Background:

-An eventration or incisional hernia is a postoperative hernia due to a healing issue of the abdominal wall. Is a more common situation after a laparotomy (which is surgery to open the abdomen for access) comparative with a laparoscopic or robotic surgery (that is performed by small incisions).

-An eventration is different from a hernia by its origin, in fact, it follows previous surgical incision on the abdominal wall. The healing of musculo-aponeurotic tissues at the level of the scar can present an issue and the scar can distend until it breaks. Thus, only the skin and the peritoneum retain the viscera. When the abdominal content is exteriorised completely, this pathology calls evisceration.

-An eventration can occur on all abdominal scars (midline, lateral or on old laparoscopy holes). In this orifice can pass from the digestive tract (small intestine or colon) but also the omentum (intra-abdominal fat apron) or any element contained in the abdomen.

–Smaller eventrations are treated by laparoscopy in the same manner as the midline hernias.

–Large eventrations, larger than 5 cm or several eventrations on the midline extending over (swiss cheese eventration) > 10 cm are a good indication for treatment by laparotomy with abdominal wall reconstruction and placement of the non-resorbable mesh at the retro-muscular level if the location is at the median or intermuscular level if the localization is lateral.

-Usually during surgery, an aspirating drain is positioned in a retromuscular position, if the dissection was difficult or haemorrhagic due to the scarring aponeurotic changes. Another aspirating redon can be also placed subcutaneously in order to decrease the occurence and quantity of seromas.

-An abdominal belt placement immediately postoperatively is important, especially for large parietal defects, because it can reduce wall pain during mobilization and therefore promotes early mobilization of the patient.

Postoperative attitude:

– Day1- The patient is authorized to have a normal diet. The early mobilization is encouraged and the patient is assisted by the medical team.

– Day2- The drain is removed if the quantity is <30cc and the appearance is clear, otherwise will be kept for the next days. If the patient is in good general status, the, discharge may be authorized. The patient can leave the hospital with the drains in place, which will removed in consultation.

Complications:

– Hematoma / Seroma- the most common complication for this type of surgery. The presence of aspirating redons significantly reduces this complication. If the seroma or hematoma is limited, conservative treatment is possible.