White hernia surgery

White cress is a connective tissue between two straight abdominal muscles, combining them together to form the strengthening of the anterior abdominal wall. Sometimes the fibers of the discussed band may separate, we have to deal with the so-called white border hernia otherwise called the stretch of straight abdominal muscles. This is one type of abdominal hernia. Occurs most often in overweight men. White hernia also affects women, most often develops during pregnancy.

Characteristics of white hernia surgery

White cress is a connective tissue band that arises as a result of the crossing of the tendon fibers of both straight abdominal muscles. It is located in the middle, between the straight muscles and extends from the parietal process (the lower pole of the sternum) to the pubic symphysis.
White cress is buried with numerous small vessels, especially in the area of the upper abdomen. There are small holes in the places through which the dishes pass. These slots can grow over time, which are points of reduced resistance and are a potential site of hernia formation. Another theory regarding the occurrence of white hernia hernia is that they arise in places of congenital weakness of the white border tissues. Behind this theory is the occurrence of this type of hernia in infants. The contents of the white hernia can be a retroperitoneal fat in a small degree of hernia. In larger hernias, the peritoneum can be bloated along with the abdominal organs. Then, the contents of the hernia sac can be a network (fatty apron attached to the colon, loosely placed on the abdominal cavities), small intestine, large intestine, stomach. The most dangerous complication of inguinal hernia is the incarceration of the intestine with its subsequent necrosis, which leads to peritonitis and, consequently, can lead to death. For this reason, inguinal hernia can not be underestimated.

The white hernia is most often located between the alveolar process and the navel. It occurs in many cases as a plural change.

White border hernias occur in 3-10% of the population usually between 20 and 50 years, 3 times more often in men than in women.

Diagnosis is based on physical examination. The patient reports to the doctor most often because of abdominal pain and a palpable nodule in the abdominal wall in pain. During the clinical examination, the doctor tries to drain the nodule, so that he can assess the size of the hernia gates (fissures in the abdominal wall).
Recognition is not so easy in every case. Sometimes hernia of the white border gives a strong pain symptoms, which may suggest a different disease, for example peptic ulcer disease or cholelithiasis. An abdominal ultrasound examination is helpful in such a situation.

Other symptoms associated with white hernia include:
• longitudinal bulge of the layers in the midline of the abdomen of various sizes, from the size of the pea grain to the large size of the tumor of the abdominal wall,
• the hernia reveals when the abdominal wall is stretched and in a standing position,
• pains may be accompanied by flatulence, nausea, vomiting, which are particularly severe after heavy meals, and relief can be achieved by lying down in a semi-recumbent position.
Obesity is a very difficult factor to diagnose.

The treatment of choice in the white hernia is surgery with or without mesh.

The incidence of relapse after a white line hernia without using a mesh is 15-20%.

Benefits of white border hernia surgery

The patient undergoing a hernia surgery has a lot of benefits. Treatment of hernia primarily eliminates the risk of hernia trapping, which is the most dangerous complication of the disease. It is a state of imminent danger to life, because in such a moment the intestinal perforation and peritonitis can occur, which often ends in death. At this moment urgent surgery is required, which is associated with a higher risk of complications. Symptoms of hernia incarceration are very strong abdominal pain, severe pain in the projection of the hernia itself and often bruising the skin over the visible bulge.

Other benefits of a white hernia surgery include preventing the hernia sac from growing, which at the onset of the disease can only be seen as an unsightly deformity, a tumor in the area of the anterior abdominal surface. Over time, the size of such a hernia may worsen the quality of life.

Submission to surgery reduces or completely eliminates pain related to the disease. Thanks to hernia surgery, you can return to full activity from before the disease.

Indications for white hernia surgery

White hernia hernia operations are carried out in two modes, as a planned operation and a procedure performed based on life indications at the moment of her incarceration.

The most anticipated and giving the least complications is scheduled surgery.

The indication for a white borderline surgery in the planned mode is the appearance of symptoms associated with the disease.

The main symptom of the white hernia is a bulge in the middle abdomen (between the tip of the sternum and the navel) increasing in size during coughing, in a standing position. In the initial stage, the hernia is only felt by touch. Later on it comes to its visible embossing. Hernia may also be accompanied by pain. Pain complaints have varying degrees of severity, depending on the size of the hernia and its content. The pain most often occurs when the abdominal wall is stretched and may radiate towards the back or towards the lower abdominal region. It may also be accompanied by bloating, nausea and vomiting.

