The term "hernia" means the exit of a part of an entire organ from the anatomical cavity, which it usually occupies, or through regular or pathologically formed openings. With poor scar healing after the operation, a hernia occurs; the organs come out through a weak point in the abdominal wallSometimes this occurs as a result of suppuration or inflammation at the site of the scar. In other cases, if the formed connective tissue turns out to be weak due to concomitant diseases or metabolic disorders, which lead to diabetes, rheumatic diseases, and hereditary connective tissue diseases[1,2]

Statistics show that postoperative hernias occur in 6-8% of patients undergoing abdominal or abdominal interventions. In 50% of patients, a 

hernia occurs in the first year after surgery, and all remaining cases are within five years. Hernias often appear after emergency interventions, with suppuration of the operation wound, after large oncological operations. However, it can also occur after endoscopic procedures at trocar placement sites or the site of a tumor or organ extraction [3]

The problems of treating incisional hernias are not always adequately covered in the extensive literature, the population about the unsuccessful results of treatment and their negative experience of rehabilitation after the first surgery led to the fact that many patients with incisional hernias for a long time refused the planned surgical treatment [4,5].This helps to extend the time of the hernia. At the same time, the size of the hernia increases, the adhesion process develops in the abdominal cavity, and irreversible changes occur in the tissues of the abdominal wall and those organs in an abnormal anatomical position. All of the above significantly worsens the results of treatment [6]

Classification of Incisional Hernia

Hernia protrusions are categorized by size. Customize:

A small incisional hernia is located in any area of the abdomen and does not change its shape. It is determined only by palpation or by ultrasound examination with a size of the hernia opening up to 5 cm [7]

             middle incisional hernia occupying part of the abdominal region with the formation of a visible protrusion and the size of the hernia opening from 5 to 10 cm;

             sizeable incisional hernia, wholly occupying any area of the anterior abdominal wall, changing the shape of the abdomen, gate size from 10 to 15 cm;

             Giant incisional hernia, occupying two or three areas of the stomach and more, sharply deforms the core, interferes with everyday life. The size of the hernia opening is more than 15 cm. In 2006

This classification considers three main criteria: the localization of the hernia about the umbilicus (median, lateral, and combined), the size of the hernia opening, and the presence of relapses [8]

Etiology and Pathogenesis of a Disease or Condition (A Group of Diseases or Infections)

The causes of ventral incisional hernias are varied. Surgical techniques of laparotomic wound closure and postoperative wound infection are considered the most important causative factors that increase the risk of incisional hernia formation. The occurrence of incisional hernias during the first year after surgery is most often due to the presence of early postoperative complications (suppuration of the postoperative wound, eventration), which, in turn, can develop as a result of an unreasonable choice of surgical access, traumatic surgery, poor hemostasis, stitching of heterogeneous tissues, overlapping frequent or rare sutures on aponeurotic structures, incorrect choice of suture material, removal of tampons and drains through the primary wound, poor postoperative wound care, terrible choice of antibiotic therapy, etc. [9,10].Important etiological factors leading to the development of incisional hernias during the first year after the operation are conditions and diseases that contribute to an increase in intra-abdominal pressure: mental agitation, cough, intestinal paresis, chronic constipation, difficulty urinating, etc. [11].Factors that increase the risk of incisional hernias are male gender, BMI, old age, diabetes mellitus, jaundice, anemia, use of vasopressor drugs, smoking [12]. Postoperative hernias are also caused by postoperative respiratory failure, aneurysmal disease, chronic nutritional disorder, hormonal drugs, renal failure, cancer, several operations through the same access, chronic obstructive pulmonary disease, benign prostatic hypertrophy, ascites ... Impaired collagen metabolism, and diastasis of the rectus abdominis muscles predispose to the development of postoperative hernia at a later date. The reasons for the development of hernias during these periods are often a violation of collagen synthesis against the background of obesity, cachexia, old age, anemia, hypoproteinemia, oncological diseases, liver diseases, diabetes mellitus, etc. [13,14].The previously listed risk factors have been confirmed to influence the number of recurrences. When planning a surgical operation, consulting a patient about the expected course of the postoperative period and the prognosis of relapse in the long-term, these risk factors must be considered.

