Laparocele imprisoned like Pope Francis: what it is and how to intervene

Professor Campanelli clarifies why Pope Francis underwent surgery to treat hernia known as incarcerated incisional hernia

Roberto De Filippis

It’s because of a incarcerated incisional hernia that this afternoon Pope Francis was operated on at the Gemelli Polyclinic in Rome. The pontiff was subjected to an abdominal surgery not urgent, but necessary to prevent the situation from worsening. Let’s clarify what incisional hernia is, the reasons why it forms, how to treat it and recovery times.

LAPAROCELE: IT CAN FORM AFTER AN OPERATION

Not a rare event, incisional hernia is nothing more than a hernia that appears over a scar which is formed following a suture performed at the end of a surgical procedure, both traditional (“open”) and performed laparoscopically. In both cases, even a long time after the operation, it may happen that the edges of the scar move away and thus create a sort of hole. When the hole is located in the abdomen, the peritoneal sac, within which the loops of the intestine and colon are located. “The removal of the edges of the scar can give rise not only to a problem of an aesthetic nature, with the emergence of a sort of ‘ball’ of variable dimensions based on the size of the hole, but also to health risks . Indeed, adhesions of the viscera can form, which in turn can hinder intestinal transitcausing abdominal pain and constipation” explains the professor Giampiero Campanelli, director of the Hernia Center of the Casa di Cura La Madonnina in Milan and head of the General Surgery Day & Week Surgery service of the Irccs Galeazzi-Sant’Ambrogio Hospital in the Lombard capital and full professor of Surgery at the University of Insubria. If not treated in time, incisional hernia can also give rise to series intestinal obstructions.

LAPAROCELE: IT’S GREATER IF HE’S CHOKED

In all probability, in the case of Pope Francis, incisional hernia is the consequence of the diverticular surgery he underwent in 2021. In general, various risk factors favor its formation: tissue laxity, which becomes more pronounced with advancing age, smoking, chronic obstructive pulmonary disease (COPD), characterized by a cough that greatly abdominal wall, previous infections and previous surgeries. In less serious circumstances, in the presence of incisional hernia, it is possible to return the peritoneal sac to its location with simple palpation. “The situation is a little more serious, but in any case not worrying, if the incisional hernia is incarcerated, as in the case of Pope Francis, because it is not possible to carry out this manoeuvre. On the other hand, the strangulated incisional hernia requires an emergency interventionas the viscera are compressed. In these circumstances, if you stall too much, you also run the risk of having to resect parts of the organs that leak into the peritoneal sac” warns Professor Campanelli.

LAPAROCELE: YOU CAN INTERVENE WITH TWO TECHNIQUES

In the presence of incarcerated incisional hernia, the surgery consists in putting the organs that have come out of their seat back into the correct position and repairing the abdominal wall using a non-absorbable network, which is inserted into the space between the posterior fascia of the rectus muscles and the rectus muscles themselves. This intervention can be performed both with the “open air” technique and with the robotic laparoscopic technique. “In the absence of complications, it takes about 10 days to fully recover after such an operation. However, if you intervene with the robotic laparoscopic technique the recovery it is also faster” concludes Professor Campanelli.



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