Incisional Hernia in a Dog

Background: The rupture of the suture in the abdominal wall, but with integrity of the cutaneous suture, results in a condition known as incisional hernia. It is characterized by the protrusion of the abdominal viscera through orifices or areas of the abdominal wall. In most of the cases these defects in the abdominal wall are iatrogenic. The incisional hernia occurs in an intact wall that is weakened by surgical incisions. The available literature on the incidence of incisional hernias in animals is scarce. With the aim to contribute to the information about incisional hernia in animals, it was decided to describe the case of incisional hernia in a female dog after performing ovariohysterectomy (OH).Case: An adult mongrel shelter bitch, of unknown age, weighing 9.5 kg was admitted for OH in a practical class of the veterinary surgical technical discipline. Once the anesthetic condition was established, a retro-umbilical cutaneous incision was made. After opening the abdominal cavity, the bitch was castrated routinely. The abdominal wall was sutured including peritoneum, muscle fascia, and rectus abdominis muscle with nylon thread and U-stitches. The subcutaneous tissue was then sutured with the same thread using Cushing suture. Ten days after the surgery, when the stitches were removed, the bitch revealed an increase in volume at the region of the surgical scar. Incisional hernia was diagnosed after careful palpation. For correction of the hernia, the bitch was submitted to surgical procedure. After the skin opening, an intense inflammatory reaction was observed in the subcutaneous tissue. The inflamed skin and subcutaneous tissue were removed. The abdominal cavity was closed with nylon thread by means of U-stitches. The subcutaneous and skin sutures were the same as the first surgery. Ten days after the second surgery, stitches were removed, and the bitch had fully recovered. Discussion: One of the factors that may have contributed to the occurrence of the hernia was carrying out the surgical procedure in a practical class. The difficulties shown by students are related to the long learning curve, the complexity of the invasive technique, and the lack of ability. The apprentice surgeon can cause injuries in the tissues due to excessive manipulation. Post-incision hernias are acquired and formed when a cavity wall closed by surgery is ruptured. Another factor that may have contributed to the occurrence of the hernia described here is unsatisfactory postoperative care, which may be considered as one of the factors for acute cases of incisional hernias. Information on postoperative care after the patient was returned to the shelter is not available. Therefore, it cannot be ruled out that the patient, in contact with other animals by means of games or even fights, could have ruptured the points, thus causing dehiscence of the suture in the abdominal wall. However, it was concluded that the most probable factors involved in the etiology of the hernia in question were nutritional deficiencies along with the inexperience of the surgeon. The treatment adopted in the patient (herniorrhaphy) was adequate for the correction of the hernia. The technique and the material to be used in the procedure are of great importance, since it must be resistant enough to avoid recurrences. In the patient in question, nylon thread was used in separate U-shaped stitches. In the literature, there are reports that unabsorbable yarns used at separate points present the lowest rate of dehiscence and relapse in the abdominal wall sutures. The incisional hernia can be prevented by preparing the patient for surgery, improving the nutritional requirements, and by a more intense training of the students performing the surgical procedure in the neutering program of dogs and cats during practical classes.

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A randomized controlled study to compare the efficacy of hughes abdominal repair with conventional abdominal closure-to reduce the incidence of incisional hernias in Indian population

International Surgery Journal ◽

10.18203/2349-2902.isj20172783 ◽

2017 ◽

Vol 4 (7) ◽

pp. 2291

Author(s):

Rajasekaran C. ◽

Vijaykumar K. ◽

Arulkumaran M. ◽

Meera S. S.

