special double-sided mesh can be placed laparoscopically or by a direct open approach. It has a low risk of recurrence.
Another alternative, depending on the case, is open surgery and the use of techniques on the abdominal musculature to face the edges and the placement of a special intra-abdominal mesh.It is not recommended to close a hernia with sutures alone without using unique meshes or specific abdominal muscle relaxation techniques. They have a high risk of recurrence of up to 40%.
Possible complications of wall hernia surgery are seroma, hematoma, or wound infection. The hernia may recur in less than 1% by laparoscopy.
Care after wall hernia surgery, if performed by laparoscopy, is mainly bed rest for 1 week, performing activities in the second week. In the open technique, rest is recommended for 2 weeks, and avoid carrying heavy things for 2 months due to the risk of the hernia forming again. In both cases, the wounds should be washed with soap and water and kept covered with sterile gauze. The stitches are removed in 7 days.