Abdominal Wall Hernias
It is the displacement and bulging out of abdominal structures and organs in places with the weak abdominal wall. There are a lot of varieties, but they mainly occur in the groin, which is followed by umbilical hernias. They are important since the intestines are present in the hernia sac and intestinal obstructions (knotting), fluid-electrolyte incompatibility and death are observed.
Inguinal, umbilical, and incisional hernias are anterior abdominal wall hernias. Hiatal hernias, which are called stomach hernias and lead to reflux, are hernias at the junction of the stomach and esophagus.
They are observed in both genders, but more in males.
The causes of hernia are as follows: a sudden, severe increase in the intra-abdominal pressure, increased intra-abdominal pressure due to lung problems induced by smoking and continuous coughing, infections in which weakening of the anterior abdominal wall and prolonged coughing are observed,
– In individuals with chronic obstructive pulmonary disease (COPD)
– In cases of increased intra-abdominal pressure in pregnant women
– In obese individuals (especially in individuals with a weak abdominal wall)
– In renal failure patients undergoing peritoneal dialysis
– In individuals with collagen vascular disease.
Health professionals are consulted with complaints such as:
– Fullness and pain in the inguinal regions at the beginning of the event (they disappear when the person lies especially in the supine position)
– In advanced cases, swelling that emerges when standing and disappears when the person lies
– The sound coming from inside the swelling
– In cases of complete obstruction, pain in the hernia area, nausea, vomiting, difficulty in passing gas and defecation.
- The diagnosis of hernia is usually made by examining the patient after receiving information about the course of the disease.
- In obvious hernias, there is no need for an additional examination such as ultrasound or tomography to diagnose a hernia.
- However, in the early stage of hernia, when we consider the presence of an uncertain hernia in the examination, the diagnosis can be made by determining whether there is a loose area in the abdominal wall by making the patient strain during the ultrasound and ensuring the displacement of abdominal organs. The point that should be considered here is the necessity to perform the “straining procedure.” Preferably, the examination should be performed when standing. Otherwise, it can easily be overlooked.
- Fıtık tanısı genellikle kişiden hastalığın gidişatı ile ilgili bilgi alındıktan sonra muayene edilmesi ile konur.
- Aşikar fıtıklarda, fıtık tanısı koymak üzere ultrasound veya tomografi gibi ek bir tetkike gerek yoktur.
- Ancak başlangıç aşamasındaki fıtıklarda muayenede belli belirsiz fıtık varlığını düşündüğümüz hallerde ultrasound esnasında hasta ıkındırılarak karın içi organların yer değiştirmesi sağlanmak suretiyle karın duvarında gevşek bir bölgenin olup olmadığı tespit edilerek tanıya gidilebilir. Yalnız burada dikkat edilmesi gereken bir nokta; “ıkındırma işlemi”nin yapılması gereğidir. Tercihan ayakta bakılmalıdır. Aksi takdirde kolaylıkla gözden kaçabilir.
- The treatment of hernia is surgery. Only in neonates, the treatment of umbilical hernia is not surgery. Apart from this, all hernias are repaired by surgery.
- Open surgery
- As well as closed (laparoscopic) surgery can be performed.
- – It is the type of surgery which involves repairing the existing defect and supporting it with the foreign material accepted by the body.
- – In recent years, patch (mesh) repair is popular because it is accepted by the body and any problems are not experienced. Both inguinal hernias and umbilical and incisional hernias can be repaired by this method.
- – The most important case to be questioned here is the recurrence of hernia in the postoperative period. The possibility of recurrence is generally between 1-5% for patch repair, and this ratio is about 1% in the repair of inguinal hernia with a patch (the Lichtenstein operation).
- – The healing process after surgery is different for everyone, but it is about 1 week-10 days. The person returns to active life within 1 week – 10 days after open surgery.
- – The existing defect is repaired by patching the hernia through the ports entered through 0.5-1 cm holes. – In open surgery, since there is no wound as big as an incision, the postoperative period is more comfortable. Less pain is felt.
- – Cosmetically, fewer surgical scars are left.
- – Since the incision and tissue damage are less in the skin/subcutaneous tissue, the healing process and return to normal active life will be earlier.
- – The rate of recurrence after surgery is equivalent to the operation performed with an open patch, and it is 1%.
- – Both inguinal and umbilical hernia patients can be treated in a closed way.
- – If incisional hernias are very large, the aesthetic results of closed surgeries are not very good.
What Should Be Taken intoo Account After Surgery
– Especially there is a process of wound healing lasting for 1 week-10 days. After dressing on the 1st day after surgery and since the 2nd day, the wound can be left open. The patient can take a bath after the 2nd day.
– Male patients should wear slip panties so that the testicles and the elements are suspended and no edema occurs
– Constipation should be avoided, the patient should avoid straining for a long time
– Situations that increase the intra-abdominal pressure (such as cough, suppressed sneeze) should be avoided, and measures should be taken for this
– Abdominal stretching movements should not be performed for 2 months
– Wound healing takes 1 week. Again, after dressing on the 1st day after surgery and since the 2nd day, the wound may be left open. The patient can take a bath after the 2nd day.
– In terms of abdominal movements, abdominal movements can be started earlier.
– Again, male patients should suspend the testicles by wearing slip panties
– Movements that increase the intra-abdominal pressure should be avoided (measures should be taken for constipation and coughing)
– In addition to the above-mentioned precautions, each patient should be treated according to his/her condition. The path is drawn for patients according to the size of the wound and the width of the defect
– In the case of abdominal incisional hernias, we definitely recommend the use of an ABDOMINAL CORSET. However, while doing this, we recommend that the abdominal muscles should not be passivized but actively used.
– The importance of physiotherapy in our program is here.
We do not want to melt the abdominal muscles due to not using the muscle tissue and provide isometric contractions with our physiotherapists.