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Post Op Care

POST OPERATIVE CARE IN PATIENT UNDERGOING ABDOMINAL WALL RECONSTRUCTION

Post operative management of AWR can be classified as

AWR for giant incisional hernia was traditionally associated with high rates of post operative complications and slightly longer post – operative hospital stays. This was mainly because AWR for giant incisional hernia almost always involved major surgical trauma with adhesiolysis, and large wounds, placement of large prosthesis and altered anatomy, combined with long duration of surgery on mostly diabetic and overweight patients. Wound complications followed by chest complications are the most common complications associated with AWR.

Immediate Management :

  1. CHEST COMPLICATIONS:

ROLE OF MUSCLES IN RESPIRATION

Rectus abdominis                            Pulls ribcage downward in forced expiration

External oblique                               Pulls rib cage downward to assist in forced expiration

Internal oblique                               Reinforces work of External Oblique

Tranversus abdominis                    Increases Intra- Abdominal pressure to assist in forced expiration

 

The patients with giant incisional hernias show decreased expiratory lung function. Initially these release procedures were considered to further hamper pulmonary function and was considered as one of its drawback . However, recent studies have shown that it improves the lung functions.

This has been validated by the study done by Jensen KK, Backer V, Jorgensen LN in which the pulmonary functions were done preoperatively and postoperatively following abdominal wall reconstruction. The examined lung functions were forced vital capacity FVC, peak expiratory flow PEF, maximal inspiratory pressure MIP, maximal expiratory pressure MEP.

It was observed that the PEF and MEP increased postoperatively while rest all parameters remained the same, so it was concluded that following AWR procedures the respiratory functions of the patient improved.

Chest physiotherapy plays a very important role to prevent any post operative chest complications like pneumonia and atelectasis. These patients are very prone to chest complications as AWR procedures are carried out under general anaesthesia and are also long duration surgery. Hence rigorous chest physiotherapy and incentive spirometry post operatively play a very important role in avoiding all the possible chest complications.

Preoperatively use of incentive spirometry exercises with use of abdominal corset have shown to optimise the chest and reduce the incidence of post-operative chest complications, and also optimises the patient for the post-operative state.

  1. WOUND COMPLICATIONS

Following AWR wound complications are not uncommon. Inspite of maintaining high standards of sterility intra-operatively, patients following AWR still have moderate amount of risk to develop surgical site infection. This is because of dissection involved in the procedure at every level of the abdominal wall thus leading to a potential chance of seroma formation. Most of these patients are also diabetics thus further increasing the risk of surgical site infection. Poor personal hygiene along with skin infections also tend to increase the risk of surgical site infection by many fold. The presence of a prosthetic mesh in itself is risk factor for development of surgical site infection. However, it must be mentioned that TAR has reduced chances of wound events compared to open ACST because skin flaps are not raised.

The following practice is common but not entirely supported by evidence.

Surgical site infection can be prevented by simple interventions:

  1. RETURN OF BOWEL FUNCTION

DELAYED ISSUES

  1. ABDOMINAL WALL FUNCTIONS :
  1. QUALITY OF LIFE

 

 

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