Incisional Hernia (incisional hernia)
(Update: ) - Hernia
In a patient who has had previous surgery dislocated hernias. Incision hernias may occur early after the first surgery or years later. English Incisional Hernia (incisional hernia).
Causes of Incisional Hernia?
Incision hernias can be caused by reasons related to the patient or surgery. Wrong selection and wrong application of the materials or surgical technique used during the surgery are doctoral reasons. Patient reasons systemic diseases such as diabetes, anemia, chronic heart disease, chronic lung disease, malnutrition, collagen tissue disease and cancer, and the use of drugs that disrupt wound healing.
Regardless of the reason, incision site hernias should be considered as if the previous problem still continues and should be repaired in the most reliable and robust way. Otherwise, they will relapse easily.
Hernia in the surgical entry areas after closed operations port-site incisional hernia called. Since porter hernias are smaller than other hernias, they can be closed with primary surgical repair.
However, although it is small, it may cause much larger abdominal wall tears in cases where no surgical intervention is performed.
Small incisional hernias (<5cm) can be treated with primary surgical repair (In umbilical hernia surgery The methods applied can be used). In this case, the patch (meshSince it is not used, the technique of the surgical intervention and the suture material used are very important. Unsuccessful operations can often result in recurrence. Experienced surgeons can usually choose special repair techniques according to them.
Incision hernias can reach very large sizes in a short time if not treated. In some cases, choking and rotting can be seen in the intestinal and intestinal membranes coming out of the torn area (WHAT IS INTESTAL DECAY??). Although it varies according to the size of the tear in the abdominal wall, it is technically the most difficult hernia. The source of the difficulty is that in very large hernias, for example, abdominal wall tears up to 15-20 cm in diameter, it may not be possible to stitch and close the abdominal membrane, because there is not enough soft tissue under the skin. Composite patches should be used for large incision hernias.
Composite patches have two layers. One side of these patches is covered with a special layer that prevents them from sticking to the intestine. If the patch is placed in such a way that this side remains in the abdomen, a smooth and successful repair can only be achieved.
The reliable and tissue-friendly structures of these high-tech patches are their advantages and their disadvantages. “Dual layer”Or“compositeThe prices of these patches, called "", vary according to their size and shape.
When repaired with the open method, standard patches are used for medium-diameter incision hernias (5-10cm), while composite patches must be used for large-sized hernias (> 15cm). When the composite patch is not used, it is necessary to either stretch the abdominal wall tightly to close it, or allow the standard patch to touch the intestines. Both situations lead to serious complications.
Incision hernias are repaired by open or closed method. Composite patches are used in all large / small incision hernias repaired by the closed method. Because here the patch is placed in the abdomen: Intra peritoneal onlay mesh -IPOM.
With this method, there is a chance to examine the entire abdominal wall from the inside and to close all the tears from the inside with a patch that is large enough to cover all weak points, if any. The only problem here is that the cost of surgery increases due to the price of the patch.