How can you prevent a hernia from developing. What are the most effective strategies for reducing hernia risk. Which lifestyle changes help strengthen abdominal muscles and prevent hernias. Why is proper lifting technique crucial for hernia prevention. How does maintaining a healthy weight impact hernia risk.

Understanding Hernias: Types, Causes, and Risk Factors

A hernia occurs when an internal organ or tissue pushes through a weak spot in the surrounding muscle or connective tissue. While hernias can develop in various parts of the body, they most commonly affect the abdomen and groin areas. Understanding the different types of hernias and their causes is crucial for effective prevention.

Common Types of Hernias

• Inguinal hernia: Occurs in the groin area
• Ventral hernia: Develops in the abdominal wall
• Umbilical hernia: Forms around the navel
• Hiatal hernia: Affects the upper stomach and diaphragm

It’s important to note that what’s often referred to as a “sports hernia” is actually a misnomer. Dr. Gary Anderson, a general surgeon and hernia specialist with Kettering Health, explains: “Sports hernias are a different pathology. They’re not really hernias at all. The word ‘hernia’ means ‘hole,’ but what is referred to as a ‘sports hernia’ is really a torn muscle.”

Risk Factors for Hernia Development

Several factors can increase your likelihood of developing a hernia:

• Heavy lifting or strenuous physical activity
• Obesity or excess body weight
• Chronic coughing or sneezing
• Pregnancy
• Constipation or straining during bowel movements
• Previous abdominal surgeries
• Family history of hernias
• Smoking
• Diabetes

Proper Lifting Techniques: The Foundation of Hernia Prevention

One of the most effective ways to prevent hernias is by using proper lifting techniques. This is especially important for athletes and individuals whose jobs involve heavy lifting. By following these guidelines, you can significantly reduce your risk of developing a hernia:

Essential Lifting Tips

1. Assess the weight: Before attempting to lift an object, evaluate whether it’s within your capacity. If it’s too heavy, seek assistance or use mechanical aids.
2. Bend from your knees: Always bend your knees instead of your waist when lifting.
3. Engage your leg muscles: Use the strength of your legs to lift, keeping your back straight.
4. Maintain proper alignment: Keep the object close to your body and avoid twisting while lifting.
5. Warm up before heavy lifting: For athletes, start with light weights to prepare your muscles.
6. Lift slowly and steadily: Avoid rushing or jerky movements that can strain your muscles.
7. Listen to your body: If you feel pain, stop immediately to prevent injury.

Why is proper lifting technique so crucial for hernia prevention? When you lift incorrectly, you put excessive strain on your abdominal muscles and connective tissues. This strain can weaken these structures over time, creating vulnerable areas where hernias can develop. By using proper technique, you distribute the weight more evenly and reduce the risk of creating weak spots in your abdominal wall.

Maintaining a Healthy Body Weight: A Key Factor in Hernia Prevention

Excess body weight can significantly increase your risk of developing a hernia. Dr. Anderson emphasizes, “Being overweight can increase your risk of inguinal hernia.” The additional weight puts constant pressure on your abdominal wall, potentially weakening it over time.

Strategies for Achieving and Maintaining a Healthy Weight

• Adopt a balanced, nutrient-rich diet
• Incorporate regular physical activity into your routine
• Practice portion control
• Stay hydrated
• Get adequate sleep
• Manage stress levels
• Consult with a healthcare professional for personalized advice

How does maintaining a healthy weight impact hernia risk? When you carry excess weight, especially around your midsection, it puts constant strain on your abdominal muscles and connective tissues. This ongoing pressure can weaken these structures, making them more susceptible to herniation. By maintaining a healthy weight, you reduce this strain and help preserve the integrity of your abdominal wall.

Strengthening Your Core: Building a Natural Defense Against Hernias

A strong core is essential for preventing hernias. Your core muscles act as a natural corset, providing support and stability to your abdominal region. By strengthening these muscles, you can create a more resilient barrier against hernia formation.

Effective Core-Strengthening Exercises

• Planks (front and side variations)
• Bridges
• Bird dogs
• Dead bugs
• Hollow body holds
• Russian twists
• Pallof presses

The plank is particularly effective for core strengthening. It engages multiple muscle groups simultaneously, including your abdominal muscles, obliques, and lower back muscles. To perform a basic plank, start in a push-up position with your forearms on the ground, elbows directly under your shoulders. Keep your body in a straight line from head to heels, engaging your core muscles throughout the hold.

Why is core strength so important for hernia prevention? A strong core provides better support for your internal organs and helps distribute pressure more evenly across your abdominal wall. This improved support and pressure distribution can help prevent weak spots from developing, thus reducing your risk of hernia formation.

Managing Diabetes: An Often Overlooked Aspect of Hernia Prevention

Controlling diabetes is crucial in preventing hernias, especially for those at risk of ventral or umbilical hernias. Recent studies have shown a concerning link between diabetes and complications following hernia repair surgeries, particularly in women.

