Incisional hernia /ventral hernia

Definition

Cure of eventration

Definition

 

Hernia on old scar or operational eventration post

 

The eventration is a hernia that develops on scar of laparotomy (incisionnelle hernia).
 

It is about a defect parietal (aponevrotic déhiscence with bag péritonéal) consequence of a surgical operation for 95% of the cases or of a trauma for 5%.

 The majority are constituted and become apparent in the year which follows the initial operation.

  

  •  The éventrations frequent, assigning 5% to 20% of are operated there by classical opening of the abdomen (laparotomy)

Symptoms

Symptoms

Symptoms eventration

 

The eventration generally are painless and quite reducible.

The eventration present like a curve or masses localised on old abdominal scars.

It can contain small intestine or large intestine, sometimes both at the same time.

The progressive development of the bag and the heaviness of its contents cause embarrassment which can become invalidating.

A eventration which becomes painful can become complicated of an obstruction of the bowels (the intestine is wedged in the hernia) with risk of intestinal perforation

The signs of occlusion are the stop of gases and the matters, sometimes associated with vomiting.

A surgical operation is then necessary in urgency.
 

  • Symptoms

  •  Pain

    Obstruction of the bowels (strangled eventration)

        

    Intestinal perforation (caused to become gangrenous)

           

Respiratory disorders of the subject having a large eventration

 

Two cases of figure:

  • Large eventration with mobile contents

It involves an abdominal paradoxical breathing with secondary respiratory insufficiency.
Permanently the diaphragm is slackened and the Pressure will intra abdominal is low.

  • Large eventration eventration with fixed contents

The internal organs are contained in a bag péritonéal out of the abdomen (second abdomen of Goni Moreno).
The surgical cure is delicate because the rehabilitation of these internal organs causes a respiratory imbalance.

Causes

Causes

Causes and risk factors of eventration

 

  • Type of incision (> risk)

  • Median Laparotomy the median incisions are more likely to become complicated eventration than the transverse or oblique incisions.

  • Iterative Laparotomies

  • Site of colostomies

  • Multiple openings of drainages

  • Wounds by balls and muscular knives damage and infections

  • risk factors

  • Obesity

  • Operational infection post: abscess or bruises of wall

  • Pulmonary complications, with obstruction and efforts of cough

  • Factors of very operational pressure abdominal post

  • Irradiation

  • Treatment immunodepressor (corticothérapie and chemotherapy).

  • Denutrition

 

Best the prevention of a eventration is the development of the surgery by laparoscopy avoiding the large classical incisions

 

 

Surgical Treatment

Surgical treatment

Treatment surgical of the eventration with installation of prosthesis

  • Indications

  • It is necessary to often operate the eventration of volume growing, awkward and especially painful, announcing then occurred of a throttling.

The treatment of the post-operative éventrations of the former abdominal wall consists in dissecting the hernial bag, to reinstate the internal organs in

abdominal cavity then to repair the wall, with or not poses of a prosthesis.

The way initially can be former (laparotomy) or intrapéritoneale (laparoscopy).

 

Cure of eventration with installation of plate by laparotomy (former way)

  • The old scar is réséqués.

  • It is about an operation requiring of vast separations, and the wide dissections. It can last 1 to 3 a.m. according to the cases.

  • The musculo-aponevrotic banks are perfectly dissected in order to present each side of healthy and solid fabrics (avivement of the banks)

  • The hémostase is meticulous person to avoid the postoperative bruises.

  • Parietal repair is possible thanks to a plate.

  • The prosthesis is placed in retro muscular pre fasciale between the péritonéal plan and the plan aponevrotic according to the technical tension free.

  • In certain cases, rare, space between the peritoneum and the muscles are inaccessible or unusable. A plate should then be laid out doubles phase in the cavity péritonéale (likely not to adhere to the internal organs)

  • The intervention generally ends in an aspiration drainage in space under cutaneous (drain of Redon).

  • These prostheses are tolerated perfectly by the organization and there does not exist allergic phenomenon.

Complications cleans eventration

  • Bruise

  • Repetition

  • Infection of the plate (0,5-1%): once the infection installed, the complete withdrawal of the plate is necessary to allow the cure

Laparoscopy

Laparoscopy

 

Cure of eventration by laparoscopy with prosthetic installation of plate will intra péritonéale

The surgeons of the iGEA team are specialized in the cure of the éventrations by laparoscopy.
 
  • Benefits

  • not very aggressive

  • less post-operative pain

  • fast recovery of the physical-activity

 

  • Countered indications of the laparoscopy

  • eventration strangled

  • size of the collet of the eventration higher than 6 cm in diameter.

Pratical info

Practical information

Cure of eventration with installation of plate per classical way

 

A precise evaluation of these risks is essential into preoperative

The consultation in a lung specialist with evaluation of the respiratory functionality (EFR) is obligatory for large the eventration (kinesitherapy

respiratory post operational)

In the event of ponderal overload, a slimming is always desirable.

  • to note

  • You will enter the day before at the evening or the morning of the operation to the private clinic.

    Do not forget anti bottoms – thrombosis (ordinance provided during the consultation)

    Do not forget the belt of application adapted to your size (ordinance provided during the consultation)

    Announce your cutaneous allergies (especially with iodine) if you know some.

    Antibiotics will be managed during and after the intervention.

    The blood losses are usually weak and no transfusion is necessary.

    The plate is deep, does not obstruct, is not perceptible.

    Shrinking of the” aspiration drains (Redon) 2nd and the 4th postoperative day. It are placed, in separations, between plate and muscles, and under the skin

    Drink and food will be taken again the evening or the shortly after the operation.

    Usually the pain is not very intense, but in any event calming are always envisaged.

    The cutaneous sons will be withdrawn between 8th and the 15th day.

    The showers are possible as soon as there are no more drains.

    You will leave the private clinic between 2nd and the 6th day, according to the importance of the operation.

 

  • Important

  •  For one month it is recommended to you not to make physical efforts.

    Wait 3 months to make intense, abrupt efforts or violent one and to go back a physical-activity and sporting normal.

    The sick leave is function of the importance of the eventration and the type of work: it goes from 7 to 49 days