Sometimes the hernia may not bulge and give only pain, thus causing difficulties with diagnosis.

In the case of an evident white hernia, clinical examination is a sufficient indication for surgery. The diagnosis of the white line in most cases is not difficult and is determined only on the basis of symptoms and palpation. In doubtful situations, an ultrasound should be performed by an ultrasound scanner.

At the moment when the lack of symptoms can be abandoned from the white border surgery and consider the observations themselves.

Contraindications for hernia surgery white line

Contraindication to the operation of the white line hernia in planned mode is the presence of inflammation or purulent skin or subcutaneous tissue in the area of the hernia.

Contraindications are also diseases with general inflammation, others are taking anticoagulants, for example: Polocard, Acard, Plavix, etc.

Before the operation of the white hernia

During consultations before the operation of the white hernia, the physician collects the interview and examines the patient. It is important then to inform the doctor about all diseases, medicines and allergies you have. People taking anticoagulants must, according to the doctor's instructions, set them aside one week before the procedure or switch to another anticoagulant with a lower potency.

On the day, up to several days before the hernia surgery, appropriate examinations may be ordered. The surgeon may also order a medical consultation with another specialist, such as a cardiologist if the patient has a chronic heart disease.

During the consultation, the type of anaesthesia to which the patient will be subject is also determined. The white border hernia is operated in two types of anaesthesia. Under local anaesthesia when there is a small hernia and we are sure that there is no need to open the peritoneum and under general anaesthesia in more severe cases. If the patient undergoes general anaesthesia, he must not eat 6 hours before the procedure and drink 2 hours before the operation.

Before the operation of the white hernia as before each surgery, consent is signed. Before signing the patient should be informed by the doctor about how the procedure will proceed, what are the consequences of withdrawal from surgery and what are the possible complications.

In the case of a white hernia surgery, it is also determined whether the mesh will be implanted.

Before the operation of the hernia, the surgical site should be shaved.

Type of anaesthesia during white border hernia surgery

The operation of the white hernia, depending on the size and content of the hernia sac, is operated in two types of anaesthesia.

In a small degree of hernia, where the content is only fat, it is usually performed under local anaesthesia, thanks to which the patient returns to full activity in a much faster time.

In situations in which there are large hernia gates or the content of the sac is the intestine, stomach or network, operations are performed under general anaesthesia. However, this method of anaesthesia is associated with a longer period of hospitalization.

Using the laparoscopic method, general anaesthesia is also necessary.

How does the white border hernia work?

The treatment of choice in the White Border hernia is an operation.

During the procedure, the surgeon initially injects the anesthetic with the anesthetic. Then he performs a longitudinal cut below the xiphoid process. Depending on the size of the hernia, we have different cutting sizes. The hernia gate is located next. If there are several hernias of the white border, then the gates are joined with one cut. In the next stage, the hernia bag is dissected, which most often goes into the abdominal cavity without opening. In some situations it is required to open the bag, then the contents are drained to the abdominal cavity and the excess removed.

At the end, the continuity of the white line is reproduced with non-absorbable suture and the subcutaneous tissue is sewn separately with absorptive threads and the skin with non-absorbable threads. If there is a risk of bleeding, a drain is placed in the wound (a rubber or plastic tube with holes to drain the liquid content from the wound).

At the end the wound is washed, wiped dry and a dressing is placed on it.

Depending on the clinical situation, which consists of such factors as the size of the hernia gut, laxity of the tissues, patient's age, activity, occupation performed, an appropriate method of supplying the hernia's gates is selected. In small-scale hernias, a Mayo type of plastic may be used, which consists in sewing the layers onto the so-called overlap (one edge of the gate covers the other). If the coatings are weak or the hernia was large in size, the coating is additionally reinforced with a non-absorbable or semi-absorbable synthetic mesh. The mesh is usually placed in the space before retardation.

Plaque hernia with mesh implantation can also be performed laparoscopically.

The operation lasts from 20min to 1h.

Time and course of convalescence after white hernia surgery

Recuperation time after white hernia repair and inability to work depends on the type of surgery, after the treatment with the use of mesh, this time is typically 1-3 weeks, without a 4-12 week grid.

The pain associated with the operation in most cases disappear completely within 2-3 months, in the initial period help painkillers.