Strategies for Managing Diabetes

1. Follow your physician’s medication recommendations
2. Monitor blood glucose levels regularly
3. Plan balanced meals with a focus on low-glycemic foods
4. Reduce intake of trans fats, sugar, and salt
5. Incorporate whole grains into your diet
6. Engage in regular physical activity
7. Maintain a healthy weight
8. Manage stress levels

How does diabetes impact hernia risk and recovery? Diabetes can affect wound healing and increase the risk of infections following hernia repair surgery. Additionally, poorly controlled diabetes can lead to nerve damage and weakened connective tissues, potentially making the abdominal wall more susceptible to herniation. By managing diabetes effectively, you can reduce these risks and improve your overall health.

Quitting Smoking: A Crucial Step in Hernia Prevention

Smoking is a significant risk factor for hernia development and can complicate hernia repair surgeries. The chronic coughing often associated with smoking and smoking-related conditions like COPD can put repeated stress on the abdominal wall, increasing the likelihood of hernia formation.

Benefits of Quitting Smoking for Hernia Prevention

• Reduced frequency and severity of coughing
• Improved overall health and immune function
• Better wound healing after surgery
• Decreased risk of complications during and after hernia repair
• Improved cardiovascular health, reducing strain on the body

Why is quitting smoking so important for hernia prevention? Smoking-related coughing creates repeated, forceful pressure on your abdominal wall. Over time, this can weaken the muscles and connective tissues, creating vulnerable areas where hernias can develop. By quitting smoking, you eliminate this source of chronic strain on your abdominal wall, significantly reducing your risk of hernia formation.

Additional Lifestyle Modifications for Hernia Prevention

While the five main tips discussed above form the foundation of hernia prevention, there are several other lifestyle modifications that can further reduce your risk:

Dietary Considerations

• Increase fiber intake to prevent constipation and reduce straining during bowel movements
• Stay hydrated to support overall digestive health
• Consume foods rich in vitamins and minerals that support tissue health, such as vitamin C and zinc

Exercise and Physical Activity

• Engage in low-impact cardiovascular exercises to maintain overall health
• Practice yoga or Pilates to improve flexibility and core strength
• Avoid exercises that put excessive strain on your abdominal muscles if you’re at high risk for hernias

Stress Management

• Practice relaxation techniques like meditation or deep breathing exercises
• Ensure you get adequate sleep each night
• Seek support from friends, family, or professionals when needed

How do these additional lifestyle modifications contribute to hernia prevention? By adopting a holistic approach to your health, you create an environment in your body that is less conducive to hernia formation. Proper nutrition supports tissue health and reduces strain from constipation. Balanced exercise strengthens your muscles without overexertion. Effective stress management can prevent behaviors that might increase hernia risk, such as overeating or smoking.

When to Seek Medical Attention: Recognizing Hernia Symptoms

While prevention is key, it’s also important to be aware of potential hernia symptoms so you can seek medical attention promptly if needed. Early detection and treatment can prevent complications and improve outcomes.

Common Hernia Symptoms

• A visible bulge in the affected area, especially when standing or straining
• Pain or discomfort in the abdomen or groin, particularly when lifting or bending
• A feeling of heaviness or pressure in the abdomen
• Weakness or a burning sensation in the affected area
• In some cases, nausea, vomiting, or constipation (signs of a potentially serious complication)

If you experience any of these symptoms, it’s crucial to consult with a healthcare professional. They can perform a physical examination and, if necessary, order imaging tests to confirm the presence of a hernia and determine the most appropriate treatment plan.

Why is early detection of hernias important? Prompt diagnosis and treatment can prevent the hernia from becoming larger or developing complications. In some cases, small hernias can be managed conservatively with lifestyle modifications and monitoring. Larger or symptomatic hernias may require surgical repair. Early intervention often leads to simpler procedures and faster recovery times.

Remember, while these prevention strategies can significantly reduce your risk of developing a hernia, they cannot eliminate the risk entirely. Some hernias may occur due to genetic factors or unavoidable circumstances. However, by implementing these tips and maintaining overall good health, you can minimize your risk and promote better abdominal wall strength and integrity.

5 Tips for Preventing a Hernia

A hernia is a hole in the abdomen or muscle, occurring when part of an internal organ pushes through the wall of the muscle. Usually, they occur in the abdomen and groin and show as bulges in your midsection or along scars from previous surgical procedures.

This condition is known as an inguinal hernia and affects more than a half-million Americans every year.

Sports hernias are also commonly referred to, but the name is somewhat misleading. “Sports hernias are a different pathology,” said Gary Anderson, DO, a general surgeon, and hernia specialist with Kettering Health. “They’re not really hernias at all.

The word ‘hernia’ means ‘hole,’ but what is referred to as a ‘sports hernia’ is really a torn muscle.”

1. Use proper lifting techniques.

Athletes or those who do heavy lifting, are at risk of an inguinal hernia every time they pick up something. Using proper lifting techniques can minimize risk and decrease fatigue.

