Rehabilitation after abdominal surgery

Before surgery

After consultation with one of our specialists regarding surgical treatment of a hernia and setting a preliminary date for hospitalization, the following tests must be taken:

1. ECG (with description);
2. Clinical blood test (with platelets, leukocyte formula, reticulocytes, ESR);
3. blood test for group and Rh factor;
4. blood test for sugar (glucose);
5. prothrombin index + INR;
6. APTT (kephalin-kaolin time), fibrinogen;
7. Blood biochemistry (total bilirubin, direct bilirubin, AST, ALT, total protein, albumin, creatinine);
8. Blood test for hepatitis B (Hbc antigen);
9. Blood test for hepatitis C (anti-HCV antibodies total Ig M, Ig G);
10. Syphilis blood test - antibodies to Treponema pallidum;
11. Blood test for HIV - antibodies (Ig M, Ig G) to HIV types 1 and 2;
12. General urine analysis.

Tests can be taken at the Phlebology Center at the address: st. 10th Anniversary of October, 9, st. Radio, no. 10, p. 9.

Make an appointment by phone

Before surgery, patients follow their usual daily routine and diet. The last meal before surgery is before 20-00. If you are worried, then at night you can take a light sleeping pill, calming herbal teas, and try to ensure 7-8 hours of sleep.

On the day of surgery, you should not wear makeup or metal jewelry. Do not eat or drink under any circumstances.

Hospitalization is carried out in the morning on the day of the operation (the time is set when registering for the operation). The clinic provides patients with: personal hygiene items, clothes and slippers for the ward, free 3 meals a day, a choice of dishes from the menu.

What is the most effective method for removing an umbilical hernia?

Our surgeons are fluent in endoscopic technology, but this technique is not always applicable for complex hernias. Often, much better results can be achieved by open hernioplasty.

Based on many years of experience in hernia repair, our surgeon will choose the optimal access method based on the characteristics of your particular disease.

The main factor in the successful outcome of hernia surgery is its impeccable technical execution. Poor surgical technique can ruin any method, even the best one. If all stages of the operation are performed correctly, then with any type of access the probability of hernia recurrence is minimal.

After operation

1. 5-6 hours after the operation you will be able to walk independently.
2. After surgery, moderate pain is possible in the surgical area. They go away either on their own after a few hours or after taking any painkiller tablet;
3. By the evening, the bandage may become wet with discharge from the postoperative suture. Don't be alarmed by this: this is how any postoperative wound heals.
4. After the operation, the dressing is performed the next morning. The next dressing is usually performed 7-9 days after surgery. It is necessary to remove sutures.
5. For 2 weeks after surgery, you should not lift more than 5-6 kg. Then physical activity can be gradually increased. Normal physical activity is possible 1.5-2 months after surgery;
6. If your doctor does not draw your attention, then wearing a bandage after surgery is not necessary, since its role is perfectly performed by a mesh implant;
7. If after the operation you have any questions, even the most insignificant ones in your opinion, be sure to contact your doctor by phone!

Symptoms of an umbilical hernia

The most important and noticeable symptom characterizing umbilical hernias is the expansion of the umbilical ring and the formation of a protrusion. A tumor-like hernia consists of skin, fatty tissue and part of an organ. Most often, the hernial sac contains the large (small) intestine and omentum. The protrusion can come in different shapes and sizes. Sometimes it is not visible and can only be felt. With a large hernia complicated by adhesions, the defect is always noticeable. It is not uncommon for an umbilical hernia to grow to gigantic proportions.

The hernia may appear unnoticed. There have been cases where a pathological formation can develop suddenly. For example, when lifting weights.

At first, the disease does not cause problems or anxiety to the patient. Many people live with hernias, get used to their existence and even forget about the presence of the disease. The absence of pronounced symptoms of an umbilical hernia does not make it possible to determine the presence of a serious pathology. Many patients believe that protrusion in the navel area is an individual anatomical feature of their body. Meanwhile, doctors warn that there are no safe hernias. Even in the absence of symptoms, over time the size of the umbilical hernia begins to increase. The growth is especially noticeable after heavy physical work, sneezing, prolonged coughing, a person staying in an upright position for a long time, or after overeating.

The skin under the protrusion is so thin that loops of intestine can be seen through it. Even in this state, the patient does not experience any particular discomfort. Only rarely does a person with a similar diagnosis develop dyspeptic disorders: nausea, belching, frequent constipation.

When a hernia is strangulated, the clinical picture changes. This is a very dangerous condition that requires immediate medical attention. The strangulated hernial protrusion becomes painful. The pain is very severe and can cause shock in some patients. The hernia tightens, rapidly increases in size and becomes hot. Redness and swelling appear in the umbilical cavity area. It is no longer possible to repair such a hernia on your own. The abdomen is soft at first, but gradually, with the addition of intestinal obstruction, severe bloating and muscle tension appear. Sometimes this is accompanied by hiccups, vomiting and complete retention of bowel movements. Within a few hours, the patient's condition can change dramatically. It worsens sharply: the pulse quickens, the pressure drops, the temperature first rises and then drops over time. This is due to the fact that an irreversible process of poisoning by intestinal toxins begins in the body. If left untreated, a strangulated umbilical hernia can be fatal.

