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The abdominal wall is a strong muscle and connective tissue structure that wraps the abdominal organs like an envelope and gives our body its shape. This envelope has some potential weak points. Intra-abdominal organs (especially adipose tissue and intestines) pass through the abdominal wall through these weak points and cause swelling under the skin. It is also called hernia. Abdominal wall hernias are treated surgically by General Surgery specialists.
There are some potential weak spots in the abdominal wall, both congenital and later. The weak points that may occur later are the incisions on the abdominal wall caused by surgeries. During the operations, an incision is made on the abdominal wall along with the skin, and these incisions are closed after the operation is over. During the healing process, these incisions are potential weak points and are risky in terms of hernia formation. The negativities to be experienced in the postoperative period increase this risk. For a hernia to occur, the abdominal wall must be forced. Situations that increase intra-abdominal pressure create this strain. Conditions such as carrying excessive and prolonged heavy loads, constipation requiring constant straining, and prolonged coughing increase intra-abdominal pressure. In addition, they prepare the ground for surgical site hernia (incisional hernia), as problems that may arise in the abdomen after the operation will adversely affect wound healing.
The principle of treatment in abdominal wall hernias is basically the same as repairing a hole in a wall. It is clear, therefore, that a mechanical problem must have a mechanical solution. In today's conditions, there are no drugs or methods (exercise, etc.) to close the openings in the abdominal wall by creating new and solid tissues. Until a better one is developed, surgery will be the only option in the treatment of abdominal wall hernias.
In the treatment of incisional hernia, the opening in the abdominal wall is repaired without tension with a patch. With the development of new technology materials, the use of synthetic materials has become very common today. Synthetic patches are advantageous for tension-free repair. When the patch is placed on the body, it is perceived by the body as a foreign body and a hard tissue forms around it. This hard tissue provides a solid and durable closure of the hole in the hernia area.
Incisional hernia surgeries can be performed with open or closed (laparoscopic – robot-assisted) methods.
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In open surgery, the opening in the abdominal wall is revealed with an approximate incision made to the old incision area, and it is closed without tension with a synthetic patch spread over . In addition, in cases where it is too large and the abdominal wall cannot be closed without tension, repairs are made by separating the abdominal wall layers (component separation).
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In the laparoscopic method, the camera and special instruments are entered through 3 small incisions made on the left side of the abdomen, and the opening in the abdominal wall is seen from the inside. The patch that will close this opening is placed and attached to the abdominal wall with a screw-like technique and repair is made. The layering method described above can also be applied laparoscopically.
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In cases where the opening in the abdominal wall is very large and the opening in the abdominal wall is large, the hernia is repaired using the layering method with the help of a robot, the results are quite successful.
Since the incisions made in laparoscopic-robotic surgeries are smaller, postoperative pain and hospital stay are significantly less. Closed methods are more frequently recommended to patients because of the comfort they provide in the postoperative period.
There are many difficulties that surgical site hernia brings to one's personal life. Its symptoms vary. As it causes a swelling under the hernia, it causes deterioration in physical appearance, and as it grows, it causes restriction in daily movements. This situation prevents the person from moving freely in society and damages his self-confidence. Since hernia is a growing and progressive disease unless treated, it should be treated as soon as possible after detection.
Avoiding more serious medical problems also necessitates the treatment of surgical site hernia. As described, hernia occurs when intra-abdominal organs pass through the opening in the surgical incision area and form a swelling under the skin. Often, organs constantly enter and exit through these openings. From time to time, due to the high intra-abdominal pressure, a large volume of organs passes through the abdominal wall and settles under the skin, but due to the large volume, it cannot return to the abdomen. This condition is called compression of the hernia (incarceration) and can lead to intestinal obstruction. If this process is prolonged, the blood vessels feeding the organs will be under pressure and can cause decay, a condition called strangulation of the hernia. Both conditions should be treated surgically under emergency conditions. Since surgery in emergency conditions may involve unpredictable risks for both the patient and the physician, surgical treatment should be performed as soon as possible by providing ideal conditions when a hernia is detected. This is much more comfortable for both the patient and the physician.
In the vast majority of hernia surgeries (assuming no problem occurs), the hospital stay is short. The length of hospital stay in incisional hernias varies according to the size of the hernia, but mostly does not exceed five days. Laparoscopic – This period is much shorter in robotic procedures. After the patient returns home, he is invited to the hospital for a control examination on the seventh day of his surgery, and the patient does not have to come to the hospital for a check-up, mostly, the doctor is consulted if there is any complaint.
Since the surgical area is repaired, the surgical area will be weak at the beginning, so heavy exercise and strain should be avoided until the wound healing process here reaches a certain stage. Patients can return to their daily lives 48 hours after the surgery. The patient should rest between 3 and 7 days, depending on the weight of the job and the pain condition. The vast majority can return to work (not requiring heavy physical activity) within 4-5 days. Lifting more than 5 kg or heavy sports for six months is not recommended for those who do not do active sports. Active athletes can start routine training after 6 weeks.
The most important problem that may occur during or in the early postoperative period is bleeding in the operation area. Rarely, second surgeries may be required to control bleeding.