Lift an appropriate amount of weight. If the load is too heavy, get help, use a hand truck or forklift, or reduce the weight. Always bend from your knees, not your waist. Lift using the muscles of your legs with a straight back and proper support over your ankles.

For athletic lifters, warm up with light dumbbells or barbells before any heavy lifting. If you are doing a barbell exercise, always start with a set using just the bar to get your blood pumping and warm up your muscles.

Avoid rushing, and lift the weight slowly—this ensures your body is properly aligned, and you have taken the proper steps beforehand. If you feel pain, stop! Pain means something is not right, so you should stop before injuring yourself.

2. Maintain a recommended healthy body weight.

Excessive body weight can put tremendous pressure on the abdominal wall, causing it to weaken over time. “Being overweight can increase your risk of inguinal hernia,” said Dr. Anderson.

Whenever you stand or move, the walls surrounding the abdomen are constantly under pressure from excess body fat. Being overweight can also put more stress on other muscle groups during movement and exercise. While maintaining a recommended healthy body weight seems easier said than done, your doctor can recommend dietary changes and exercise routines right for you.

3. Increase core strength

Increasing core strength has many benefits in helping to prevent a hernia. Put simply, your “core” refers to the major muscles of the pelvic and abdominal region, such as the pelvic floor and oblique muscles, and minor muscles, gluteus maximus, and trapezius.

Regular core-strengthening exercises will strengthen the muscles surrounding your abdomen and groin and help them stay strong and elastic.

One of the best core-strengthening exercises is the plank. A basic plank is like the beginning of a push-up, but you just hold yourself up on your arms or elbows. It also can be done on your side. Talk to your doctor about what core exercises might be right for you.

4. Control diabetes

Dr. Anderson says controlling diabetes is also important in hernia prevention. According to recent studies, there is an increasing concern about the success of ventral and umbilical hernia repair in diabetic women. Studies suggest diabetes increases the risk of complications following the repair of a ventral (surgical scar site) or umbilical (at the navel or belly button) hernia surgery. Results indicated a higher rate of complications among those who were insulin-dependent.

Follow your physician’s orders to control your diabetes with the proper medications. You can also improve your glucose levels through better meal planning, consuming lower-calorie foods, and reducing your intake of trans fat, sugar, and salt. Using whole-grain cereals, bread, rice, and pasta can also help.

5. Quit smoking

If you smoke, you could be contributing to a potential hernia. Smokers and those with COPD or similar diseases caused by tobacco use are plagued by continued, violent coughing that can contribute to hernia development.

If you are already facing the challenge of a hernia, the Kettering Health Hernia Care team can create an individual treatment plan for you to obtain the best long-term results from your surgery.

Need to see a provider about your possible hernia?

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How to Prevent a Hernia

Not all hernias can be prevented, but there are steps you can take to make them less likely.

By Quinn PhillipsMedically Reviewed by Justin Laube, MD

Reviewed: April 23, 2018

Medically Reviewed

Eating a diet high fiber, maintaining a healthy weight, and quitting smoking can all help prevent hernias.Shutterstock

A hernia develops when a section of your intestine, or other tissue in your abdomen, pushes through a layer of muscle that has become weakened.

Most often, this happens when part of your intestine pushes through your abdominal wall toward the outside of your body. This is called an external hernia, and it usually affects the lower abdomen and groin.

Each type of hernia has different causes, which means that the steps you can take to prevent them will also be somewhat different.

Not all hernias, though, are preventable. There are certain factors outside your control — such as prior abdominal surgery, and muscle weakness that you’re born with — that can lead to a hernia no matter what preventive steps you take. (1)

Preventing an Inguinal Hernia

Most hernias are inguinal hernias, in which a section of intestine pushes through muscle in your groin area at a location known as the inguinal canal.

Like all hernias, inguinal hernias develop due to a combination of muscle weakness and pressure inside the abdomen. (2)

There’s not a lot you can do to avoid the type of muscle weakness that lead to hernias, but there are steps you can take to reduce pressure in your abdomen.

Steps that may help prevent an inguinal hernia include the following:

Maintain a healthy body weight. When you’re overweight or obese, your abdominal wall is constantly under pressure from your extra body fat whenever you stand or move around. Losing weight is easier to recommend than to actually do, but talk to your doctor about developing an exercise and diet plan that works for you. (2,3)

Get enough of the right exercise. Being physically active in certain ways has been shown to help prevent hernias, but other types of exercise can put too much pressure on your abdomen.

Beneficial exercises may include:

• Yoga
• Pilates
• Sit-ups or crunches
• Light weights
• Aerobic activities, like running or cycling

Activities to avoid include jumping exercises and squats, both of which can increase pressure on your abdominal wall. Fast movements can also lead to muscle tearing.

Any type of exercise than involves very high levels of exertion can also increase your hernia risk. (3)

Ask your doctor about any new type of exercise that you’re considering.

Incorporate high-fiber foods into your diet. Fiber-rich foods can support regular bowel movements and help prevent constipation, which can lead to straining that increases your hernia risk.