The patient experiences the greatest discomfort associated with hernia surgery during the first few days. Painkillers are helpful during this period. In the surgical site, as with any surgical procedure, there is swelling and bruising may also occur.

It is necessary to quickly return to daily activities, too long lying in bed increases the risk of blood clots in vessels, which can be a fatal complication.

Change the dressing every day, wash the wound with disinfectant preparations for the skin, eg skinsept, octenisept, or ordinary soap with water. Remember to wipe the wound dry before applying the dressing. Bathing in the bathtub and soaking the wound is not recommended, it is best to wash in the shower.

The drain, which was placed in the wound because of the possibility of bleeding, is removed by the surgeon in the first days after surgery.

The seams on the skin are kept for 7-10 days. After suturing, you can use preparations for scars, especially ointments and silicone patches.

Follow the doctor's instructions and apply for an appointment.

A special ventral hernia belt should be worn within 4 to 12 weeks.

If bleeding, severe edema, fever, persistent pain, difficulty urinating, leaking of the purulent content from the wound occur, please contact your surgeon or other surgeon if there is no other option.

The effects after white hernia surgery

The operation of the white hernia performed with the use of a mesh gives a much less frequent relapse than operations without its use.

The size of the scar depends on the size of the hernia.

It should also be remembered that the scar in the human body is formed from half a year to a year, only after this period, the effect of the surgeon's work can be fully assessed.

Recommendations after white hernia surgery

• daily dressing change,
• prohibition of the use of anticoagulants in the first days after surgery, eg: Polocar, Acard,
• in the case of pain, oral analgesics, e.g. Paracetamol, Ketonal, Pyralgin,
• first postoperative check and removal of seams 7 to 10 days after surgery,
• a quick return to daily activity, which significantly accelerates convalescence,
• for the first four weeks after hernia surgery, you should limit the lifting,
• using a hernia belt within 2 months of the surgery,
• for physical work the patient can return a few weeks after the surgery,
• a ban on carrying loads over 5 kg for up to six months after the surgery.

How long do the effects of the white border hernia persist?

The effects of the white hernia surgery may last for the rest of their lives.

The postoperative recurrence rate of the primary white hernia varies from 1% in operations using nets up to 20% without their use.

How to avoid complications after a hernia surgery white line?

As in the course of each treatment, the most important thing is to follow the doctor's instructions. Each patient is treated individually, for whom separate recommendations may be required.

The general principles to be followed to avoid complications are the ban on lifting in the first period after surgery. Maximum 5 kg from 3 months to half a year after a white hernia surgery.

No physical work for the first few weeks.

The use of the hernia belt for a period of 2 months after the surgery.

After surgery you should also quickly return to activity and not lie in bed because it may cause thrombotic problems.

Possible complications after a white hernia surgery

As with any procedure, the hernia of the white borderline is fraught with certain risk of complications.

• vascular injury that may result in hematoma or postoperative bleeding that may require surgery again,
• damage to the nerves located in the vicinity of the white hernia which leads to a disturbance of sensation on the skin in the vicinity of the performed procedure, it may also lead to hyperalgesia in the area of a dozen or so centimeters from the cutaneous cut,
• the appearance of serous reservoirs,
• infection of the surgical wound, infection of the mesh (requires removal), abscesses inside the abdominal cavity,
• damage to the abdominal organs during surgery (intestines, bladder)
• recurrence of the white hernia,
• unsightly surgical scar,
• the formation of kelo,
• chronic postoperative pain.

Recommended additional treatments after white hernia surgery

In principle, no operations are required after a white hernia surgery. Patients are advised to increase their effort on their own after approximately 2 weeks of surgery.

Patients who have problems with making the effort themselves can be referred to a rehabilitation practitioner.

Occasionally, lymphatic massage may be used in the situation of persistent edema in the surgical area.

Author: Piotr Bargiel, MD

Literature:
K. Bielecki, M.Krwaczyk "Recommendations of the Main Board of TChP in diocesan-therapeutic proceedings in selected surgical diseases"; 2012; Medical Standards in Practice; s.62
J. Szmidt and J. Kużdżała "Fundamentals of surgery"; Krakow 2010; ed. Practical Medicine volume II; pp. 1131-1132;
M. Śliwiński and W. Rudowski "Clinical and surgical Surgery" PZWL; Warsaw 1985; volume III, part 2; pp. 445-447