Nevertheless, the main factors are the little choice of the method of hernioplasty during the primary operation, wrong choice of mesh prosthesis sizes, poor technical performance [15,16]After the formation of small hernias on the abdominal wall, they increase in size over time due to the constant exposure to intra-abdominal pressure, contraction of the diaphragm, and muscles of the anterolateral abdominal wall. As a result, the abdominal organs move through the abdominal wall defect, expanding the latter and forming a hernia protrusion. Risk factors influence the incidence of recurrent incisional hernias [3]

Patient Sample

One hundred patients were collected from Al-Yarmouk Teaching Hospital, Baghdad, AL-Ramadi Teaching Hospital, Al-Anbar, and Baquba Teaching Hospital, Diyala, Iraq.

Research Design

Many factors contribute to the formation of a postoperative hernia; an essential moment for its occurrence is a violation of the dynamic balance between intra-abdominal pressure and the ability of the abdominal cavity walls to resist it.

And among the factors predisposing to the formation of a hernia are the individual characteristics of each individual - heredity, nutritional status, age, concomitant diseases, and metabolic disorders. With some connective tissue conditions, such as Marfan syndrome, their weakening occurs, and the scars at the operation site are weak. Often, soft connective tissue forms with poor nutrition, in the elderly, people with cancer or rheumatic diseases, diabetes, and obesity also slow the formation of scars.

Producing factors can be diseases or conditions of a person that lead to a significant increase in intra-abdominal pressure (bronchial asthma, chronic bronchitis with a persistent cough, prolonged constipation, difficulty urinating with problems with the prostate gland, pregnancy, childbirth, physical work or sports activities associated with lifting and transporting weights, Under normal conditions, the formation of a strong scar occurs within 2.5-3 months, and its final regulation - within 12 months. Hernias form in the first year after surgery.

There are also local factors that affect postoperative wound healing and can cause a hernia. Inflammation of a postoperative wound can significantly affect the scar, making it unreliable and brittle, increasing the risk of developing a hernia. Intolerance of the body to diseased suture material also leads to this. The inflammatory reaction to the sutures often leads to the formation of narrow fistulas and, in the future, to the appearance of postoperative scar defects. Many current threads are created based on biomaterials, which practically do not cause inflammatory or rejection reactions.

Period

This study was conducted by collecting patients from Al-Yarmouk Teaching Hospital, Baghdad, AL-Ramadi Teaching Hospital, Al-Anbar, and Baquba Teaching Hospital, Diyala, Iraq, during the period 29/3/2019 to 20/5/2020

Aim of Research 

The research aimed to know and improve the Surgical Treatment of Incisional Abdominal Hernia results. The average age ranged between 45 and 60 years. They were the type of hernia in patients of small and medium type B 10 cm defects in the anterior abdominal wall (W1-W2), who underwent surgical treatment of abdominal hernia using mesh substitutes. 

Table 1- Frequency Table of Age CG

Table 2- Frequency Table of Age CCG1

Table 3- Frequency Table of Age CCG2

Table 4- Mean ± SD between Parameters according to Age

Figure Image is Available in PDF Format

Figure 1 – P-Value

Table 5 – Results of the Patient Depend on Positive Outcomes

Table 6- Results of the Patient Depend on Infantile Intraventricular Haemorrhage.

Table 7- Results of the Patient Depend on the Complication

Figure Image is Available in PDF Format

Figure 2- P-Value of CG between Parameter

Figure Image is Available in PDF Format

Figure 3- P-Value of CGG1 between Parameter

Figure Image is Available in PDF Format

Figure 4- P-Value of CGG2 between Parameter 

One hundred patients were collected from Baghdad Hospital. The patients were divided into three types, the comparison group, which included 40 patients; the CCG1 group, which included 30 patients; and the third group, CCG3, which also included 30 patients.

By relying on the statistical analysis program, SPSS soft 22, the collected demographic data were analyzed, where the actual value and the arithmetic mean were found to the patients. The average age of the comparison group was 52.32 ± 3.77, as for the CCG group 1 = 52.73 ± 2.94 and the group 3rd CCG2 = 51.96 ± 3.52 4.