Foods that may help in this area include:

• Fruits
• Vegetables
• Whole grains
• Nuts and seeds
• Legumes (dried beans and peas) (2)

If needed, take other steps to avoid constipation. Taking a fiber supplement or bulk-forming laxative, like a preparation containing psyllium, can help keep you regular and prevent straining during bowel movements.

If this doesn’t do the trick, you can try certain other laxatives, like mineral oil, milk of magnesia (magnesium hydroxide), or MiraLAX (polyethylene glycol).

Staying well-hydrated is also essential to avoiding constipation.

Since anesthesia and certain painkillers can cause constipation, it’s important to take extra steps to avoid constipation after any surgery — especially because surgery carries the risk of hernias at the incision site. (3)

Avoid heavy lifting, or do it carefully. If you have to lift a heavy object, bend down with your knees instead of your waist. Make your legs — rather than your torso — do most of the lifting effort.

And if an object is too heavy for you to lift comfortably, know your limits and don’t do it. (1,2)

Don’t smoke. Smoking can cause coughing, which can put pressure on your abdomen and lead to an inguinal hernia, or worsen symptoms in one that you already have. (2)

See a doctor when you have a persistent cough. Because coughing can lead to or aggravate a hernia, it’s important to get this symptom under control whenever you have an infection or another condition that causes it, including asthma.

Related

Justin Verlander’s Top Tips for Allergy Relief

Sneezing due to allergies can also increase abdominal pressure, so it’s important to control this symptom as well. (1,3)

Get treated if you have an enlarged prostate. Having an enlarged prostate can lead to straining during urination, which can increase pressure in your abdomen.

Signs of enlarged prostate may include waking up twice or more each night to urinate, straining to make your urine flow faster, and straining to empty your bladder at the end of urination. (3)

Preventing an Incisional Hernia

An incisional hernia develops after abdominal surgery, when an area of the intestine or other tissue pushes through the abdominal wall at or near the site of an incision.

It most commonly develops three to six months after abdominal surgery, when your abdomen is healing from the incision. (4)

Some factors in preventing an incisional hernia are beyond your control. For example, it’s your surgeon’s job to use effective techniques to limit your hernia risk and prevent other complications.

You’re also more likely to develop a hernia after surgery if you’re older or in poor overall physical health.

What you can control, though, is following the hospital discharge instructions you’re given, which aim to minimize your risk of developing an infection or putting too much pressure on the area of your incision. (5)

The following steps may reduce your risk of an incisional hernia after surgery:

• Don’t overexert yourself.
• Take steps to prevent and treat constipation to avoid straining.
• Seek treatment for any persistent cough.
• Try to limit the strain of sneezing, and get treated for any allergies.
• Avoid any activities that put pressure on the area of your wound.
• Use any gel you’ve been prescribed to promote wound healing.
• Avoid or limit sexual activity until your wound has healed.
• Quit smoking, or reduce it as much as possible to limit coughing.
• Try not to gain weight.
• Don’t become pregnant within six months of your surgery. (4,5)

There’s no guarantee that you won’t develop an incisional hernia even if you follow these steps and your discharge instructions faithfully. Your abdominal muscle may simply be too weak at or near an incision site. (5)

If you do develop an incisional hernia, you’ll most likely need surgery to repair it. (4)

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Editorial Sources and Fact-Checking

References

1. Hernia. Cleveland Clinic. June 16,2015.
2. Inguinal Hernia. Mayo Clinic. January 6, 2018.
3. Hernia Prevention. Beverly Hills Hernia Center.
4. Incisional Hernias. Mount Sinai.
5. Incisional Hernia. Florida Hospital.

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Prevention of vertebral hernia | Articles

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Prevention of vertebral hernia

What is a herniated disc? This is an extreme manifestation of the degenerative-dystrophic process in the intervertebral disc and its surrounding tissues, which leads to rupture of the outer fibrous ring and prolapse of the nucleus pulposus of the disc. The tissues of the prolapsed part of the disc cause compression i.e. compression of the spinal nerve at the point of division of the spinal root into anterior and posterior branches. The dura mater is also exposed. Hence, there is a variety of clinical manifestations of such a condition as a herniated disc.

Much has been written in detail about the methods of diagnosis and treatment of herniated discs. And in my opinion, very little and superficially mentioned in the medical literature about the prevention of these rather serious conditions of the body. My work activity is 25 years of continuous contact with such patients, so I will write about my observations and, accordingly, draw my own conclusions and conclusions.