In 1-2 months

1. You will lead a normal lifestyle: work, play sports, relax.
2. Traces after surgery completely disappear 1.5-2 months after surgery. Only a thin postoperative scar about 5-6 centimeters long will remind you of the operation.
3. 4-6 months after surgery, the strength of the abdominal wall in the area of ​​the hernia is comparable to that of a completely healthy person. Therefore, even physical labor will not be contraindicated for you.

Surgical wound care

The scar after surgery for umbilical hernia, inguinal hernia and other problems should always be treated properly to avoid unwanted health complications. As for hygiene, from the third day after surgery the patient can briefly rinse the scar with water. However, after this it is necessary to dry the seam well and leave it open.

After the stitches are removed, the patient can begin to wash the wound with non-irritating soap. However, a person should not take a regular bath until the scar has completely healed.

Sexual relations after surgery

Many patients who have undergone hernioplasty are embarrassed to ask about the timing of resuming sexual relations after the operation. If little time has passed after the operation, sex can lead to undesirable consequences - increased swelling, pain in the area of ​​the postoperative wound, hematomas (bruises) and even bleeding, the development of wound infection, cutting of sutures and displacement of the mesh graft. You can resume sexual relations 12-14 days after surgery, if movements do not cause pain, and in men there is no severe swelling of the scrotum. The next day, the absence of pain in the postoperative wound, discomfort, increased swelling, and increased body temperature indicates that the relationship can be continued in the same preoperative mode, observing some caution. First of all, strong tension should be avoided, as well as exposure to pressure on the area of ​​the postoperative wound.

Pain after hernia surgery

After the procedure, the patient may experience mild to moderate pain, which is quite natural and is associated with hernia removal. Of course, the patient perceives the problem individually, but it usually depends on the type of hernia, the operation and the age of the patient. Acute postoperative pain lasts 24 to 48 hours and then subsides.

During hospitalization, pain is usually relieved by painkillers and are no longer necessary after discharge. If the discomfort does not go away within 3-4 days and the patient still feels severe pain, he should consult his doctor. You may also experience vomiting, which is an unwanted side effect of anesthesia, or testicular pain after inguinal hernia surgery.

Surgery for umbilical hernia according to compulsory medical insurance at the Central Clinical Hospital of the Russian Academy of Sciences

The clinic of the Central Clinical Hospital of the Russian Academy of Sciences provides the full range of medical services for umbilical hernia: from examination and diagnosis to high-quality rehabilitation after surgery.

1. An experienced doctor performs an examination, assesses the patient’s condition and, if the diagnosis is confirmed, prescribes a planned herniotomy operation.
2. Surgical treatment is carried out in a modern operating room using high-quality instruments and drugs;
3. The operation is performed by experienced, highly qualified surgeons.

Hernia treatment under compulsory medical insurance is a service that every citizen of the Russian Federation can receive at the Central Clinical Hospital of the Russian Academy of Sciences. In this case, the treatment will be carried out at the highest level with a caring and attentive attitude of all medical staff towards the patient.

The clinic has a rehabilitation treatment department, where you can undergo high-quality rehabilitation, which will allow you to return to your normal lifestyle as soon as possible.

The advantages of contacting the Central Clinical Hospital of the Russian Academy of Sciences for the treatment of umbilical hernia:

• consultations with experienced specialists;
• carrying out an operation under compulsory medical insurance;
• careful and attentive attitude towards the patient;
• use of modern surgical techniques, high-quality equipment, safe drugs;
• opportunity to receive rehabilitation treatment.

To make an appointment for examination and treatment at the Central Clinical Hospital of the Russian Academy of Sciences and clarify the cost of services, you can call or use a special form on the website.

Diagnostic methods

After making an appointment with a vertebrologist, orthopedist, neurologist or other doctor (depending on the location of the formation), a palpation examination will be performed. The doctor determines the density of the protrusion, the possibility of its reduction into the cavity, and the condition of the surrounding tissues. Using ultrasound, CT, and MRI, the hernia is examined from the inside. After collecting anamnesis and identifying the problem, the day of surgery is set and preparation begins.

Preparatory activities

To undergo surgery at our center, the patient is sent for biological fluid tests and other procedures recommended by a specialist. To obtain admission to the operation, you also need to obtain a referral from an allergist stating that the patient does not have allergic reactions to the medications used and agree on anesthesia with a narcologist.

Some aspects of terminology

In any hernia, the hernial sac, hernial contents and hernial orifice are distinguished.

• A hernial sac
  is a stretched section of the peritoneum, which, together with the internal organs, has emerged through a defect in the abdominal wall and covers them. With postoperative hernias, “multi-chamber” hernias often occur, when the scar has not one, but several adjacent defects.
• Hernial contents
  are those organs or parts thereof that have extended beyond the abdominal cavity.
• Under hernial orifice

  understand the hole itself or defect in the abdominal wall, through which the hernia subsequently emerges.