Keyword(s):

Randomized Controlled Trial ◽

Incisional Hernia ◽

Abdominal Wall ◽

Controlled Trial ◽

Secondary Outcome ◽

Midline Laparotomy ◽

Incisional Hernias ◽

Abdominal Closure ◽

Randomized Controlled ◽

Abdominal Repair

Background: Incisional hernia forms the most common delayed morbidity following midline laparotomy surgeries- causing mental trauma to the patient impairing their quality of life and scars the name and fame of the surgeon. So, the need for possible attributes on surgeon’s aspect to prevent the incisional hernia is the need of the hour. We planned a randomized controlled trial to compare two different abdominal closure techniques to reduce the incidence of Incisional hernia following midline laparotomy incisions. We advocated Hughes abdominal repair which includes a series of two horizontal and two vertical mattresses within single suture whereby the tension load of suture is distributed both along and across the suture line.Methods: 1:1 Randomized controlled trial in which the patient is blinded and obviously operating surgeon is non-blinded. Evaluating examiner and radiologist are blinded.100 patients who underwent emergency and elective midline laparotomies were enrolled in the study and intra-operatively randomized into two groups in 1:1 pattern. Ethical clearance obtained from the Institutional ethical committee. The primary outcome measure is the incidence of burst abdomen at the end of 15 days by the evaluating surgeon (non-operated surgeon who is blinded). The secondary outcome is the incidence of incisional hernia at the end of one year-evaluated by detailed clinical examination with radiological proof using CT abdomen.Results: The incidence of incisional hernia is significantly low in Hughes abdominal repair than conventional abdominal closure.Conclusions: Hughes abdominal wall closure is superior to conventional closure in both emergency and elective laparotomy cases, in prevention of wound dehiscence and Incisional hernias later. Present study encourages us that Hughes abdominal wall repair is comparable to mesh repairs. This study needs to be continued further to a vast sample size to perfectly assess the statistical significance.

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Recurrent Incisional Hernia Associated with Interferon Treatment for Virus C Hepatitis: Case Report

Acta Medica Marisiensis ◽

10.1515/amma-2015-0101 ◽

2016 ◽

Vol 62 (2) ◽

pp. 260-262

Author(s):

Mircea Gherghinescu ◽

Călin Molnar ◽

Daniel Popa ◽

Cristian Russu ◽

Alexandra Lazăr ◽

...

Keyword(s):

Case Report ◽

Hepatitis C ◽

Incisional Hernia ◽

Abdominal Wall ◽

Postoperative Analgesia ◽

Subcutaneous Tissue ◽

Incisional Hernia Repair ◽

Components Separation ◽

Viral Hepatitis C ◽

Virus C

AbstractBackground: Hepatitis C prevalence in Romania is 3.5%. Nowadays, the treatment of this condition comprise of interferon. One of the interferon’s side effects is the reduction of collagen synthesis, substance that is necessary in the process of abdominal wall healing.Case report: We report the case of a 56 years old female patient, admitted in our Clinic for a giant, recurrent incisional hernia. The patient’s history was eventful: a hysterectomy for uterine fibroma in 2009, incisional hernia repair in 2010, the treatment with Interferon in 2011 and 2012 for viral hepatitis C. A well represented subcutaneous tissue is observed intraoperator, a wall defect of 15 cm in diameter with a 5 mm thick muscle aponeurosis lay. We performed abdominal wall plasty by components separation technique, reinforced with a polypropylene mesh disposed on lay. Postoperative analgesia was provided by inserting a wound catheter through which Ropivacaine 0,5% was continuously injected for 72 hours. The postoperative evolution was uneventful, the patient being discharged 7 days after the surgical intervention.Conclusions: The treatment with Interferon of hepatitis C can favor the recurrence of an incisional hernia. The Oscar Ramirez procedure seemed to be the best choice for surgical treatment of this giant incisional hernia. Postoperative analgesia can be accomplished by a wound catheter through which Ropivacaine 5% is continuously infiltrated.

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CRITICAL ANALYSIS OF EXPERIMENTAL MODEL FOR STUDY OF ADHESIONS AFTER INCISIONAL HERNIAS INDUCED IN RATS’ AND REPAIR OF ABDOMINAL WALL WITH DIFFERENT BIOMATERIALS

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202015000300008 ◽

2015 ◽

Vol 28 (3) ◽

pp. 178-182 ◽

Cited By ~ 5

Author(s):

Leonardo Carvalho SERIGIOLLE ◽

Renato Lamounier BARBIERI ◽

Helbert Minuncio Pereira GOMES ◽

Daren Athiê Boy RODRIGUES ◽

Sarah do Valle STUDART ◽

...

