Abdominal incisional hernia repair

The occurrence of incisional hernia in the abdominal wall is often affected by the following factors: whether the incision is infected, whether the incision has tension, the position of the incision, the type of suture, and the suturing technique. Most of these factors can be avoided and corrected to prevent the occurrence of incisional hernias. After the incision is made, if there is no special contraindication, it is advisable to repair it early. The longer the time, the larger the hernia sac and the weaker the muscle around the abdominal wall, the less chance of success. On the other hand, the incisional hernia is mostly the sequelae of wound infection. After the wound is healed, there is still congestion and edema in the scar, and there are even hidden infections. It is not easy to perform repair surgery too early. Therefore, it is generally appropriate to repair the incision half a year after healing. If the patient has a serious cardiovascular system and is not suitable for surgery, he can use the sputum. Treating diseases: incisional hernia Indication The occurrence of incisional hernia in the abdominal wall is often affected by the following factors: whether the incision is infected, whether the incision has tension, the position of the incision, the type of suture, and the suturing technique. Most of these factors can be avoided and corrected to prevent the occurrence of incisional hernias. After the incision is made, if there is no special contraindication, it is advisable to repair it early. The longer the time, the larger the hernia sac and the weaker the muscle around the abdominal wall, the less chance of success. On the other hand, the incisional hernia is mostly the sequelae of wound infection. After the wound is healed, there is still congestion and edema in the scar, and there are even hidden infections. It is not easy to perform repair surgery too early. Therefore, it is generally appropriate to repair the incision half a year after healing. If the patient has a serious cardiovascular system and is not suitable for surgery, he can use the sputum. Contraindications Older, combined with severe heart, liver, kidney and other diseases and difficult to tolerate surgery. Preoperative preparation Should pay attention to strengthening the abdominal muscles before surgery, eliminate the factors that increase intra-abdominal pressure. Surgical procedure The surgical incision depends on the position and size of the incisional hernia. A fusiform incision is often used because the original incision scar is removed together. The above abdominal abdominis incisional hernia is taken as an example: For incisional hernias covered with skin, it can be sharply separated after incision of skin scars. For scars covered only by scars, it can be cut at the junction of skin and scar connective tissue, revealing the fibrous connective tissue covered by the outer layer of the incision, the so-called pseudo sac, which connects the connective tissue around the pseudocapsule Separate sufficiently to separate it from adjacent abdominal wall skin and subcutaneous tissue. Generally, both sides need to exceed 2 to 3 cm to reduce the tension during sewing. The fascia tissue of the anterior sheath of the rectus abdominis was lifted with a hemostatic forceps, pulled outward, and the anterior rectus sheath was cut along the edge of the base of the pseudocapsule. The rectus abdominis muscle was pulled forward again, and the pseudo sac was further separated sharply from the deep part until the posterior rectus sheath and the peritoneum of the rectus abdominis were exposed. The sac is first cut at the non-adhesive site of the sputum and the sac, and then cut along the ring at the junction of the pseudo sac neck and the normal peritoneal tissue. Care should be taken to avoid damage when cutting, and the omentum adhesion can be ligated and cut. The pseudo sac is completely removed, and the contents of the sputum are returned to the abdominal cavity. After examining the following intra-abdominal organs without adhesion and injury, suture the rectus abdominis posterior sheath and peritoneum with a 7-0 silk suture. Suture the rectus abdominis with a 4-0 or 7-0 silk thread (a distance of 1 to 1.5 cm). The anterior rectus sheath was sutured with 7-0 silk sutures (intermittent suture suture and intermittent suture). Finally suture the subcutaneous tissue and skin. complication Intra-abdominal pressure, gastrointestinal pressure.