Why did the seam fail?
- Suppuration or prolonged healing of a postoperative wound is the main factor
- Obesity: adipose tissue impairs blood supply and increases stress on the suture
- Diabetes mellitus and tissue nutrition disorders
- Smoking has been proven to impair the healing of aponeurosis
- Early heavy load after surgery
- Chronic cough, constipation, difficulty urinating
- Emergency surgery and large midline incision
- Repeated interventions through the same access
Отдельная группа риска — пациенты, перенёсшие операцию по поводу перитонита или кишечной непроходимости: там рана заживает в условиях воспаления, и вероятность грыжи заметно выше.
How it manifests itself
First - a soft, painless protrusion next to the scar, noticeable when straining. As you grow, nagging pains, a feeling of heaviness, and stool disturbances appear. With giant hernias, a significant part of the intestine moves into the hernial sac, and the stomach loses its ability to normally hold organs: breathing, posture, and bowel function suffer.
- Protrusion in the scar area, increasing while standing
- Nagging pain and heaviness in the abdomen
- Constipation, bloating, discomfort after eating
- Irritation and maceration of the skin in the fold above the hernia
- Limiting physical activity
Survey
- Осмотр хирурга с определением количества и размеров дефектов — их часто несколько по ходу рубца.
- УЗИ передней брюшной стенки.
- МСКТ брюшной полости при крупных, рецидивных и многокамерных грыжах: позволяет спланировать методику и оценить объём содержимого.
- Оценка сопутствующих diseases — диабета, ожирения, дыхательной функции.
Methods: how they differ
- ON LAY - the mesh is placed over the sutured aponeurosis. Technically simpler, used for small and medium defects.
- IPOM is a laparoscopic installation of a special mesh from the abdominal cavity. Less trauma, shorter recovery; The mesh has an anti-adhesion coating.
- E-TAR and other techniques for separating abdominal wall components are for large defects where the edges cannot be brought together without tension. Allows you to restore the anatomy of the abdomen.
- Plastic surgery using your own tissues - only for small defects.
There is no universally “best” technique: the choice depends on the width of the defect, the number of chambers, the condition of the tissues, the patient’s weight and previous operations. The surgeon’s task is to close the defect without tension, because it is tension that leads to relapse.
What reduces the risk of relapse
- Снижение веса до операции — это реально меняет прогноз, а не формальность.
- Отказ от курения минимум за несколько недель до вмешательства.
- Компенсация сахарного диабета.
- Treatment хронического кашля и запоров.
- Соблюдение ограничений по нагрузке в первые 6–8 недель.
- Ношение бандажа в назначенный период после операции.
