A study of abdominal wall hernias

Meena Ranjani, C (2013) A study of abdominal wall hernias. Masters thesis, Tirunelveli Medical College, Tirunelveli.

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Abstract

INTRODUCTION: Sir Astely Paston Cooper’s words: “No disease of the human body belonging to the province of the Surgeon requires in its treatment a better combination of accurate anatomical knowledge with surgical skill than Hernia in all its varieties” Abdominal wall hernias are familiar surgical problem. Abdominal wall hernias are those that appear through the layers of abdominal walls at sites of weakness. They occur both due to congenital and acquired defects. Hernias commonly cause pain and are aesthetically distressing to patients. This coupled with the risk of incarceration, is the most common reason patient seeks surgical repair of hernias. Advances in the basic and clinical sciences have allowed a better understanding of the pathophysiology of hernia formation. The field of hernia repair has evolved as a result of surgical innovation and has benefited significantly from technologic improvements. AIM AND OBJECTIVE OF STUDY: 1) To study about the incidence and presentation of various types of abdominal wall hernias. . 2) To evaluate for obvious etiological factors and identifying contributory risk factors such that they can be eliminated. 3) To analyze the various surgical modalities and treatment performed at this institution. INCLUSION CRITERIA: All cases of abdominal wall hernias presenting above 12 yrs of age. EXCLUSION CRITERIA: Age <12 yrs, Inguinal and femoral hernias. MATERIALS AND METHODS: Present study is based on the analysis of cases of abdominal wall hernias observed during January 2011 to Sep 2012.the study accounts for all the cases of abdominal wall hernias that were diagnosed and treated both electively and emergency. Ethical committee clearance obtained. Consent was obtained from all patients. A simple random sampling was done for selecting the patients. The patients related factor namely age, sex, multi parity, obesity, cough/COPD, constipation, prostatism, diabetes mellitus, hyper tension, steroid therapy, consumption of tobacco and alcohol, past surgical history were recorded. A master chart has been made recording relevant history and findings of personally studied 185 cases of ventral hernia. Routine investigations viz Hematology, Urine examination, chest x-ray, ECG, Ultrasound abdomen and Pelvis for all patients and other special investigations were done for associated diseases wherever required. As clinical diagnosis was made, patients with medical illness were appropriately treated to attain near normal parameters before surgery. At the induction of anesthesia, prophylactic dose of antibiotic (1st generation cephalosporin) was given. Patients were assigned to undergo suture repair or mesh repair at operating surgeon’s discretion. In suture repair continuous stitches with stitch width and interval approximately 1 cm was put using polypropylene (Prolene no. 1). In mesh repair Prolene mesh was used with at least 4 cm of mesh overlapping the approximated edges of the facial defect and secured with no. 1 Prolene interrupted stitches over the fascia. Suction drain was used for all patients with Incisional hernia and drain removed 48 to 72 hrs interval or when drain decreased. Sutures were removed on 8 post operation day. CONCLUSIONS: 85 cases of ventral hernias were studied with follow up a period of 6 to 18 months: • Incisional hernias constituted 46.4% of all ventral hernias, epigastric 11.4%,umbilical hernia 40.5%, spigelian(.005%), and lumbar (.01%). • Female preponderance was seen in Incisional hernias with male to female ratio of 6.7:1, where as in epigastric and umbilical/Para umbilical hernias male predominance was seen with ratio of 4:1 and 1.2:1 respectively. • Most of the ventral hernias 88.7% were uncomplicated at the time of presentation, remaining 9.7 % presented with either obstruction or irreducibility, necessitating emergency repair. • Swelling was the most common complaint in 55%, followed by pain 31.6. • Previous surgery or trauma was the single most important cause for ventral (Incisional) hernias. Other etiological factors were multiparity, obesity, anemia, COPD, BPH, diabetes mellitus alcoholism and smocking. • Post operative wound infection was important cause for development of incisional hernias. • Rare hernias viz, spigelian1case, lumbar 2cases were seen during our study period. • Simple suture repair and or Mayo’s repair was the choice of repair in children and in emergencies in all age groups. It was done for all veritiesof ventral hernias with smaller defect size. • Mesh repair is the technique of choice for most of Incisional hernias and or all ventral hernias with large defect. Though sub lay/underlay mesh placement is more physiological, it can be placed either inlay or on lay. • Laparoscopic approach for ventral hernia repair is definitely method of choice with the advantages of good operative field visibility, lessened duration of hospital stay, minimal post operative scar. Cost of surgery and surgical expertise being the limiting factors for our study. • Mesh repair can be combined with elective bowel surgeries provided careful pre operative preparation of the patient, meticulous dissection, complete haemostasis, and proper post operative care is given. This still needs further studies. • Prolene hernia system was primarily developed for repair of inguinal hernias, now a days this novel technique is being increasingly employed for the management of epigastric and umbilical hernias also. • Size of the defect and presence of complication are the guiding factors for choosing the type of repair.

Item Type: Thesis (Masters)
Uncontrolled Keywords: abdominal wall hernias.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 09 Jun 2018 17:38
Last Modified: 13 Jan 2020 14:06
URI: http://repository-tnmgrmu.ac.in/id/eprint/8361

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