Keyword(s):

Abdominal Wall ◽

Experimental Model ◽

Primary Repair ◽

Statistical Significance ◽

Abdominal Cavity ◽

Incisional Hernia Repair ◽

Greater Omentum ◽

Abdominal Wall Defects ◽

Hernia Sac ◽

Incisional Hernias

Background: Adhesions induced by biomaterials experimentally implanted in the abdominal cavity are basically studied by primary repair of different abdominal wall defects or by the correction of incisional hernias previously performed with no precise definition of the most appropriate model. Aim: To describe the adhesions which occur after the development of incisional hernias, before the prosthesis implantation, in an experimental model to study the changes induced by different meshes. Methods: Incisional hernias were performed in 10 rats with hernia orifices of standardized dimensions, obtained by the median incision of the abdominal wall and eversion of the defect edges. Ten days after the procedure adhesions of abdominal structures were found when hernias were repaired with different meshes. Results: The results showed hernia sac well defined in all rats ten days after the initial procedure. Adhesions of the greater omentum occurred in five animals of which two also showed adhesions of small bowel loops besides the omentum, and another two showed liver adhesions as well as the greater omentum, numbers with statistical significance by Student's t test (p<0.05). Conclusion: Although it reproduces the real clinical situation, the choice of experimental model of incisional hernia repair previously induced implies important adhesions, with possible repercussions in the evaluation of the second operation, when different implants of synthetic materials are used.

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P018 COLLABORATIVE APPROACH FOR SIMULTANEOUS REPAIR OF COMPLEX INCISIONAL HERNIA AND STOMA REVERSAL

British Journal of Surgery ◽

10.1093/bjs/znab395.017 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Carles Olona ◽

Aleidis Caro ◽

Raquel Casanova ◽

Beatriz Espina ◽

Jordi Vadillo ◽

...

Keyword(s):

Colorectal Surgery ◽

Incisional Hernia ◽

Abdominal Wall ◽

Surgical Techniques ◽

Incisional Hernia Repair ◽

Clinical Results ◽

Intestinal Transit ◽

Simultaneous Treatment ◽

Incisional Hernias ◽

The Mean

Abstract Aim The simultaneous repair of incisional hernias (IH) and the reconstruction of the intestinal transit may pose a challenge for many surgeons. Collaboration between units specialized in abdominal wall and colorectal surgery can favor simultaneous treatment. We present our experience in the collaboration between specialized units for the simultaneous treatment of complex incisional hernias and ostomy closure. Material and Methods Descriptive study of patients undergoing simultaneous surgery of complex IH repair and intestinal transit reconstruction in the period 2018.2021. All interventions were performed electively and with the collaboration of surgeons experts in abdominal wall and colorectal surgery. Demographic variables, hernias characteristics, surgical techniques, postoperative evolution, morbidity and mortality are recorded Results 16 patients are included. 8 with ileostomy, 3 lateral colostomies and 5 end colostomies . All the patients presented IH of the middle laparotomy and 12 had stomal hernias associated. The mean diameters of the IH were 16.2cm longitudinal and 11cm transverse. Intestinal transit was reconstructed in 15 cases (94%) and incisional hernia repair in 100%. Component separation was required in 75% of cases (8 posterior and 4 anterior). Morbidity in the first postoperative month was 18%, requiring 2 reoperations (12%). At the end of the mean follow-up of 10.8 months, 81% of the cases did not present complications. Conclusions The collaboration between specialist allows the use of advanced techniques in the simultaneous reconstruction of the abdominal wall and intestinal transit, with good clinical results and patient quality of life.

