INCISIONAL HERNIA THE SURGICAL PATIENT.pptx

Surgical hernia

1. INCISIONAL HERNIA Maryann Onipe Abigail Adegbulu Eniola Fatungase Olobatoke Tunde

2. Outline Introduction Relevant anatomy Epidemiology Causes/Risk Factors Clinical Features Complications Management Complications of surgery Summary References

3. Introduction A hernia is the protrusion of a viscus or part of it from the cavity in which it is enclosed through an abnormal or weak opening in the wall of the cavity The common abdominal hernias in order of frequency in adult life are: inguinal umbilical incisional femoral epigastric.

4. Introduction: Incisional Hernia An abdominal incisional hernia is a hernia through an acquired scar in the abdominal wall, caused by a previous surgical operation or injury. These arise through a defect in the musculofascial layers of the abdominal wall in the region of a postoperative scar. Thus they may appear anywhere on the abdominal surface.

5. Relevant Anatomy

6. Relevant Anatomy

7. Epidemiology Incisional hernias have been reported in 10–50 per cent of laparotomy incisions 1–5 per cent of laparoscopic port-site incisions Approximately 50% occur within the first 2 years after surgery and 74% occur in 3 years Highest incidence is seen with midline incisions

8. Causes (1) Vertical scar, midline scar, lower abdominal scar Scar of major surgeries Poor nutritional status of patient Presence of cought , tuberculosis, anaemia , hypoproteinemia Smoing in post operative period Increase intraabdominal pressure (BPH, straining, urethral stricture)

9. Causes (2) Closure techniques (Layer > Single, ( Continous >> interrupted closure) Incision type: Vertical incision >> horizontal incision Sture type: Absorbable >> nonabsorbable Surgery type: Emergency surgical wound >> elective surgical wounds Chroic diseases like DM, malnutrition, malignancy, immunosussopresive disorders Old age

10. Clinical Features Asymptomatic Swelling in the scar region Pain Impulse on coughing Gurgling sound Visible bowel peristalsis Symptoms of complications

11. Complications Irreducibility Obstruction Incarceration Traumatic rupture of the atrophic skin with eviscera tion of the contents Strangulation (rarely)

12. Management HISTORY TAKING History of lower abdominal surgery History of wound infection (esp. deep wound infection) History of postoperative coughing, vomiting and abdominal distension History of drainage tube through the wound EXAMINATION Swelling at the site of the scar Expansile impulse on coughing present Swelling is partially reducible in standing position Palpable defect in the lower abdomen

13. Management (Contd.) Investigation Abdominal Ultrasound Scan: To demonstrate the size of the defect FBC: Anaemia may be present Chest X-ray: To evaluate COPD or other pulmonary diseases Nutritional assessment: To evaluate the general wellbeing of patient Evaluation of the cardiac and renal status Treatment A. Conservative: Abdominal belt/corset: Used especially if hernia is non-symptomatic, upper-abdominal and patient not fit for surgery. B. Definitive (surgical repair): Mesh repair (Gold standard) Primary fascial repair Autogenous repair by vascularized innervated muscle flaps

14. Management Preoperative preparations Weigh t reduction by dieting and exercise. Patient is asked to stop smoking . Treattherespiratoryproblems. Postoperative care In the post-operative period bowel distension should be prevented, if necessary by nasogastric decompression and flatus tube. Chest infection should be vigorously combated . Patients should be instructed to give support to the wound with the hand when coughing or straining.

15. Complications of incisional hernia repair Wound infection Seroma formation Wound sinus Enterocutaneous fistula Recurrence Infection of the mesh *Recurrence is 10-23% with mesh repair and up to 46% with the overlapping repair*

16. Summary An incisional hernia develops when tissue pushes through a weakened area of the abdominal wall, usually at the site of a previous surgical incision. It can cause a visible bulge, discomfort, and sometimes pain. Treatment typically involves surgical repair to strengthen the abdominal wall and prevent further complications.

17. References Bailey and Love’s short practice of Surgery 26 th edition Hope WW, Tuma F. Incisional Hernia. [Updated 2023 Jun 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK435995/

18. Thank you