Generality
The incisional hernia is a particular type of hernia, which occurs at the level of the large scars resulting from abdominal "open" surgery. Not surprisingly, the surgical technique that involves performing large scars on the abdomen takes the specific name of laparotomy.
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At the origin of the laparocele episodes, there is a failure of the surgical scar closure process, resulting from the laparotomy operation.
The presence of a laparocele is characterized by the formation of a protrusion, at the site where the scar is located.
The complications of the incisional hernia include intestinal obstruction - if the bowel that comes out is the intestine - and the narrowing of the hernia.
The treatment of laparocele is of a surgical type and consists in replacing the escaped bowel in its original seat and in strengthening the abdominal wall, to avoid a subsequent hernia.
Definition of hernia
A hernia is the outflow of a bowel - and, often, of adjacent tissues (for example the surrounding fatty tissues) - from the body cavity that normally contains it (NB: the word viscera indicates a generic internal organ).
The spill may be total or partial.
What is laparocele?
The laparocele is a particular type of hernia, which is formed in correspondence with the large scars resulting from abdominal surgery "in the open" .
In fact, therefore, the laparocele is a complication of the operations of classical surgery, which have as their object the abdomen.
The aforementioned large scars are, clearly, the results of surgical incisions.
IS IT AN IMMEDIATE OR LONG-TERM SURGICAL COMPLICANCE?
The laparocele is a surgical complication that tends to arise after several months, if not even years, from the operation of abdominal surgery "in the open".
In essence, therefore, the laparocele is a long-term surgical complication.
ORIGIN OF THE NAME
The term laparocele refers to the laparotomy .
The laparotomy is the surgical technique that involves the practice of large incisions on the abdomen, to be able to access the latter; otherwise known as abdominal surgery "in the open".
Reminding the readers that the medical suffix "-cele" derives from the Greek and means "hernia" or "leakage", laparocele could translate as "hernia of a laparotomic nature" or "hernia due to laparotomy".
HOW MUCH IS IT COMMON?
According to some statistical surveys conducted in the United Kingdom, 12-15% of abdominal surgeries would lead to the formation of a laparocele.
Causes
At the end of a laparotomy surgery, the operating doctor applies a series of stitches on the abdominal incision, in order to allow correct closure.
Laparocele episodes occur when, for some reason, the process of closing the abdominal incision is inappropriate or fails; in fact, the failed closure of the abdominal incision deprives the muscular wall of the abdomen - which has the task of containing the underlying viscera - of a fundamental support for its containment action.
RISK FACTORS
Several statistical surveys have shown that the incisional hernia is more frequent between:
- Overweight people;
- Elderly people;
- Individuals suffering from chronic cough (eg chronic obstructive pulmonary disease), constipation, urinary obstruction and ascites. These conditions elevate intra-abdominal pressure; in turn, the high intra-abdominal pressure favors the escape of the abdominal viscera where there is a weakening of the containing muscular wall;
- Subjects who use, or have used in the past, steroid anti-inflammatory drugs;
- Individuals who developed an abdominal wound infection, home of the laparocele;
- Individuals who have undergone more than one laparotomy intervention.
Symptoms and Complications
The characteristic sign of the laparocele is a protrusion (or swelling ), located in a point of the surgical scar.
Soft to the touch and with a tendency to get bigger on physical exertion, protrusion / swelling indicates the release of the viscera contained in the latter from the abdominal cavity.
The presence of the aforementioned protrusion (or of the aforementioned swelling) may or may not be associated with a certain symptomatology. When present, the typical symptoms of a laparocele consist of:
- Moderate abdominal discomfort;
- Real abdominal pain;
- Sense of nausea;
- He retched.
WHAT CAN IT LEARN IN SERIOUS CASES?
In cases of laparocele of mild or intermediate severity (most patients), the protrusion is wrapped in a layer of skin. This means that only the abdominal muscle wall and not the skin has cleaved.
In cases of severe or very severe laparocele, however, it is highly probable that the protrusion of the viscera lacks a skin wrap. In these situations, the continuity not only of the abdominal muscle wall, but also of the skin was interrupted.
WHAT TYPES OF ENGRAVING PROVIDE LAPAROCELE?
Any type of laparotomic incision can cause the incisional hernia. However, the longitudinal incisions - in other words the incisions that go from the xiphoid process of the osteria to the pubic area - are those that characterize most clinical cases.
The reason why the incisional hernia is more common during a longitudinal incision (compared to a transversal incision) is unclear.
COMPLICATIONS
The laparocele can become a life-threatening condition in two circumstances:
- When it comes out of its abdominal area is a portion of the intestine and this portion suffers an occlusion ( intestinal obstruction ). An intestinal obstruction prevents the bowel contents from advancing normally and this is the cause of some characteristic symptoms, such as: nausea, vomiting, pain (or cramping) in the stomach.
