SURGICAL LAPAROSCOPIC METHOD OF POSTOPERATIVE VENTRAL HERNIA

Alex Magufwa, student of 5th course

Supervisor - Ph.D. Sergei Zhdanov

Sumy State University, Department of Surgery

 

Hernia is simply defined as the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it, or a sac formed by the lining of the abdominal cavity (peritoneum). 

Ventral hernia occurs in the abdomen and is a fragment of intestines or other organs that push through the abdomen muscle wall. These most often are called incisional hernias because they usually develop along an area where an incision (cut) for surgery has occurred. Some people have ventral hernias that result right after a surgery on the abdomen has taken place and others may develop them years after a surgery.

Types of hernia: there can be classified according to their location within the body, such as:-abdominal hernias, pelvic hernias, and diaphragm related hernias i.e. Hiatus hernia.

Further classification of hernia is as follows: hiatus hernia, inguinal hernia, femoral hernia, umbilical hernia, incisional hernia, epigastric hernia, spigelian hernia, and sport hernia.

These are the most commonly known group of hernias. However, a hernia can develop as a result of a protrusion of any internal organ or tissue and not just through the abdominal wall. There are types of less well known hernias which include: - sciatic hernia, scrotal hernia, vaginal hernia (vaginocele), ovarian hernia, perineal hernia.

Causes of the hernia: heavy lifting is one of the most common causes of hernia, but there are factors as well which include:- excessive coughing, excessive vomiting, excessive exercise, e.g. power lifting, constipation/straining on the toilet, old age poorly healed scar tissue/wound following an injury, accident or surgery, also pregnancy, obesity and genetic

Management using polypropylene mesh: advantages of application of polypropylene mesh grafts in repairing: significant reduction in frequency of recurrence of hernia; reduction of postoperative mortality; can view the giant hernia as inoperable.

Complications arising from the use of polypropylene mesh grafts: early complications; - seroma; hematoma; suppuration; necrosis of dermal-fat graft;; and the separation of the grid; long-term complications: - The formation of skin-subcutaneous fistula; intestinal fistula; chronic infection; adhesive disease ; biomechanical functional complications:-foreign body sensation; chronic pain; restriction of the anterior abdominal wall. 

In order to avoid the complications of retention (i.e. Seroma and hematoma) one should: minimally traumatizing tissue; mobilizing the subcutaneous layer; careful implementation of homeostasis;drainage with active aspiration.

Conclusions: applying alloplasty in the anterior abdominal wall with linear polypropylene allograft is a good but not perfect way to cure; the main reason is the occurrence of complications such as negative properties of polypropylene mesh as the ability to cause local inflammatory reaction, the formation of connective tissue and coarse wrinkling.