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Polypropylene endoprostheses in the surgical treatment of strangulated postoperative ventral hernias

Kazan medical journal ◽

10.17816/kmj1890 ◽

2012 ◽

Vol 93 (3) ◽

pp. 541-544

Author(s):

I M Fatkhutdinov

Keyword(s):

Surgical Treatment ◽

Abdominal Wall ◽

Abdominal Wall Defect ◽

Subcutaneous Tissue ◽

Abdominal Cavity ◽

Subcutaneous Fat ◽

Postoperative Mortality ◽

Early Postoperative Period ◽

Mesh Endoprostheses ◽

Ventral Hernias

Aim. To determine and implement the best ways to position mesh endoprostheses in the anterior abdominal wall during strangulated postoperative ventral hernias; to introduce methods of non-stretch hernioplasty into emergency surgery of giant hernias. Methods. 115 patients (27 males and 88 females) with strangulated postoperative ventral hernias aged 30-73 years were under observation. Depending on the size of the hernia and on the intraoperative findings different methods of implantation of the mesh endoprostheses were used, which prevented the mesh contact with subcutaneous fat and abdominal organs. For small and medium-sized hernias the mesh was placed under or over the abdominal membrane, it was fixed to the abdominal wall, the aponeurosis was sewn together in an «edge to edge» fashion. In cases with giant hernias non-stretch hernioplasty was performed. During the operation of non-stretch hernioplasty, dissection and excision of the hernial sac was performed in such a way that made it possible to use it to cover the abdominal wall defect. Results. In the early postoperative period in 17 (14.8%) patients seromas had formed in the wound, which were treated by needle puncture under ultrasound guidance. Postoperative mortality was 5.2% (6 people). In 5 cases the deaths were due to myocardial infarction and pulmonary embolism. One patient developed peritonitis due to suture insufficiency of the enteric anastomosis. Of all patients with lethal outcomes five patients were admitted after more than 6 hours from the start of the strangulation, one patient was admitted after 3 hours. Conclusion. The usage of techniques that delimit the mesh prosthesis from the abdominal cavity and subcutaneous tissue, and the introduction of non-stretch methods for giant hernias in the surgical treatment of strangulated postoperative ventral hernia contribute to improved outcomes of treatment in this group of patients.

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Patient-reported outcomes after incisional hernia repair

Hernia ◽

10.1007/s10029-021-02477-7 ◽

2021 ◽

Author(s):

N. van Veenendaal ◽

M. M. Poelman ◽

B. van den Heuvel ◽

B. J. Dwars ◽

W. H. Schreurs ◽

...

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Abdominal Wall ◽

Patient Reported Outcomes ◽

Incisional Hernia Repair ◽

Hernia Surgery ◽

Incisional Hernias ◽

Patient Reported ◽

Postoperative Symptoms

Abstract Purpose Patient-reported outcomes (PROs) are pivotal to evaluate the efficacy of surgical management. Debate persists on the optimal surgical technique to repair incisional hernias. Assessment of PROs can guide the selection of the best management of patients with incisional hernias. The objective of this cohort study was to present the PROs after incisional hernia repair at long term follow-up. Methods Patients with a history of incisional hernia repair were seen at the out-patient clinic to collect PROs. Patients were asked about the preoperative indication for repair and postoperative symptoms, such as pain, feelings of discomfort, and bulging of the abdominal wall. Additionally, degree of satisfaction was asked and Carolina Comfort Scales were completed. Results Two hundred and ten patients after incisional hernia repair were included with a median follow-up of 3.2 years. The main indication for incisional hernia repair was the presence of a bulge (60%). Other main reasons for repair were pain (19%) or discomfort (5%). One hundred and thirty-two patients (63%) reported that the overall status of their abdominal wall had improved after the operation. Postoperative symptoms were reported by 133 patients (63%), such as feelings of discomfort, pain and bulging. Twenty percent of patients reported that the overall status of their abdominal wall was the same, and 17% reported a worse status, compared to before the operation. Ten percent of the patients would not opt for operation in hindsight. Conclusion This study showed that a majority of the patients after incisional hernia repair still report pain or symptoms such as feelings of discomfort, pain, and bulging of the abdominal wall 3 years after surgery. Embedding patients’ expectations and PROs in the preoperative counseling discussion is needed to improve decision-making in incisional hernia surgery.

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Hernioplasty with Laparoscopy Mesh Application in Equine with Incisional Hernia

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.104372 ◽

2021 ◽

Vol 49 ◽

Author(s):

Anny Raissa Carolini Gomes ◽

Bruna Machado Amaral Rosa ◽

Andressa Duarte Lorga ◽

Jéssica Do Rocio Janiszewski ◽

Lucimara Strugava ◽

...