The techniques were divided into two types, as they were used in incisional hernias about the ccg1 group by only and about the ccg2 sub lay group

Complications during surgery, including intestinal obstruction. Currently, there are no reliable, effective methods

Astronomy prophylaxis is iatrogenic. Bowel perforations can be performed regardless of surgical experience. The average frequency of enterotomy is about 2%, much higher than open surgery; 92% are in the thinnest intestine, and intestinal lacunae are identified during surgery in 82% of cases.

Early and late postoperative complications Intestinal problems unresolved, unexplained tachycardia after approximately 36 hours and acute postoperative pain is a normal consequence of surgical trauma and is localized indistinctly in the area of operation, and reaches its scope up to a maximum of 3 hours after surgery and in general, subsides after three days.

The only way to treat any hernia, including postoperative, is surgery. The main task is to return the hernia contents into the abdominal cavity to the correct anatomical position and restore the integrity of the abdominal wall (that is, plastic). It is necessary to distinguish between two main types of abdominal wall plastics.

The advantage of this method is the binding of monolithic fabrics and the absence of the need to use synthetic materials. However, the possibility of its implementation depends on the size of the hernia gate and the condition of the abdominal wall tissues. Postoperative hernia repair with localized tissues is possible only if the defect size is less than 5 cm; there is no tension of tissues and a good condition of the aponeurosis and muscle tissue. If a small incisional hernia is eliminated, local anesthesia is allowed; in other cases, anesthesia is given.

The need for implant placement arises in the vast majority of cases of incisional hernias. The implant can be fitted with a complete suture to the hernia to strengthen the suture line and close the hernia opening "without tension."

Compensatory hernioplasty is performed in the presence of recurrent hernias, multiple hernial defects along the postoperative scar, and systemic disease of the connective and muscle tissues.

In the case of large and giant incisional hernias, in the presence of respiratory or cardiovascular insufficiency, only “stress-free” bite methods are used when the mesh closes the hernia opening in the form of a patch.

The mesh prosthesis is installed traditionally after excision of the old postoperative scar and laparoscopy through holes on the lateral surfaces of the abdomen. For endoscopic installation, unique “anti-adhesion” mesh implants are used, which eliminate the “adhesion” of intestinal loops to the mesh surface. These implants are selected individually depending on the size of the hernia opening in the patient's abdominal cavity. The advantage of laparoscopic fitting is faster recovery after surgery, less pain, and the possibility of early activation and return to everyday life. In addition, the risk of infection of the implant from inflammatory granulomas around the old suture material is eliminated. Still, several contraindications exclude the choice of this method of surgery.

The primary manifestation of postoperative hernia is the appearance of a tumor-like protrusion along the scar line after surgery and on its sides. With sudden movements and physical pressure, the hernia increases, and painful sensations appear. In the supine position, the hernia decreases or disappears as the name implies; a postoperative hernia, or abdominal hernia, develops due to an operation in the abdominal organs.

The appearance of incisional hernias is associated with the thinning of muscles and connective tissues in the area of the scar after surgery, which leads to the exit of internal organs (intestines) through defects of the surgical spot behind the subcutaneous abdominal wall.

The cause of the appearance of a postoperative hernia may be technical errors in the placement of the suture, non-compliance with recommendations for rehabilitation after surgery, as well as the individual characteristics of the patient (weak connective tissue, obesity, diabetes mellitus

             Doctors usually repair other types of hernias surgically when diagnosed because of the high chance of strangulation. Surgery should be performed as soon as entrapment or strangulation occurs in the hernia. In other cases, surgery is optional.

             Surgical repair aims to tighten or cover the opening to prevent abdominal contents from slipping out. Surgery usually relieves hernia symptoms, depending on its size and the severity of the discomfort it causes.

             Sometimes, lifting the hernia with a ligature or other means provides additional comfort for the person but does not reduce the risk of strangulation or close the opening.

             These treatments are not recommended, and the only cases in which the hernia heals without treatment are umbilical hernias in infants.

The authors declare that they have no conflict of interest

No funding sources

The study was approved by the Al- Yarmouk Teaching Hospital, Baghdad, Iraq.

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