O que é a hérnia incisional?

A hérnia incisional é um tipo de hérnia que acontece no local da cicatriz de uma cirurgia no abdome. Isso acontece por causa de uma tensão excessiva e uma cicatrização inadequada na parede abdominal. Devido ao corte dos músculos, a parede do abdome fica enfraquecida, e faz com que o intestino, ou qualquer outro órgão que esteja por baixo do local da incisão, tenha maior facilidade para se deslocar e pressionar o local da cicatriz, levando à formação de um pequeno inchaço nessa região.

Embora as hérnias incisionais sejam uma complicação relativamente comum em qualquer pessoa que faça uma cirurgia abdominal, são mais frequentes em pessoas com obesidade, que tiveram uma infecção da ferida operatória ou que têm algum problema de saúde anterior, como diabetes, doenças pulmonares ou qualquer doença que aumente a pressão dentro do abdome.

Sempre que existir suspeita de estar se desenvolvendo uma hérnia incisional após uma cirurgia é muito importante ir ao hospital ou consultar o médico que fez a cirurgia, para que a hérnia possa ser avaliada e o tratamento iniciado o mais rápido possível.

Principais sintomas
O sintoma mais comum da hérnia incisional é o surgimento de um inchaço junto da cicatriz da cirurgia abdominal, no entanto, também é frequente que surjam outros sintomas associados, como:

Dor ou desconforto no local da hérnia;
Náusea e vômitos;
Febre abaixo de 39ºC;
Dificuldade em urinar;
Alterações do trânsito intestinal, com prisão de ventre ou diarreia.
A hérnia incisional normalmente surge 3 a 6 meses após a cirurgia, mas pode surgir antes desse período. Além disso, também é habitual que a hérnia seja mais facilmente observável quando se está de pé ou pegando peso, podendo até desaparecer quando se está sentado e relaxado.

Como confirmar o diagnóstico
Na maior parte dos casos, a hérnia incisional pode ser diagnosticada por um clínico geral ou cirurgião, apenas pela observação dos sintomas e avaliação do histórico clínico. Assim, é aconselhado que, sempre que exista suspeita de hérnia, se vá no Centro de Saúde da Família ou se faça uma consulta com o cirurgião que fez a cirurgia.

Possíveis causas e como evitar
A hérnia incisional pode acontecer em qualquer caso em que exista um corte dos músculos da parede abdominal e, por isso, é relativamente comum após uma cirurgia ao abdômen. Porém, existem alguns fatores que parecem aumentar o risco de desenvolver este tipo de hérnia, como:

Ter uma infecção no local da cicatriz;
Ter excesso de peso ou obesidade;
Ser fumante;
Utilizar alguns remédios, especialmente imunossupressores ou esteroides;
Ter outros problemas de saúde, como diabetes, insuficiência renal ou doenças pulmonares.
A melhor recomendação para diminuir o risco de desenvolver uma hérnia incisional, além de evitar os fatores de risco, consiste em esperar o tempo recomendado pelo médico antes de iniciar atividades que possam aplicar pressão sobre a barriga, incluindo ter uma gravidez.

Como é feito o tratamento
O tratamento da hérnia incisional deve ser sempre avaliado junto com o médico, dependendo do estado de saúde geral, anatomia e localização da hérnia. Porém, o tipo de tratamento mais utilizado é a cirurgia, na qual o médico pode voltar a abrir a cicatriz ou fazer pequenos cortes na pele para inserir uma rede que ajude a fortalecer os músculos da parede abdominal, impedindo que os órgãos consigam passar e façam peso em cima da cicatriz.

Geralmente, hérnias de maior tamanho são mais difíceis de tratar e, por isso, precisam de uma cirurgia clássica, na qual a cicatriz é novamente aberta. Já hérnias menores, podem ser tratadas com laparoscopia, onde o médico faz pequenos cortes ao redor da hérnia para repará-la, não precisando abrir novamente a cicatriz da cirurgia anterior.

Possíveis complicações
Quando não é tratada de forma adequada a hérnia incisional pode acabar estrangulando o intestino, o que faz com que exista menos sangue com oxigênio chegando na parte que está presa. Quando isso acontece, pode se desenvolver uma situação grave de morte dos tecidos do intestino.

Além disso, mesmo que a hérnia tenha um pequeno tamanho, com o passar do tempo, é possível que vá aumentando de tamanho, agravando os sintomas e dificultando o tratamento.

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