Abdominal wall incisional hernia, surgical treatment tips!

Author: Chen Jie, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Reviewer: Liang Zhen, Chief Physician, Peking University Cancer Hospital

Surgery is a very important treatment for abdominal wall incisional hernia. Many friends have some questions about incisional hernia surgery, such as what complications are likely to occur after surgery? How long will it take to be able to move normally after surgery? What is the frequency of postoperative follow-up? Will it recur after surgery?

Next, let’s take a look together.

1. What are the complications of abdominal wall incisional hernia surgery?

The most common postoperative complication is infection, with an incidence rate of approximately a few percent. This is a problem often encountered in clinical practice.

Another issue is postoperative pain, because no matter what kind of patch is placed in the body, it is different from muscle tissue. If the patch is displaced before it heals, pain will occur after it heals, so chronic pain after surgery is also one of the more common complications.

Some patients with chronic pain can take painkillers, but most patients cannot be completely cured. Because if there is no clear tender point, it is difficult to treat. If there is a clear point, such as nailing on the nerve, sometimes the pain can be solved by removing the nail or removing the stitches. If the pain is caused by shrinkage caused by the patch, it is difficult to treat and the patch may have to be removed in the end.

Then there are some patients with intestinal obstruction, intestinal adhesion, and even some patients have delayed intestinal fistula.

Figure 1 Original copyright image, no permission to reprint

Therefore, if you experience any discomfort after surgery, you must communicate with your doctor in a timely manner and actively deal with it under the doctor's guidance.

2. How long will it take to be able to move around after abdominal wall incisional hernia surgery?

Generally speaking, within one month after the operation, patients can actually walk, carry out daily life, or do housework, such as cooking, mopping the floor, buying groceries, etc., without any problem.

But it will take at least three to six months for the tissue and patch to completely heal together before the patient can fully recover to normal. In other words, after three to six months, the patient will be like a normal person and can do what he needs to do.

But be careful if you are doing particularly heavy physical labor or particularly intense exercise. For example, some girls asked, after having an incisional hernia surgery, they still want to do yoga and dance, is it okay?

That would be very difficult, because yoga and dance both require stretching of muscle tissue. Once the patch grows together with the flesh, the muscle tissue in this part will not have much elasticity, and you may not be able to do yoga or dance anymore. In fact, you generally cannot do special exercises anymore.

Figure 2 Original copyright image, no permission to reprint

3. How often should you have a follow-up check after abdominal wall incisional hernia surgery?

All patients with abdominal wall incisional hernia need to be followed up after surgery. It is rare for patients with incisional hernia to be discharged from the hospital on the same day or the next day after surgery. It is often more than ten days before discharge. Therefore, patients will generally be examined before discharge to see if they have any problems. If there are any problems, they will be dealt with in a timely manner and they can be discharged only if there are no problems.

Generally, we will do a follow-up check after one month to check if there are any problems with the wound or the local area. If there are no problems, we will do another CT scan in three months to check if there is any fluid accumulation, whether the patch is flat, whether there is any adhesion in the intestine, whether the patient is feeling uncomfortable, etc.

If there is no problem after three months, a follow-up call can be made after six months, one year, or even one year. Generally, patients are told to come to the hospital at any time if there is any problem. If there is no problem, a follow-up call or tracking call can be made after six months or one year of incisional hernia.

4. Is it easy for abdominal wall incisional hernia to recur after surgery?

There is a possibility of recurrence.

So the question that doctors are most afraid of patients' families asking is, will the disease relapse? Because the answer is yes. Why? It's just like a piece of clothing that is torn and you put a patch on it, but the clothing may be torn again in the future.

Of course, if it breaks again, we can use a larger patch to repair it, but with a larger patch, the patient's postoperative comfort and compliance will be worse, because the patch is a foreign body after all, no matter how good the patch is, it is different from normal human tissue. So using a larger patch is more difficult for doctors to operate on the one hand, and the patient's postoperative comfort is also not good.

Another issue is the economy. If a large patch is placed in the abdominal cavity, an extra centimeter may cost two thousand dollars more, and an extra ten centimeters may cost tens of thousands of dollars more, which is even more uneconomical.

Just like our clothes, you can't change a new piece of clothing. You say there is a hole here, can I replace the entire sleeve? Yes, you can. But if this sleeve is not torn, the other sleeve may also be torn. That's the concept.

Fortunately, the recurrence rate of incisional hernia is not too high. If the surgery is performed by standardized and experienced doctors, the recurrence rate should not exceed 10%, so there is no need to worry too much about recurrence.