So: the main factors that lead to the appearance of vertebral hernias

1. Compression factor (weight lifting)
   For each person, the weight, after lifting which the disc tissue is torn, is different.
2. Consequences of injuries (blows, falls, unsuccessful movements of the lower and upper limbs, which lead to a sharp rotation of the spine, twisting and tearing of the tissue of the fibrous ring (here it should be noted that a herniated disc disc develops gradually from a sharp rupture to 7, 10, 15 years of constant compression ( increased disk load)
3. Hypothermia: frequent myositis (inflammatory phenomena in the muscles that take part in the movements of the spine against the background of hypothermia lead to contraction of these muscles and an increase in their tone. Under these conditions, the vertebrae are forcibly brought closer to each other and, accordingly, pressure on the intervertebral disc increases.
4. Stress. At the moment of stress, muscle tissue contracts (we seem to shrink into a ball!) I will give an example: having felt some kind of sharp sound stimulus – (clap, explosion, noise of a large object falling, etc.) leads to the following reactions: a person instinctively crouches, involuntarily draws in head to shoulders. All these are contractions of different muscle groups. The retraction of the head occurs due to the contraction of the trapezius muscle on both sides. Impulses from the cerebral cortex force a person to take the safest position in space. The vestibular analyzer and others are involved here.

In order to competently carry out the prevention of diseases of herniated discs, one must be able to prevent the impact of the above factors.

That is, if you follow the kinesiological principle (strengthen the muscles of the back and abdominals, then do it carefully and adequately to the state of the patient’s skeletal muscles, otherwise decompensation and further disc rupture will occur.

Smart weight lifting! Having a hernia of 4-5 mm (sagittal size) for 2-3 years, regeneration occurs, during this period, weight lifting is limited to 5-7 kg. You need to lift weights with the “weightlifter technique”, i.e. the back is straight, getting up from your haunches, we lift the weight with the strength of the muscles of the legs.

Avoid injury and falls!

Avoid hypothermia and drafts. When working in the cold season, wear warm belts on the lower back.

Dealing with stress is the most difficult task. Constant stress at home in the family, at the workplace, as well as sudden stress causes an increase in muscle tone, more insignificant, but long-lasting.

Know how to relax, although this is not an easy task! (Shiatsu gymnastics, various techniques described in modern literature).

Manual therapist-neurologist Geraskov S.M.

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Prevention of postoperative ventral hernias: the current state of the problem

The proportion of postoperative ventral hernias is 6-8% of all hernias of the anterior abdominal wall. Due to the steady annual increase in the number of laparotomies, there is an increase in the number of patients suffering from this disease. According to the summary data of a number of domestic authors, such a hernia occurs in Russia in approximately 500 thousand people [3, 4]. Postoperative hernia causes atrophy and flabbiness of muscles, thinning of the aponeurosis, sharply disrupts the function of both the abdominal wall and abdominal organs, which leads to frequent cases of temporary disability, and often (with a large and giant hernia) to disability of patients. The well-known medical aphorism “a disease is easier to prevent than to cure” is the best fit for the problem of prevention of postoperative ventral hernia [18].

Currently, prevention is carried out in four areas. The first and most studied are the prevention and treatment of complications in the early postoperative period. During operations on the abdominal organs, it is necessary to strictly observe the rules of asepsis and antisepsis to prevent the ingress of infectious material into the surgical wound, conduct thorough hemostasis, exclude unreasonable drainage and packing of the abdominal cavity through the wound [24, 35].

It is necessary to rationally choose a surgical approach that excludes the intersection of nerve trunks, carefully suturing the wound in layers with modern biocompatible (no toxic, allergenic, carcinogenic and teratogenic effects on the body) suture material.

In the early postoperative period, it is necessary to prevent an increase in intra-abdominal pressure due to vomiting, coughing, urinary retention, abdominal distention, as this creates an increased load on the abdominal wall sutures and often leads to the development of eventration. Dosed wound compression with the help of an elastic, air-permeable bandage prevents an increased load on the sutures and promotes the formation of a strong postoperative scar [38, 39].

The second direction is to stimulate reparative processes in the wound. For this purpose, the timely elimination of hypoproteinemia, anemia, beriberi, candidiasis is essential. Glucocorticoids, sulfonamides and antibiotics should be used rationally, since these drugs can cause depression of reparative processes. Some authors propose the introduction of fibrinogen, cryoprecipitate, bone marrow cells into the deep layers of the wound (subaponeurotic, interaponeurotic, intermuscular) during the repair phase of the wound process, which contributes to the early induction of fibroplastic activity, the formation of a strong connective tissue scar adapted to specific conditions [5, 10].

The third direction is the optimization of methods for closing the laparotomic wound with local tissues. The technique of closing the abdominal wall is one of the most important factors in the prevention of postoperative hernia. To date, there is no final opinion on the best way to close a laparotomic wound. The success of a surgical intervention largely depends on the properties of the suture materials used in its execution. The main requirements for a suture thread: biocompatibility, smooth surface, high manipulation properties, minimal wick effect [11]. A promising direction is the introduction into surgical practice of biologically active suture materials – threads, which include substances that have the ability to exert a biological effect when implanted into tissues. Most often, antimicrobial suture threads containing the antiseptic triclosan are used abroad [31, 37]. In studies in vitro and in vivo proved their pronounced and prolonged action on a wide range of microorganisms [32]. Domestic suture materials with the antibiotic doxycycline and ciprofloxacin, a drug from the fluoroquinol group, also showed high antimicrobial activity. The maximum portions of antibacterial drugs were released from the threads in the first 5-7 days, which ensured the most intense effect on the course of the wound process [8]. In recent years, Russia has begun to use suture materials that not only have antimicrobial activity, but also stimulate regenerative processes. Stimulation of tissue repair is achieved by introducing organic compounds containing germanium into the structure of the thread sheath. The suture material, which has antimicrobial and reparative activity, can reduce the number of purulent complications in the wound of the abdominal wall by 2 times compared with the control group of patients in which nylon threads were used [9].

