Ernie della parete addominale

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Ernie della parete addominale

 
A hernia of the abdominal wall is a protrusion of the abdominal contents (intestinal loops, omentum) through an acquired or congenital area of weakness or defect in the wall. Many hernias are asymptomatic, but some become incarcerated or strangulated, causing pain and requiring immediate surgery
Hernias are classified according to their position in the abdominal wall (epigastric, inguinal, umbilical hernia, etc); incisional hernias occur through an incision from previous abdominal surgery. Among causes that promote hernia formation: age, diabetes, steroid therapy.
Obesity increases the risk for developing abdominal wall hernias. Being overweight increases the strain and pressure on your abdominal muscles and makes them weaker and more prone to developing a hernia. Over time, this additional weight contributes to a growth in the size of the hernia. In some cases, this can lead to a loop of intestine becoming trapped in the muscle tissue, causing severe pain and requiring immediate treatment. Obesity can also lead to the development of multiple hernias in the muscle wall.

 

Most patients complain only of a visible bulge, which may cause vague discomfort or be asymptomatic. Most hernias, even large ones, can be manually reduced with persistent gentle pressure; placing the patient in the Trendelenburg position may help. An incarcerated hernia cannot be reduced and can be the cause of a bowel obstruction. A strangulated hernia causes steady, gradually increasing pain, typically with nausea and vomiting. The hernia itself is tender, and the overlying skin may be erythematous; peritonitis may develop depending on location, with diffuse tenderness, guarding, and rebound
 

The diagnosis is clinical. Ultrasound or CT scan can be necessary especially for multiple hernias.

 

Hernia treatment aims at repairing the defect and eliminating the causing factors of herniation. This is valid especially for obese patients, whose increased abdominal pressure makes it impossibile to reduce the hernia. In these patients, hernia repair should be associated to the treatment of obesity or should be postponed after bariatric surgery in order to achieve an adequate weight loss. In both cases, for small hernias, laparoscopic approach is as safe and effective as laparotomy.Surgery should be performed before the manifestation of complications.
Sometimes hernia repair is performed one or 2 years after bariatric surgery, often combined with abdominoplasty. This procedure is both cosmetic and reconstructive, completing the cycle of rehabilitation of operated bariatric patients.