Abdominal diseases (hernia, appendicitis, etc.)

Author:

Latyshev Alexander Vasilievich surgeon, Ph.D.

Quick transition Treatment of postoperative ventral hernia

The name itself indicates that this hernia occurs after a previously performed operation on the abdominal organs and is located in the area of the postoperative scar.

A hernial protrusion may appear immediately after surgery or after some time, sometimes after several years. The incidence of this type of hernia after open surgery on the abdominal organs, according to various authors, reaches 10–20%.

Causes of hernia

Hernias appear in the presence of predisposing and producing factors. Predisposing factors are: hereditary factor - defective development of connective tissue, anatomical features (for example, congenital enlargement of the umbilical ring).

Producing factors are factors that contribute to an increase in intra-abdominal pressure - physical activity (especially heavy lifting), chronic constipation, persistent cough, internal obesity, etc.

Once a hernia appears, it does not disappear on its own (with the exception of hernias in early childhood); it can only be eliminated through surgery.

Recovery after appendectomy

With uncomplicated appendicitis, recovery occurs quickly; complications require longer hospitalization and a longer period of postoperative rehabilitation.
Factors contributing to early recovery: early diagnosis and timely surgery, absence of concomitant diseases, young age, absence of complications.

Risk factors: late hospitalization, obesity, elderly and senile age, peritonitis, sepsis, multiple concomitant diseases.

Within a month after removal of appendicitis you should:

limit physical activity, especially stress on the abdominal muscles;
follow a diet that excludes vegetables, fruits, essential oils, smoked meats, animal fats, fried, spicy foods, foods rich in purines and cholesterol (red meat, lard, jelly, strong broths, packaged soups, smoked meats, fatty fish, legumes, canned food) , raspberries, figs, grapes, eggs, cottage cheese, butter, margarine, fatty dairy products.

With the modern level of development of medicine, appendicitis is treatable, but much depends on timely access to a doctor and correct behavior after surgery.

Clinical manifestations of hernia

In one of the above areas (navel, groin areas on the right or left, closer to the pubis, etc.) a subcutaneous protrusion appears, increasing with straining and disappearing when lying down. Usually the hernia is painless, has a soft-elastic consistency, and is freely reduced into the abdominal cavity. In doubtful cases, ultrasound can help. Sometimes patients experience pain in the hernia area associated with physical activity. The size of hernias is variable, from 2-3 cm to 10-15 cm. Having appeared, the hernia gradually increases in size.

Diagnosis of appendicitis

First of all, a consultation with a surgeon is required in the first hour of hospitalization. Special diagnostic scales are used (AAS, Alvarado, RIPASA).
If you have appendicitis in women, you need to consult a gynecologist.
For dysuria, consult a urologist.
Ultrasound of the abdominal cavity.
CT scan of the abdominal cavity (pregnant women with appendicitis undergo ultrasound or MRI instead of CT).
Diagnostic laparoscopy is a minimally invasive intervention in which the abdominal cavity is examined through a small incision with a laparoscope. Having detected signs of appendicitis, they proceed to laparoscopic appendectomy.

Complications of hernia

The most serious complication is strangulated hernia. It is characterized by the appearance of severe pain in the area of the hernia; the hernia ceases to be reduced into the abdominal cavity and becomes denser and more painful.

If you suspect strangulation, you must immediately call “03”, since if the operation is not performed within 2 hours, the strangulated organ (loop of intestine, omentum, etc.) may die, which will require a major difficult operation. You should not try to repair the hernia yourself; if done ineptly, this can cause serious complications.

Other complications include intestinal obstruction in the hernial sac, dysfunction of organs that are the contents of the hernia (for example, frequent urination when the bladder wall is involved in the inguinal hernia), compression of the spermatic cord, etc.

How is the mesh used?

If a patient has a ventral hernia after abdominal surgery, implants can be used as follows:

over the stitched aponeurosis without tension and opening the abdominal cavity for small defects;
under the aponeurosis from the inside, between it and the peritoneum;
between the leaves of the aponeurosis;
combined hernioplasty using an implant and the patient’s own tissues.

The last two methods are widely used in our clinic, since in this case the implant takes on the main load and prevents recurrence of the hernia. In case of giant postoperative ventral hernias and tissue weakness, the mesh can be used for total prosthetics - modeling the anterior abdominal wall. In this case, the synthetic material actually replaces the muscles and aponeurosis.

Hernia treatment

Treatment for hernia is surgical only. Currently, there are various modifications of operations - plastic surgery with local tissues, surgery with the installation of a polypropylene mesh , laparoscopic surgery.

What kind of operation to perform depends on the specific situation, the issue is decided individually. All methods have their advantages and disadvantages.

Before surgery, patients are advised to avoid heavy lifting (no more than 5 kg), prevent constipation, and eliminate other factors that contribute to increased intra-abdominal pressure.

Recovery after surgery is quite fast. Stay in the hospital for up to 7 days; for small uncomplicated hernias, surgery in the hospital for one day is possible, local anesthesia, intravenous potentiation is possible, for laparoscopic surgery - only anesthesia.

After discharge, the patient remains on sick leave for an average of another 10–14 days, then begins work. It is recommended to limit physical activity (lifting weights up to 5 kg) from 2 to 5 months after surgery (depending on the method of surgery). If work activity involves lifting heavy objects, the patient is temporarily transferred to light work.

