Bowel adhesions + Incisional hernia

Question 1

Symptoms of bowel adhesions

Answer 1

Ther are generally asymptomatic, but the effect of the adhesions presents with symptoms such as:
* Obstruction
* Infertility
* Chronic pelvic pain

Question 2

When is surgical management warranted for bowel adhesions?

Answer 2

• Ischaemia or
• Perforation or
• Failed conservative management

Question 3

Surgery for bowel adhesions

Answer 3

• Adhesiolysis - cutting through adhesions
• Should be limited to adhesions causing the problem to reduce risk of recurrent adhesional disease
• Laparascopic is preferred BUT low threshold for conversion to open approach due to it being challenging with distension of the bowel

Question 4

Preventing bowel adhesions

Answer 4

• Correct surgical technique
• Reducing intraperitoneal organ handling

Question 5

RF for incisional hernia

Answer 5

• Emergency surgery
• BMI >25
• Midline incision
• Post op wound infection
• DM, CTD, steroid use
• Advancing age
• Current smoker

Question 6

Presentation of incisional hernia

Answer 6

• Reducible, soft, non-tender swelling
• At or near site of previous surgical wound
• If incarcerated can become painful, tender and erythematous

Question 7

Investigation for incisional hernia

Answer 7

• Usually clinical but can use CT imaging to confirm

Question 8

Management incisional hernia

Answer 8

• Depends on size, defect in wall, clinical features, patients age and co-morbids
• Surgery is possible

Question 9

Types of surgical repairs for incisional hernias

Answer 9

• Suture repair
• Laparoscopic mesh repair
• Open mesh repair
• If large - abdominal wall reconstruction