Reasons for education

The disease treated in our center can be classified by location (umbilical, intervertebral, anterior abdominal wall, linea alba) or may occur due to improper surgical intervention, excessive physical activity (lack thereof) or as a complication after a difficult birth . The disease progresses due to:

• excess weight;
• injuries of the spine (vertebral discs), peritoneum, groin;
• individual features of body structure;
• muscle tension (with permanent coughing, heavy lifting).

The hernia cannot be delayed

This disease, common at all times, even today takes many people by surprise: they have no idea how dangerous a hernia is and how to treat it. Why this disease occurs, how it manifests itself and what deadly consequences inattention to it can lead to, said Rinat Mudarisov, deputy chief physician for surgical care at City Clinical Hospital No. 52.

– Rinat Rifkatovich, abdominal hernia is a very common disease that can occur regardless of age and health status. What provokes its appearance?

– The main provoking factors are increased intra-abdominal pressure, tension in the anterior abdominal wall. But life is such that we constantly strain it, performing the simplest actions: getting up, walking, coughing. Of course, the risk group includes people who regularly lift weights: loaders, builders, athletes. Regular physical activity can also provoke a hernia. There are also congenital defects of connective tissue or anatomical features (wide inguinal or umbilical ring). There are patients who have a combination of, for example, umbilical and inguinal hernias. But this is a reason, first of all, to think about your lifestyle, and only then to attribute the disease to heredity.

REFERENCE

An abdominal hernia is a protrusion of internal organs through natural or pathologically formed openings in the abdominal wall - known to mankind from time immemorial. The name of the disease was given by the ancient Roman physician Claudius Galen. For centuries, they fought the disease as best they could: they applied herbal compresses, drank healing broths, and reduced the protrusion manually. Today, hernias are treated with surgery - hernioplasty. It comes in two types: tension and non-tension. With tension repair, the hernial orifice is closed with body tissues; with non-tension repair, it is closed with a mesh implant. Among abdominal hernias, the most common are inguinal and umbilical, which is understandable, because the umbilical ring and inguinal canal are anatomically weak points of the anterior abdominal wall. In third place are postoperative hernias. Every year, more than 20 million operations are performed worldwide for hernias of the anterior abdominal wall.

– There is an opinion that a hernia that does not interfere with life is not worth operating on. Is it really?

– The position of surgeons is clear: the presence of a hernial protrusion is an absolute indication for surgery. A hernia can cause various complications, including life-threatening ones. One of the most dangerous is infringement. The mechanism in general looks like this: a person coughed - intra-abdominal pressure increased. For a split second, the hernial ring expanded, and through it, part of the intestine came out into the hernial sac. After the hernial ring closes, a person feels a sudden sharp pain that cannot be confused with anything, and sees a very painful dense formation at the site of the hernia. This situation cannot be delayed. To save the strangulated organ, urgent surgery is required.

– What modern methods of treating hernias are the most organ-saving and safe for the patient?

– The gold standard for hernia treatment is laparoscopic hernioplasty using minimally invasive technologies and a mesh implant. Unlike traditional tension plasty, it is less painful, promotes a speedy recovery of the patient (in the hospital - from one to three days), and allows, in most cases, to avoid complications characteristic of open surgery (hematomas, suture dehiscence). It also leads to relapses less often: after all, nature does not tolerate tension. Any stretched tissue tends to return to its place; any tension causes tension in the muscles, disrupts their nutrition and leads to displacement. All this is accompanied by pain. But patients with tension-free repair have an order of magnitude less recurrence of hernias. Tensionplasty is performed for those patients for whom laparoscopy is contraindicated due to medical criteria, or for those who refuse to install a mesh.

– Technology is technology, but a mesh implant is a foreign body in the human body. Is there a risk of rejection?

– Modern implants are made from materials that are least aggressive to the body, for example, polypropylene. Now it is possible to install meshes that are in contact with internal organs - the intestines, omentum, stomach. Such implants are covered with a special film that prevents fusion with the organ on the first day after surgery. After this period, fusion no longer occurs, despite the fact that the mesh remains in the body. Over time, connective tissue grows into it, which finally fixes the structure. Within a year, the mesh takes root completely. Most often, such implants are installed for postoperative hernias, as well as for hernias of the white line of the abdomen (tendon bundles of the broad abdominal muscles - Ed.). Cases of rejection occurred only at the dawn of the use of these structures. This was due to both the quality of the material and the installation techniques. Modern technology for manufacturing implants is almost flawless. The average patient with a normally functioning immune system and reaction to surgical trauma should not experience rejection. I have been operating for more than 20 years and have not encountered such cases in my practice. Of course, some of our patients are at risk, for example with endocrinological, nephrological and hematological diseases. Nevertheless, the quality of modern transplants and our surgical experience make it possible to avoid complications and relapses. In the professional community, there is an opinion that hernioplasty is one of the simplest operations and this is where you should begin your surgical career. But over time, it becomes clear that it often requires no less knowledge of anatomy than complex operations. The variety of hernioplasty techniques allows you to gracefully solve the most complex surgical problems. The main thing is that the patient, if there is a hernia or is suspected of having one, contacts the surgeon in a timely manner, without waiting for life-threatening complications to develop.

Interviewed by Valentina Glyantseva. Source