Keyword(s):

Incisional Hernia ◽

Abdominal Wall ◽

Single Port ◽

Surgical Techniques ◽

Human Medicine ◽

Invasive Technique ◽

Operating Table ◽

Hernia Sac ◽

Aesthetic Result ◽

Laparoscopic Hernioplasty

Background: Incisional hernia in the midline can be a consequence of abdominal surgeries, which incidence is around 5.7-18%. Surgical indication occurs in cases of large hernias, and the most common techniques used involve the closing of the musculature in a primary way, with sutures, and the implantation of a mesh on the abdominal wall. Laparoscopic hernioplasty emerged as a less invasive option, showing superiority when compared with open surgical techniques in human medicine, however there are few reports describing this technique in equines. So, the aim of this paper is to report a case of hernioplasty, using laparoscopic mesh, in a horse with midline incisional hernia.Case: A 13-year-old castrated male Brasileiro de Hipismo horse, weighing 415 kg, practitioner of classic equestrian, presented an incisional hernia after 14 days from an exploratory laparotomy surgery realized to treat colic syndrome. After 6 months, the patient was referred to a Veterinary Medicine Teaching Hospital for the correction of the defect in the abdominal wall. During palpation, the animal did not present local pain or other sign of inflammation, and the hernia measured approximately 20 cm in diameter. The animal was submitted to general anesthesia and placed in dorsal decubitus for the hernioplasty surgical procedure. An incision was made in cranial region of the midline, close to the xiphoid to introduce a single port; the abdomen was inflated with CO2 gas (12 mmHg) and the operating table was tilted in order to displace the organs cranially, facilitating the laparoscopic procedure. The abdomen was inspected and the presence of a single adherence could be observed, which was disrupted with endoscopic forceps. The mesh was introduced through the single port incision and anchored to the musculature, using polypropylene 2 following the marking points previously performed on the implant, covering the defect in the abdominal musculature. In the postoperative period, analgesia was instituted with non-steroidal anti-inflammatory drugs, antibiotic therapy with intravenous benzylpenicillin potassium+gentamicin sulfate, and daily dressings. The animal showed pain responsive to the instituted analgesia in the first 24-72 h after surgery. The discharge was established after 18 days of hospitalization with the recommendation of daily dressings and use of compressive bandage until the complete healing of the wound. Postoperative complications resulting from the laparoscopic hernioplasty technique was not observed in this case.The hernia reduction was satisfactory, with a good aesthetic result after five months, when the animal resumed its athletic activities.Discussion: Laparoscopy hernioplasty is poorly described in equine medicine, and there are no reports of this procedure performed in Brazil, however, it is widely used in human medicine with results superior to open hernioplasty techniques. In the present case and in others reported in the literature, the laparoscopic technique proved to be effective in reducing incisional hernias in horses. The animals had good regression of the hernia sac and the aesthetic result was satisfactory, with few post-surgical complications. In studies in which the open hernioplasty technique was used, there was a higher occurrence of complications, in addition to more intense pain resulting from the procedure and later return to athletic activity, demonstrating that the minimally invasive technique by video surgery can be advantageous.

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Physiology in Medicine: physiological basis of diaphragmatic dysfunction with abdominal hernias–implications for therapy

Journal of Applied Physiology ◽

10.1152/japplphysiol.00276.2014 ◽

2015 ◽

Vol 118 (2) ◽

pp. 142-147 ◽

Cited By ~ 6

Author(s):

Patrick Koo ◽

Eric J. Gartman ◽

Jigme M. Sethi ◽

F. Dennis McCool

Keyword(s):

Abdominal Surgery ◽

Incisional Hernia ◽

Abdominal Wall ◽

Common Complication ◽

Diaphragmatic Dysfunction ◽

Physiological Basis ◽

Diaphragm Dysfunction ◽

Incisional Hernias ◽

Abdominal Hernias ◽

Diaphragm Function

An incisional hernia is a common complication after abdominal surgery. Complaints of dyspnea in this population may be attributed to cardiopulmonary dysfunction or deconditioning. Large abdominal incisional hernias, however, may cause diaphragm dysfunction and result in dyspnea, which is more pronounced when standing (platypnea). The use of an abdominal binder may alleviate platypnea in this population. We discuss the link between diaphragm dysfunction and the lack of abdominal wall integrity and how abdominal wall support partially restores diaphragm function.

