Incisional Hernia (Ventral or Post-Operative Hernia)Def- An
incisional hernia is one which occurs through an acquired scar in
abdominal wall caused by a previous surgical operation or an
accidental trauma. Aetiology 1) Defect with patient- a) Obese
individuals with lax muscles b) Patient with chronic cough c) Undue
abdominal distention d) Malnutrition- patient with severe
anaemia,vit.c deficiency 2) Fault during operation- a) Injury to
motor nerves supply area. e.g.- Kochers sub costal incision for
cholecystectomy inflicts injury to 8th,9th,1oth intercostal nerve.
- Battles pararectal incision for appendicetomy - Mc. Burneys
incision for appendicetomy may injure ilioingualnerve. b) Care was
not taken during closure of wound particularly deeper layers. c)
Haemostasis was not perfect or tissues were manhandled so that
early
post-operative infection was the result. d) Certain incisions
e.g. midline infra umbilical incision for L.S.C.S 3)
Post-operative- a) Infections b) Post operative cough and
distention c) Post operative peritonitis due to more chance of
wound infection d) Too early removal of sutures e) Steroid therapy
in postoperative period. Pathology - a) Starts unnoticed and
symptomless with partial disruption of deeper layers of laprotomy
wound during early post-operative period. so careful closure of
wound is important to prevent incisional hernia. b) Wound infecion
often causes disruptions of sutures thus muscles are separated by
weak scar tissue. A portion of muscles may also be destroyed by
infections which are resolved by fibrosis, this thus causes
incisional hernia. Clinical Features - a) History - Patient with
wound infection b) Age - Any age but commo nly fatty elderly
females Symptoms - a)Swelling and pain, b)sometimes attack of
subacute intestional obstruction may occur leading to
abdominal colic, c) vomiting, d) constipation and e)distention
of abdomen. On Examination - Old scar with swelling. swelling is
reducible and expansible cough impulse is present. Defect in
abdominal wall is palpable When hernia is irreducible than can be
differential diagnosis can be done with a) A deposit of tumour. b)
Old abscess c) Haematoma d) Foreign body granuloma Types - a) Type
- I ( lies in midline of lower abdomen) b) Type - II ( lies in
lateral part of abdomen) Treatment - A) Preventive treatment -- Pt.
if obese reduce weight -- chronic bronchitis should be treated
first -- care during operation = deeper layers must be sutured --
precautions to prevent immediate post operative wound infection. B)
Conservative treatment -
-- Done in Type - I cases if reducible and where operation is
contraindicated due to condition of the patient. After reducing
hernia a belt is fitted with suitable pad so that hernia doesnot
come out, if this is continued for long than there is possibility
of cure. C) Operative treatment -- Done in Type - II and if cases
are irreducible.
