abdominal wall surgery
1. Evisceration
Evisceration is the protrusion of abdominal cavity contents (such as the digestive tract or intra-abdominal fat) through an opening in the abdominal wall, typically due to a prior surgical procedure.
Symptoms
- Patients generally experience a sensation of a mass or « lump » that forms deep within an abdominal scar.
- This sensation can fluctuate and is often triggered by physical activities such as lifting heavy objects, exercising, or coughing.
- The mass might be visible to the patient and can cause discomfort or even vomiting, which necessitates urgent medical consultation.
- In rare cases, the patient may suffer complications from the contents of the evisceration, requiring emergency surgery. Evisceration can occur weeks or even months after surgery.
Treatment
- Surgical intervention is always required, as the opening will not close on its own and may worsen over time. The procedure usually involves repairing the abdominal wall at the site of the opening. The contents that have protruded are repositioned back into the abdominal cavity.
- The wall is reinforced, often using a prosthetic mesh to support the area, which is the most common approach.
- aparoscopy may be an option for smaller eviscerations, although it is more commonly reserved for smaller cases.
- Drainage tubes are inserted post-operatively to help remove any excess fluid, which are typically removed within 24 to 48 hours.
- The duration of hospitalization depends on the size of the evisceration: Minor repairs may be performed on an outpatient basis. Larger eviscerations may require several days of hospitalization.
Post-operative Care
- The patient will need pain management following surgery.
- A compression belt is typically worn for at least one month, though in some cases, it may need to be worn longer.
- Physical activity, including heavy lifting, should be completely avoided for at least one month.
- Professionally active individuals engaged in physical labor should refrain from work for at least a month.
2. Inguinal Hernia
An inguinal hernia occurs when a part of the intestine or abdominal tissue bulges through a weak spot in the lower abdominal wall or groin area. This is one of the most common types of hernia and may appear as a lump in the groin.
Symptoms
- A visible bulge or lump in the groin area, which may increase in size when standing or during activities like coughing or heavy lifting.
- A feeling of heaviness or discomfort in the groin, especially when engaging in physical activity.
- Pain or tenderness at the site of the bulge.
In some cases, the hernia may cause digestive symptoms, such as constipation or nausea.
A hernia may cause a noticeable « dragging » sensation in the groin.
Treatment
- The primary treatment for an inguinal hernia is surgery.
- Surgical repair is the most effective way to close the hole in the abdominal wall and prevent the hernia from worsening.
- There are two main types of surgery:
- Open surgery: A traditional approach where an incision is made in the groin to access the hernia.
- Laparoscopic surgery: A minimally invasive technique that involves smaller incisions and a faster recovery time.
- In most cases, a mesh prosthesis is used during surgery to strengthen the abdominal wall and prevent recurrence.
Surgery is usually performed under general anesthesia, and most patients can go home the same day or after a short stay in the hospital.
Post-operative Care
- The patient should rest and avoid physical exertion for several weeks after surgery.
- Lifting heavy objects and strenuous physical activity should be avoided for 4 to 6 weeks.
- Pain management, including over-the-counter pain relievers, is often recommended.
- Follow-up appointments are necessary to ensure proper healing and to monitor for any signs of complications.
3. Umbilical Hernia
An umbilical hernia occurs when part of the abdominal contents (such as the intestine or abdominal fat) protrudes through a natural opening in the abdominal wall. Umbilical hernias appear at the belly button, where the umbilical opening once allowed the passage of the umbilical cord elements in the fetus.
Symptoms
- A bulge or lump near the belly button, which may fluctuate in size.
The bulge may be more noticeable or painful when engaging in physical activities like lifting heavy objects, exercising, or coughing. - The lump may be visible to the patient and could cause discomfort or nausea.
In rare cases, the hernia may cause vomiting, indicating a possible complication that requires immediate medical attention. - While emergencies are uncommon, prompt medical intervention is needed to avoid complications.
Treatment
- A hernia will not resolve on its own and will usually worsen over time.
Surgical treatment is always required. The goal is to strengthen the abdominal wall at the hernia opening. - The protruding abdominal contents are repositioned back into the abdominal cavity.
In most cases, a prosthetic mesh (like a « wedding veil ») is placed to reinforce the abdominal wall. - In rare cases, simple suturing may be used.
The surgery is typically performed through a small incision of about 2 to 5 centimeters at the belly button, depending on the size of the hernia. - For larger hernias, laparoscopic surgery may be considered. This involves a small incision near the belly button, with additional incisions for instruments.
- Most of these procedures are done on an outpatient basis.
Post-operative Care
- Pain management is necessary after surgery.
- The skin is sutured with absorbable stitches, and no special care is required for the scar.
- Patients should avoid baths for 15 days, though showers are allowed immediately.
- Physical activities, including lifting heavy objects, should be avoided for at least one month. Physical work should also be suspended for about a month.
- The patient will follow up with the surgeon within 15 days of the surgery.
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