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Comparative Study on the Use of Polypropylene Mesh in the Surgical Treatment of Patients with Strangulated or Uncomplicated Incisional Hernias

Materiale Plastice ◽

10.37358/mp.18.2.4996 ◽

2018 ◽

Vol 55 (2) ◽

pp. 207-210

Author(s):

Ioana Halmaciu ◽

Bogdan Andrei Suciu ◽

Decebal Fodor ◽

Dumitru Godja ◽

Cristian Trambitas ◽

...

Keyword(s):

Surgical Treatment ◽

Postoperative Complications ◽

Incisional Hernia ◽

Abdominal Wall ◽

Polypropylene Mesh ◽

Incisional Hernias ◽

Tissue Integration ◽

Number Of Patients ◽

History Of ◽

Group B

Incisional hernias affects approximately 10-20% of patients with history of abdominal surgery. The purpose of this study was to examine the tissue integration of the polypropylene mesh in patients operated for strangulated incisional hernias to those operated for uncomplicated incisional hernias. For this purpose, we introduced 218 patients with surgical treatment of the incisional hernia with polypropylene mesh. The total number of patients studied was divided into 2 lots: group A consisting of 189 patients with uncomplicated incisional hernia and group B of 29 patients with strangulated incisional hernia. We studied separately the local postoperative complications in the two groups (hematomas, seromas, abdominal wall infections). Although the number of local postoperative complications was higher for group B, the differences were statistically significant only for the incidence of abdominal wall infections. Although the use of the polypropylene mesh in the surgical treatment of strangulated incisional hernias predisposes to a higher risk of local postoperative complications compared to its use in the surgical treatment of the uncomplicated incisional hernias, its use in the surgical treatment of the strangulated incisional hernias is beneficial.

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Experimental models of longitudinal abdominal incisional hernia in rats

Acta Cirurgica Brasileira ◽

10.1590/s0102-86501997000400004 ◽

1997 ◽

Vol 12 (4) ◽

pp. 235-239

Author(s):

Danilo N. S. Paulo ◽

Fausto E. L. Pereira ◽

Ricardo F. da Mata ◽

Fabyano R. Dauad ◽

Isabel C. A. L. Paulo

Keyword(s):

Incisional Hernia ◽

Abdominal Wall ◽

Subcutaneous Tissue ◽

Skin Incision ◽

Abdominal Muscle ◽

Experimental Models ◽

Abdominal Muscles ◽

Median Line ◽

Large Defect ◽

Linea Alba

Abdominal incisional hernias in rats has been produced after resection of a segment of abdominal muscle. In a attempt to create a model of incisional hernia in rats, without resection of abdominal muscle, the following surgical procedures were performed: (a) Rats anesthetized with ether were submitted to a 4 cm long median incision, supra and infraumbilical, followed by dissection of the subcutaneous tissue 1.5 cm laterally to the median line in each side; after, one incision was performed in the linea alba and peritoneum, with the same extension of the skin incision; the skin incision was sutured. (b) Rats were submited to a suprapubic transversal incision and a scissors introduced through this incision and used to dissect the subcutaneous tissue at least 1.5 cm for each side of median line; after, the linea alba and peritoneoum were incised and the transversal skin incision sutured. (c) For control, rats were submitted to a resection of a 2.5 x 4 cm of the abdominal muscles, creating a large defect in the abdominal wall. All the animal, submitted to the three different procedures, developed similar well constituted hernias. We concluded that abdominal incisonal hernias are easily induced in rats after an incision of the abdominal wall, without partial resection of abdominal muscle, since the subcutaneous have been dissected at least 1.5 cm laterally to the median line.

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