The method of using suture material is of particular importance in the prevention of postoperative hernias. The tensile strength of knotted sutures is 80% less than that of a continuous suture; therefore, it is advisable to use a continuous suture for suturing the abdominal wall [29, 30].

Domestic and foreign surgeons propose to modify the existing methods of closing the wound of the abdominal wall with local tissues by using various techniques: creating duplication of the aponeurosis, applying submerged two-story sutures, eight-shaped and retention sutures [4, 35]. However, the use of any methods of autoplasty of the abdominal wall does not lead to a decrease in the frequency of postoperative hernias, since it does not take into account changes in the abdominal wall due to flabbiness, muscle atrophy and degenerative processes in aponeurotic structures. The preoperative weakness of the abdominal wall becomes even greater after surgical interventions [19].

The fourth direction is the primary closure of the laparotomic wound with a mesh endoprosthesis in order to prevent the occurrence of postoperative hernia. This direction is the least studied, but the most promising. In Russia, most surgeons are reserved about this direction, believing that the main reasons for the development of postoperative hernia are defects in the surgical technique for suturing the abdominal wall or wound purulent complications.

The first publications on preventive arthroplasty appeared in foreign literature in the 70-80s of the last century. Until the middle of the first decade of the 21st century, this technology of strengthening the abdominal wall was used occasionally in coloproctology to prevent parastomal hernia, in vascular surgery after a complete midline laparotomy performed for abdominal aortic aneurysm, and in abdominal surgery in elderly and senile obese patients. Summarizing the results of these studies are presented in a previously published commentary by B.Sh. Gogia et al. [2].

The first subject of discussion is the definition of indications for preventive abdominal wall arthroplasty. It should be emphasized that in the works of foreign authors there was no scientifically based system for determining indications for preventive abdominal wall arthroplasty. This shortcoming was corrected in the works of domestic surgeons, who presented a scale for quantitative assessment of risk factors for the development of incisional hernia [12].

Study of the effectiveness of predicting the development of postoperative ventral hernia on this scale in 93 patients who underwent median laparotomy gave the following results. With a score of 0 to 5 (low risk), incisional hernia developed in 5.3% of cases, from 6 to 10 (medium risk) – in 13.3%, from 11 to 15 (high risk) – in 17.3% and from 16 and above (extremely high risk) – in 30% of cases [16].

In the first place among the indications for preventive arthroplasty is the anatomical and functional insufficiency of the abdominal wall (weakness), which is manifested by flabbiness, ptosis of the abdomen with the formation of a skin-fat apron, a dome-shaped abdomen with pronounced diastasis of the rectus muscles, and the absence of a decrease in the abdominal circumference with abdominal tension . Women are characterized by postoperative laxity in combination with ptosis of the abdomen, and for men, a dome-shaped abdomen in combination with diastasis of the rectus muscles.

Ultrasound examination of the abdominal wall of patients before and after operations on the abdominal organs and retroperitoneal space made it possible to clarify the main mechanisms for the development of its anatomical and functional insufficiency. So, damage to all layers of the abdominal wall was revealed – skin, subcutaneous tissue, aponeurosis, muscles. The skin becomes flabby, thinned. Subcutaneous adipose tissue thickens, connective tissue develops in it, which leads to a change in its structure, which turns from homogeneous into lobulated. The aponeurotic layer becomes thinner, its structure becomes heterogeneous. The width of the white and Spiegel lines of the abdomen increases 2 times with mild and 4 times with severe anatomical and functional insufficiency. There is a thinning and expansion of the muscle layer of the abdominal wall by 1. 5 times with mild and 2 times with a severe degree of damage with a decrease in the degree of narrowing and thickening of the muscles under tension, respectively, by 2.5 and 3.5 times. The structure of the muscle layer loses its homogeneity, its echogenicity increases due to fatty and connective tissue degeneration. The following critical parameters were identified, indicating anatomical and functional insufficiency of the abdominal wall: a heterogeneous structure of subcutaneous adipose tissue with a thickness of 5.2 ± 0.4 cm with the appearance of connective tissue inclusions, the width of the white line of the abdomen 2.2 ± 0.09cm, heterogeneous echostructure of the rectus abdominis muscles with increased echogenicity, thickness 1.35 ± 0.04 cm and width 11.76 ± 0.1 cm, with contractility of the rectus muscles at a tension of 20.7 ± 1.0% of the initial value, the width of the Spigel lines 0.5 ± 0.04 cm, heterogeneous structure of the broad muscles of the lateral wall of the abdomen with increased echogenicity, thickness 1. 3 ± 0.1 cm and contractility 20.3 ± 1% of the initial value [12].

