Incision hernia

　　The most common types of incisional hernia in clinical practice mainly include three types: common incisional hernia, laparoscopic puncture hernia after surgery, and incisional hernia formed by temporary abdominal closure. The latter often occurs in cases of abdominal compartment syndrome, such as patients with incisional dehiscence after intestinal fistula, due to the inability to perform secondary suture in time, the skin creeping over the intestinal incision and healing itself.

　　Incisional hernia generally refers to hernia caused by abdominal surgery. The main cause of this hernia is mainly due to wound infection or crack, which can be regarded as delayed incisional dehiscence or deep incisional dehiscence under the surface healing. The main complications of incisional hernia include:

　　1. Incisional hernia can lead to intestinal adhesion, abdominal compartment syndrome, and may also cause wound infection and recurrence, as well as subcutaneous hematoma and effusion around the wound.

　　2. Intestinal incarceration: As we all know, the contents of the hernia can pass through the hernia ring under the action of abdominal pressure and return to the abdominal cavity by themselves. When the contents of a reducible hernia suddenly cannot be returned, and the local mass increases, it indicates that intestinal incarceration has occurred, which is called incarcerated hernia at this time.

　　3. Intestinal strangulation: If the incarcerated hernia persists and is not treated promptly, the contents of the hernia (mainly the intestine) may experience circulatory disorders, which may lead to intestinal obstruction, intestinal necrosis, and even intestinal perforation and other severe consequences.

　　The main symptom of incisional hernia is the protrusion of a mass at the abdominal wall incision. The protrusion or enlargement is more obvious when standing or exerting force, and it diminishes or disappears when lying flat. When a large hernia mass protrudes with a large number of organs and tissues, there may be abdominal dull pain, dragging sensation, and other discomforts. Some patients may experience decreased appetite, nausea, anxiety, and other symptoms. The hernia contents may adhere to the extraperitoneal abdominal wall tissue and become a reducible hernia. Sometimes, it may present with incomplete intestinal obstruction. A few patients with small hernia rings may experience incarceration.

　　Incisional hernia is mainly caused by surgical reasons. To reduce the incidence of this disease, it is recommended to pay attention to the following preventive measures:

　　1. Carefully design the incision

　　To prevent the occurrence of incisional hernia, clinical doctors should carefully design the incision according to the treatment goal, minimize the use of transrectus sheath and lateral rectus incisions, and instead use transverse incisions, median incisions, and para-median incisions.

　　2. Improve healing ability

　　Strengthen the patient's nutritional support, correct anemia and hypoproteinemia, supplement vitamin C, K, etc., improve the patient's general condition and enhance healing ability.

　　3. Actively treat complications or complications

　　Active treatment should be given to complications or complications that affect tissue healing, such as diabetes, coagulation disorders, respiratory dysfunction, liver dysfunction, and kidney dysfunction. Elective surgery should be performed only after the above conditions are corrected or controlled.

　　4. Actively handle factors that cause increased abdominal pressure

　　Before surgery, actively treat diseases that increase intra-abdominal pressure, such as pulmonary infection, chronic obstructive pulmonary disease, large amounts of ascites, constipation, or difficulty urinating, and prevent and treat factors that cause increased intra-abdominal pressure after surgery, such as bloating, vomiting, hiccups, coughing, and sneezing, while using an abdominal belt.

　　5. Prevent incision infection

　　Before surgery, actively treat the patient's skin, nasopharyngeal, and gastrointestinal infections. Shaving the surgical area may damage the skin or cause minor skin wounds, and hair cutting or depilation methods should be used instead of shaving, and the time from skin preparation to surgery should be kept as short as possible.

　　The diagnosis of incision hernia usually does not require special examinations. Sometimes, preoperative assessment requires an understanding of the condition of the primary disease. Imaging examinations can show the hernia contents, especially CT can clearly show the continuity interruption of the related部位, and the hernia contents protrude outward.

　　There are no special dietary requirements for patients, generally normal diet is sufficient. Pay attention to a rich diet and balanced nutrition. Ensure the body's normal metabolic needs for calories, proteins, vitamins, and other nutrients. Increase the intake of vegetables and fruits appropriately. In terms of health care, it is important to relax the mind, build confidence, maintain a good attitude, and actively cooperate with the doctor's treatment.

　　Incision hernia should be primarily treated with surgery, but for the elderly and weak, patients with chronic diseases that increase intra-abdominal pressure, advanced cancer, and those with acute and critical medical and surgical emergencies, non-surgical treatment can be adopted, including protecting the incision hernia, preventing damage to the hernia contents; locally using elastic abdominal bands or abdominal wraps to prevent the hernia mass from protruding; treating general conditions such as cough and constipation.