After surgery there are usually no problems. In rare cases, there is long-term pain in the area of the operation - neuralgia. Sometimes a relapse occurs - the reappearance of a hernia (this happens both due to technical errors in the operation, and when the patient violates the restrictions of lifting heavy objects). During mesh operations, serous fluid sometimes accumulates under the skin, which may require puncture.

HOW IS THE SURGERY TO REMOVE AN INGUINAL HERNIA?

Surgical Department of the Pirogov Clinic

is known in St. Petersburg and abroad, since the experience of minimally invasive endovideo surgery “one day” has been successfully introduced here.
Our surgeons prefer the method of laparoscopic inguinal hernia repair (TAPP)
. Most inguinal hernias can be operated on through minimal access, without incisions. Traditional laparotomy (Lichtenstein hernioplasty) surgery with an open incision may be necessary in exceptional cases when the size of the inguinal hernia is very large.

To access the hernial orifice, the surgeon makes 3 punctures with a diameter of 3 to 10 mm. All problem areas are covered with a special mesh (prosthetic hernioplasty), which virtually eliminates the possibility of a recurrence of the hernia in the future. The advantage of laparoscopic surgery is a good cosmetic effect (three barely noticeable marks remain on the skin).

Endovideosurgical treatment of a hernia is the most painless and least traumatic method. The surgeon does not work with magnifying optics, but in front of a high-resolution video monitor. Bleeding, as well as all operational risks of open operations, are practically eliminated. After just 1.5-2 hours, the patient can walk freely, he is discharged a day later, and full recovery after laparoscopic hernioplasty of an inguinal hernia is only 7-10 days.

Abdominal pain

Abdominal pain is a fairly common occurrence. It can be caused by many conditions - from mild gastritis to severe diseases.

I would like to dwell not on any specific disease, but on the general principles of approaching abdominal pain from the standpoint of surgery.

The primary goal of the surgeon is to determine whether the pain is caused by an acute surgical condition or whether the pain is a manifestation of a chronic or non-life-threatening condition.

Acute surgical diseases include conditions in which a person’s life is in immediate danger. Such diseases require emergency surgery or mandatory treatment and observation in a surgical hospital.

Acute surgical diseases include peritonitis (inflammation of the peritoneum), acute appendicitis, acute cholecystitis (inflammation of the gallbladder), acute pancreatitis (pancreatic necrosis) - inflammation of the pancreas), intestinal obstruction, perforated ulcer (as well as perforation of any hollow organ - intestine, etc. ), mesenteric thrombosis (blockage of intestinal arteries leading to intestinal necrosis), gastrointestinal bleeding, strangulated hernia and some others.

Alarming symptoms

There are some symptoms that are “alarming” in nature, i.e. may indicate the onset of some acute disease.

Acute onset of pain (the so-called “dagger pain”) - occurs with a perforated ulcer or perforation of a hollow abdominal organ.
Pain accompanied by an increase in body temperature occurs with acute appendicitis , cholecystitis, peritonitis, etc.
Cramping pain - when the pain seems to “roll up” and “release” - is characteristic of intestinal obstruction.
Black stools and vomiting “coffee grounds” are typical for gastrointestinal bleeding.
Pain is accompanied by a severe general condition - it occurs in many acute surgical diseases.
The pain is accompanied by repeated vomiting - it happens with acute pancreatitis, pancreatic necrosis, intestinal obstruction.
The pain in the upper abdomen is of a girdling nature (i.e., radiates to the hypochondrium, back) - it happens with acute pancreatitis, pancreatic necrosis.
Yellowness of the skin, accompanied by pain in the right hypochondrium, is characteristic of obstructive jaundice.
The onset of pain in the upper abdomen, sometimes throughout the entire abdomen, followed, within several hours, by localization in the lower abdomen on the right - is characteristic of acute appendicitis.
The pain is constant and severe and occurs in many acute diseases.
Pain in the area of the hernial protrusion occurs with a strangulated hernia.

Course of the disease

Postoperative hernias in the early stages are reducible and are not accompanied by pain. However, with sudden straining, falling, or lifting, pain appears and the protrusion increases. As the hernia progresses, the pain intensifies, sometimes becoming cramping in nature. At the same time, intestinal lethargy, constipation, flatulence, nausea, belching develop, the activity of patients sharply decreases, fecal stagnation, accompanied by intoxication, is periodically observed.

What to do if you have abdominal pain?

It is important to note that only a doctor can assess the patient’s condition and make a diagnosis. The presence of the above symptoms does not always indicate a severe acute abdominal disease, just as their absence does not guarantee the exclusion of such a disease.

If abdominal pain appears , and especially with the presence of “alarming” symptoms, you need to call “03” . The doctor who arrives on call will determine whether an acute surgical disease can be suspected, and if it cannot be ruled out, he will hospitalize the patient. Before being examined by a doctor, it is prohibited to take painkillers, which can erase the clinical picture - relieve pain, reduce temperature, etc., creating the impression of imaginary well-being.

If, during the examination, the doctor excludes an acute surgical disease, as well as other diseases requiring hospitalization (food poisoning, severe influenza, acute hepatitis, renal colic, myocardial infarction, acute gynecological diseases, etc.), he prescribes treatment or recommends contacting a specialized specialist - gastroenterologist, therapist.

In addition to acute surgical diseases, abdominal pain can be caused by many other diseases - gastritis, exacerbation of peptic ulcer disease, chronic cholecystitis, chronic pancreatitis, intestinal colic, irritable bowel syndrome, neuralgia, oncological processes, gynecology and many others. They are treated by therapists, gastroenterologists, neurologists, gynecologists, urologists, etc.