When conducting genetic studies in patients with and without ventral hernia, it was found that the development of anatomical and functional insufficiency of the abdominal wall, which is directly proportional to the incidence of postoperative hernias, is based on a decrease in the functional activity of ribosomal genes [1].

Interesting data were obtained by polarization microscopy of the skin and aponeurosis in patients with and without abdominal hernia. It turned out that in patients with ventral hernia, the ratio of collagen types I and III was sharply disturbed in the direction of an increase in the content of type III collagen. When comparing genetic and histological data, it was found that the ratio of type I and III collagens in the skin and aponeurosis of less than 2.1 is associated with the AA mutant genotype in the EGF +61G/A gene polymorphism and the detection of the 1117 5A/6A mutant allele of the matrix metalloproteinase 3 polymorphism, which is a reliable prognostic criterion for the risk of developing ventral hernia [7].

The second place is occupied by obesity of patients with a body mass index exceeding 30 kg/m ² , which is clinically manifested by a significant increase in the size of the abdomen due to the excessive development of subcutaneous adipose tissue, the thickness of which exceeds 6 cm. In these patients, the lateral surface of the body is not tightened, waist is missing. The centrally located tissues of the abdominal wall are flabby, the skin is stretched. On palpation, the abdominal wall is not elastic, muscle contractility is practically absent [2]. Reparative processes are especially severely disrupted during the development of the metabolic syndrome (insulin resistance syndrome), which is manifested by abdominal obesity, type 2 diabetes mellitus, arterial hypertension, and coronary heart disease. In this syndrome, the probability of developing a ventral hernia after laparotomy is 100% [23].

The third place among the indications for arthroplasty is the age of patients. In elderly patients (over 60 years old) and especially senile (over 75 years old) age, involutional processes begin to develop in the connective tissue and muscle structures of the abdominal wall, the intensity of reparative processes decreases. In addition, older patients have other risk factors: constipation, difficulty urinating, chronic respiratory failure, abdominal aortic aneurysm. The incidence of the disease is directly dependent on age: the older the patient, the more often postoperative hernia develops. All this suggests that when performing a wide median laparotomy in elderly and senile patients, one should resort to preventive endoprosthetics of the abdominal wall [20].

One of the indications for the primary closure of a laparotomic wound with a mesh endoprosthesis should be considered a second laparotomy, which is an important predictor of the development of postoperative ventral hernia. According to a number of authors, a repeated operation in the same anatomical zone of the abdominal wall, where the primary laparotomy had already been performed, reduces the vascularization of the scar in the fascia area, increases the likelihood of bacterial contamination of the wound, and worsens its healing [27]. A study conducted by domestic surgeons found that postoperative hernia develops 2 times more often when performing a second operation than in patients who underwent a median laparotomy for the first time [16].

One of the problems in the treatment of widespread peritonitis is the development of postoperative hernia in the majority of patients who underwent a wide midline laparotomy with programmed sanitation of the abdominal cavity [33]. The development of a systemic inflammatory reaction and abdominal sepsis in peritonitis, intra-abdominal hypertension syndrome, enteral insufficiency, endothelial dysfunction and oxidative stress sharply inhibits the healing processes of a laparotomic wound. We have studied the effect of closing a laparotomic wound with a polypropylene mesh in generalized peritonitis on the results of treatment of patients. Of the 45 cases in which this technology was used to close the wound of the abdominal wall, none of them showed eventration in the immediate postoperative period and the development of a postoperative hernia in the long term [14].

In recent studies, it has been established that the frequency of postoperative ventral hernias in cancer patients after laparotomy ranges from 18.6 to 44.4%, depending on the location of the primary tumor [6]. Chemotherapy, radiation therapy and the number of laparotomies in a patient have a statistically significant effect on hernia formation. In operations performed on the background of radiation and/or chemotherapy, the authors recommend closing the laparotomic wound using autodermal lacing, which, in their opinion, helps to reduce the incidence of postoperative ventral hernias [5]. In the foreign literature, we have found the only publication devoted to the study of the quality of life of patients after oncological operations on the abdominal organs, which indicates that the formation of a postoperative hernia is a negative factor and substantiates the need for preventive abdominal wall arthroplasty [21].

The second subject of discussion is the choice of prosthesis for preventive arthroplasty. Studies of late tissue response to implantation of various polypropylene prostheses into the abdominal wall showed that their biocompatibility depends on the thread thickness. Around a standard polypropylene endoprosthesis with a thread thickness of 120 microns, a coarse-fibered deformed capsule is formed with a predominance of giant cells of foreign bodies in the late stages of implantation. In the late postoperative period, as a result of mesh wrinkling, the mobility of the abdominal wall is limited, which causes a feeling of a “foreign body” at the implantation site in 5-10% of patients [18]. When studying the late tissue reaction of the abdominal wall to the implantation of a light polypropylene prosthesis with a thread thickness of 90 µm, it was found that the endoprosthesis is completely overgrown with connective tissue 2–4 months after implantation. The connective tissue capsule around the light prosthesis also has giant cells of foreign bodies, but in a smaller amount, which, when intact tissues of the abdominal wall are strengthened, can cause an inflammatory reaction in them. A super-light endoprosthesis with a thread thickness of 70 µm after 2 months is surrounded by a very thin connective tissue capsule with a minimum number of cellular elements and a predominance of fibrous structures, which does not cause inflammatory changes in the abdominal wall and distinguishes the optimal material for its preventive endoprosthetics [15].