- When the herniated (that is, escaped) bowel suffers a " constriction ". With the term "bottleneck", doctors identify the situation in which the herniated tract of the bowel no longer receives the correct blood supply. Without the right blood supply, the cells of the portion involved in the spillage undergo death (or necrosis), lack of oxygen and nourishment.
The "choking" of a crural hernia represents a medical emergency to be treated with extreme timeliness.
Its most typical symptom is the strong and sudden pain that goes from the lower abdomen to the groin area affected by the hernia.
Diagnosis
In general, for a correct diagnosis of incisional hernia are fundamental: the physical examination, the anamnesis, an ultrasound of the abdomen, a CT scan (or computerized axial tomography) and a nuclear magnetic resonance (NMR).
Ultrasound, CT and nuclear magnetic resonance serve more than anything else to highlight the characteristics of the hernia, from or from the viscera interested at the precise point where the abdominal muscular wall has flaked.
OBJECTIVE AND ANAMNESIS EXAMINATION
The objective examination is the set of diagnostic maneuvers, carried out by the doctor or requested by the patient, to verify the presence or absence of signs indicative of an abnormal condition.
- In the case of a suspected incisional hernia, one of the most common diagnostic maneuvers consists in the request by the doctor to the patient to cough to see if, at some point of the abdomen, a bulge or bulge emerges.
The medical history, on the other hand, is the collection and critical study of symptoms and facts of medical interest, reported by the patient or his family members (NB: family members are involved, above all, when the patient is small).
- In the case of a laparocele suspicion, a past history of several laparotomy operations is a fact of great medical interest.
Treatment
The incisional hernia requires a surgical treatment. The purpose of surgical treatment is to close that point on the abdominal wall, which gives rise to the hernia.
Today, to achieve this, there are three different methods of intervention:
- The surgical operation for the application of a hernia containing metal mesh;
- The laparoscopic operation of fixing of the hernia;
- The laparotomic operation (or "open-air") of fixing the hernia.
APPLICATION OF A CONTAINING METAL MESH
In essence, the metal mesh acts as a sort of patch, which prevents the bowel from coming out of its seat.
It is a safe operation and, from the point of view of results, reliable.
OPERATION IN LAPAROSCOPY
Laparoscopy is a minimally invasive surgical technique, thanks to which surgeons can access an individual's abdominal cavity and pelvic cavity through incisions that are decidedly smaller than those performed during traditional "open-air" surgery (laparotomy) .
The most representative surgical instrument of laparoscopy is the so-called laparoscope . Similar to a drinking straw, the laparoscope is built to be inserted into the abdominal and pelvic cavity, and therein view its contents thanks to a camera, a light and a connection with an external monitor.
Generally three in number, laparoscopic incisions allow the introduction not only of the laparoscope, but also of those surgical instruments usually indicated for the removal of an organ or part of it.
The laparoscopic procedure for the fixation of a laparocele is a recently developed operative modality, which presents the important advantage of being minimally invasive.
From a practical point of view, it provides for the relocation, in its original location, of the released viscus and the suture of the leak present in the abdominal muscular wall.
All the advantages of laparoscopic surgery:
- Being small in size, surgical incisions have a lower tendency to develop infections;
- Post-operative pain is less intense than that following laparotomy surgery;
- Hospitalization lasts less (generally one day), compared to the hospitalization planned after a laparotomy operation;
- The scars resulting from surgical incisions are minimal and not very evident;
- Faster healing and shorter recovery times, compared to what happens during a laparotomy surgery.
OPERATION IN LAPAROTOMY
The operation in laparotomy for the fixation of a laparocele involves the practice of a large incision on the abdomen, the relocation in its original site of the outgoing bowel and the seam of the abdominal area presenting the leak.
Compared to the laparoscopic operation, it is much more invasive.
In recent years, it is finding less and less use, as it is not very effective due to its great invasiveness.
The main disadvantages of laparotomy surgery:
- Hospitalization must last a few days; these are necessary for the patient to take back part of the physical energy lost due to the considerable invasiveness of the procedure;
- Post-operative pain is intense and often requires the administration of painkillers for several consecutive days;
- The resulting scars are obvious and large.
WHY IS IT GOOD TO INTERVENE?
The laparocele is a hernia that tends to get bigger over time. The larger a laparocele is, the more difficult it is to remedy.
These are the two main reasons that prompt doctors to recommend timely treatment as soon as they diagnose the problem.
Prognosis
The more timely the treatment, the greater the probability that the incisional hernia has a positive prognosis. In fact, any delays in therapy favor the appearance of complications and reduce the chances of success of the surgery.
In general, the resumption of normal daily activities, after a laparocele intervention, can take place after just a few weeks.
