The laparocele or incisional hernia is a pathological condition that occurs at variable distance of time from surgery in the abdomen. The suture performed at the time of the intervention for various reasons can yield leading to the formation of one or more breaches through which abdominal contents come out. Dr. Salvatore Motta, expert in General Surgery in Catania, talks about it
What is Laparocele?
They are therefore real post-operative hernias . The viscera can spontaneously re-enter the abdomen when assuming a rest position such as the supine position or re-enter under manual push from the outside. Sometimes, however, the viscera “incarcerate” through the breach (hernial port) and no longer fall with two risks, intestinal obstruction or throttling (in which the vascular suffering of the intestinal loops can lead to necrosis). These are serious complications that require emergency surgical treatment with the need sometimes to perform intestinal resections.
What can be the consequences of an incisional hernia?
The most common complaints related to laparocele are represented by the appearance of one or more swellings of the abdominal wall, sometimes accompanied by pain and / or disturbances of the hollow. It should also be considered that over time there is a progressive atrophy of the muscles that delimit the hernial gate with the consequence of a possible increase in the size of the laparocele up to giant laparoceles with repercussions also on respiratory dynamics. That’s why it’s good to treat this pathology as soon as possible.
What are the most used treatments?
The treatment is surgical (plastic of the abdominal wall) as the use of retaining bands cannot be solved to solve the problem. For the purpose of surgery in the case of large laparoceles, the patient’s general conditions, in particular cardio-respiratory conditions, must be put in the balance between risks and benefits, not only because of general anesthesia but also and above all for the changes in respiratory dynamics that they can occur when many viscera that have lost the so-called “right of domicile” have to be brought back to the abdomen.
Since the weakening of the tissues is based on a weakening of the tissues, the possibility of a recurrence cannot be excluded. Until the 1960s, the only possibility of treatment was plastic for direct suturing obtained by simple combination with relapse rates reported from up to 45-50% even 8-10 years after surgery. The use of increasingly sophisticated biocompatible material, the so-called prostheses or nets, has made it possible to reduce the failure rate by over a third, which is why the prosthetic treatment is the one used today. Surgery can be performed both through traditional access (open) and with laparoscopic modality. In the first case the prosthesis can be positioned in different ways (Prefascial, Intraparietal, Endoperitoneal), in the second case it is endoperitoneal, that is, in direct contact with the abdominal viscera . While performing the laparoscopic technique, which I reserve above all for minor defects, my personal preference for large laparoceles goes to the technique with intraparietal retromuscular implant, which I consider the most physiological, capable of achieving the recovery of the normal function of the abdominal wall, restoring the functional fulcrum on the midline that is lost in laparocele, as well as its consolidation. The intra-abdominal pressure pushes the prosthesis against the muscles, in other words the same forces that created the hernia are now used to prevent it. In particular giant laparoceli we use an extension of this technique called “Posterior Component Separation”, certainly demanding but that gives excellent results. In preparation for the operation, in addition to the common preoperative tests, a CT scan of the abdominal wall must be performedto define the exact degree of diastasis of the abdominal muscles and the exact number of hernial gates and also an examination of respiratory function in obese patients and large laparoceles. It goes without saying that during the first postoperative month the patient, although he can carry out his normal relationship life, must be cautious in exposing himself to excessive abdominal contractions in the case of open surgery .