The third point of discussion is the placement of the prosthesis. When plastic surgery of the midline of the abdomen after an emergency operation for an acute inflammatory process of the abdominal cavity with the transition to the parietal peritoneum, it is advisable to place a mesh implant over the aponeurosis, which reduces the risk of infection during the intervention, is simpler than other options, and only slightly increases the duration of the manipulation. The prosthesis applied to the aponeurosis should be 4 cm longer and 5-6 cm wider than its suture line, since this is enough to eliminate tissue tension. It is recommended to fix the endoprosthesis with knotted sutures to the aponeurosis throughout in a checkerboard pattern. This makes it possible, in the case of relaparotomy, to dissect the endoprosthesis at the beginning of the operation and stitch it at the end [12, 33]. Unfortunately, the supraponeurotic location of the prosthesis is accompanied by the development of seromas, which requires long-term drainage of the wound with active aspiration [26].

In planned abdominal surgery, after performing a median laparotomy, to strengthen the white line of the abdomen, it is advisable to place the prosthesis under the aponeurosis, which is more justified from the pathogenetic point of view of the development of postoperative hernia. It should be emphasized that the subaponeurotic location of the prosthesis is much more difficult in technical terms and increases the duration of the operation. A positive aspect is the absence of seromas at the site of implantation of the prosthesis [4, 22, 28].

Subgaleal arthroplasty should also be used for plasty of the lateral walls of the abdomen during urological surgery on the urinary tract and vascular operations on the abdominal aorta performed from the retroperitoneal access. After performing the main stage of the operation, edge-to-edge suturing of the transverse and internal oblique muscles is performed from the lateral access. An endoprosthesis is placed on top of the suture in the retromascular space between the internal and external oblique muscles, which should be 4 cm longer and 3 cm wider on each side of the suture line. The prosthesis is fixed by the latissimus dorsi muscle, the sheath of the rectus abdominis muscle, the aponeurotic structures of the iliac crest and tissues in the region of the lower edge of the costal arch. Thus, the endoprosthesis overlaps the weak point of the abdominal wall – the Spigel line and the dissected internal oblique muscle, which is most susceptible to atrophic degeneration due to the transverse intersection of its fibers. Wound drainage is not required [13]. The subaponeurotic location of the prosthesis is used to prevent parastomal hernia in coloproctology [36].

In the presence of morbid obesity, diabetes mellitus, anemia, some authors suggest intraperitoneal placement of the prosthesis using video-assisted support, which, in their opinion, reduces the risk of postoperative complications. To strengthen the abdominal wall, a composite endoprosthesis is used, consisting of polypropylene and polytetrafluoroethylene endoprostheses fixed to each other, the latter of which faces the abdominal organs [17].

Intra-abdominal fixation of endoprostheses can be carried out using hernia staplers and fibrin glue. The use of a sutureless technology for fixing polymer endoprostheses reduces the incidence of postoperative wound complications and ensures reliable fixation of endoprostheses to the tissues of the anterior abdominal wall. In the immediate postoperative period after preventive implantation of a polypropylene mesh, an intestinal fistula is formed in 3.5-5% of cases. In this regard, for intra-abdominal implantation, it is advisable to use polytetrafluoroethylene prostheses that do not cause adhesion formation in the abdominal cavity [39].

Currently, the results of the operation are evaluated based on the study of the quality of life of patients, which is directly dependent on the size of the postoperative ventral hernia: the larger the hernia, the worse the quality of life [34, 40, 43]. A number of foreign authors conducted a comparative study of the quality of life of patients who underwent median laparotomy in combination with preventive arthroplasty and without it. Follow-up during the first year after surgery showed a statistically significantly higher level of quality of life in patients who underwent primary wound closure with a mesh endoprosthesis [22, 25, 40—42].

Thus, preventive arthroplasty is becoming more and more widespread in abdominal and vascular surgery, coloproctology, urology, and oncology. Indications for the use of this technology to prevent postoperative ventral hernia are as follows: severe anatomical and functional insufficiency of the abdominal wall; obesity of III-IV degree in combination with metabolic syndrome or without it, elderly and senile age of patients in combination with other risk factors; repeated laparotomy over the old surgical scar; closure of a laparotomic wound in patients with peritonitis and treated with the use of programmed sanitation of the abdominal cavity; laparotomy against the background of neoadjuvant radiation and/or chemotherapy in patients with cancer.