Abdominal evisceration after laparoscopy is a much more common condition than we think, it should not be taken lightly.
What is an abdominal evisceration ?
Many different names exist to talk about venting. Indeed, you may have heard scar hernia, incisional hernia, abdominal hernia or also epigastric hernia.
A hernia is the passage of an organ, most often the small intestine, through a natural orifice. In the case of abdominal ventration, the hernia occurs in the majority of cases at the level of the linea alba (median line of the abdomen passing through the navel). More rarely, ventrations can appear on one side of the abdomen. In these cases, they are located between the insertions of the abdominal muscles.
As the different names mentioned above indicate, ventrations are caused by an opening of the abdominal wall. These incisions, leading to a scar, can be of voluntary origin (surgical operations) or involuntary (accidental wounds). Ventures are caused by poor healing of the aponeuroses affected by the incision. More precisely, an aponeurosis is a fibrous membrane that envelops the muscle.
Ventures are easily recognizable. Indeed, they are materialized by a visible and palpable lump on a scar. These hernias can be painful or not depending on the case. Moreover, a hernia tends to get worse over time. Indeed, it will become more and more voluminous. This is why, in most cases, a surgical operation is performed when the patient’s health condition allows it. However, a consultation with a specialist is essential to know the procedure to follow.
Possible complications
First, the main complication that can occur is strangulation. In this case, viscera and/or fat are trapped in the vent. This is very painful for the patient and constitutes a surgical emergency. Consequently, the patient must be treated quickly otherwise the viscera will become necrotic. In this case, a resection of the viscera is necessary, which makes the operation more difficult.
Abdominal evisceration after laparoscopy
The main cause of abdominal ventration is an incision in the abdominal wall. In most situations, a ventration is observed after an operation. This can be done by laparoscopy or by laparotomy. It is estimated that 20% of laparotomy patients develop a ventricle. Moreover, 75% of them develop this pathology within two years after the operation. These are often very common procedures. The main areas of intervention being the main cause are:
- Gynecology, 30% of patients present a postoperative ventration
- Hernias, 25% of the patients present a post-operation ventration
- Cholecystectomies (removal of the gallbladder), 20% of patients present abdominal evisceration.
Factors that increase risk
Overall, we have seen that in the majority of cases, the abdominal evisceration appears after a surgical operation. However, there are factors that considerably increase the risk of occurrence.
The main aggravating factors are:
- Abdominal obesity (40% of patients are obese)
- Steroid treatment
- Chronic cough
- Malnutrition, cachexia
- Chemotherapy
- Radiotherapy
- Prostatism
- Old scar, crossing of scars
As a result, if you have one or more of the aggravating factors below, you will have a high chance of developing a blowout following abdominal surgery. Also, if you have already had a blowout, the chances of recurrence are higher. That’s why it’s going to be all the more important to do post-op treatment to prevent recurrence.
The solution, surgery
In the majority of cases, the abdominal evisceration is operated on by laparoscopy, sometimes called laparoscopy. This technique consists of operating, under general anesthesia, using a camera. This allows the surgeon to have a global view of the patient’s abdomen. He will be able to observe and even treat abnormalities if he detects them during the operation. The other technique that is used is laparotomy. This method consists of operating through a direct approach by opening the abdomen directly at the level of the abdominal evisceration.
Therefore, the main advantage of laparoscopy is the postoperative recovery for the patients. This technique is not very intrusive, count only 3 small scars at the end of the operation. These are on average 10 to 20 mm. In just a few months they will hardly be visible.
The course of the pre-operation
First of all, before you undergo surgery, your surgeon will recommend that you undergo approximately one month of respiratory physiotherapy. The objective of this is to make you aware of ventilation techniques. You will need to use them after the operation.
Secondly, the physical therapists will also teach you techniques for maintaining your scar. To do this, you will be trained to place your hands correctly. This will help to avoid tension on the scar.
Finally, for patients considered fragile (overweight, advanced age, smoking…) training in non-invasive breathing methods can be taught. This instrumental relay may be necessary in case of postoperative respiratory complications.
The course of the operation
The operation is in theory simple and quick. Count on a total of 1 to 2 hours under general anesthesia for the simplest cases.
First, the surgeon begins by removing the viscera trapped in the abdominal evisceration. Secondly, he fixes a non-absorbable prosthesis in the form of a plate. This allows the abdominal wall to be reinforced. The risk of a new abdominal evisceration through this orifice is reduced to zero.
The course of the post-operation
In the case of a small abdominal evisceration, management is done on an outpatient basis. Outpatient treatment represents the majority of treatments. In this case, the patient can go home.
However, for more difficult ventrations and if the patient is elderly or has comorbidities, the surgeon may decide to hospitalize the patient for less than a week.
How to avoid recurrences?
After the operation of a ventricle, the main objective is the good recovery of his faculties. As we have seen, physical therapy is very important after the operation. But afterwards, it will be necessary to prepare against possible recurrences. You should also think about this if you are having surgery on your abdomen. As we have seen, abdominal operations are the source of many ventures, so what to do?
First of all, after the operation, it will be necessary to gently remobilize the abdominal wall. For this, the support of a physiotherapist will allow you to manage your breathing.
In a second step, you will have to remusculate your abdominal wall. The abdominal muscles are abused during abdominal surgery. It is therefore highly recommended to train your abdominal muscles after a laparoscopy. To do this, it is necessary to proceed step by step under the supervision of a professional.
Finally, surgeons often prescribe post-operative physical therapy sessions to re-educate the abdominal muscles. This work is extremely important to prevent the risk of recurrence. In addition, these sessions, which will take place 2 to 3 times a week for 1 to 2 months, will allow you to recover more quickly.
Do not hesitate to ask your surgeon for possible sessions.
Bibliographic references
1. Parker HH, 3rd, Nottingham JM, Bynoe RP, Yost MJ: Laparoscopic repair of large incisional hernias. Am Surg 2002; 68(6): 530-3; discussion 533-4.
2. Franklin ME, Dorman JP, Glass JL, Balli JE, Gonzalez JJ: Laparoscopic ventral and incisional hernia repair. Surg Laparosc Endosc 1998; 8(4): 294-9. 3. Bucknal
3. NETTER F.H, M.D – Atlas d’Anatomie Humaine. – 2ème éd.- USA :Maloine, 1997.-354p.
4. PANSARD J.-L. – Fonction respiratoire et chirurgie abdominale. – Editions Techniques-Encycl.Méd. Chir. (Paris-Fance), Pneumologie, 6066 A10, 1992, 9p.
5. SELOT P. – Kinésithérapie et chirurgie abdominale. Encycl. Méd. Chir. (Paris-France), Kinésithérapie, 26550 A10, 12 – 1989, 6p.