Hernia surgery is a frequently performed procedure to repair weakened areas in the abdominal wall, a common condition affecting many individuals. While generally safe, patients can sometimes experience complications following the operation. A hematoma, a collection of blood outside blood vessels, may form. Understanding the factors that contribute to hematoma development after surgery is important for patient awareness during recovery.
Understanding a Hematoma
A hematoma represents a localized pooling of blood within tissues or spaces of the body, occurring when a blood vessel is damaged and blood leaks out. This differs from a simple bruise, which results from a small leakage of blood from tiny vessels, typically appearing flat and discolored on the skin. A hematoma, conversely, involves larger blood vessels and often forms a raised, firm, or spongy mass. It is also distinct from a seroma, a collection of clear, yellowish fluid that can accumulate after surgery, rather than blood.
Surgical Contributions to Hematoma Formation
During hernia repair, the surgical process itself can directly contribute to hematoma formation. Incidental cutting or damage to blood vessels during dissection is a common cause of intraoperative bleeding. The abdominal wall and groin areas are richly supplied with blood vessels, including the inferior epigastric vessels, spermatic vessels, and those near the pubic bone, susceptible to injury during the procedure.
Even with meticulous surgical technique, achieving complete hemostasis, or the cessation of bleeding, can be challenging. Despite the use of methods like cautery or ligatures to seal vessels, small blood vessels may continue to ooze after the incision is closed. Clots that form during surgery might also dislodge, leading to renewed bleeding post-operatively.
The complexity of the hernia repair can also influence the likelihood of hematoma development. Larger hernias, those that have recurred after a previous repair, or cases requiring extensive tissue dissection tend to involve more manipulation of tissues. This increased surgical involvement elevates the potential for bleeding. Recurrent hernias often present with scar tissue that makes dissection more difficult and increases the risk of vessel injury. Certain mesh fixation techniques may similarly increase the risk of bleeding.
Patient and Post-Operative Influences
Patient-specific factors and actions taken during the recovery period significantly influence the risk of hematoma development. Medications that thin the blood, such as warfarin, aspirin, or novel oral anticoagulants like rivaroxaban, dabigatran, and apixaban, notably increase the risk of bleeding and hematoma formation. Patients must inform their surgical team about all medications they are taking.
Certain underlying medical conditions also predispose individuals to bleeding complications. Uncontrolled high blood pressure can increase pressure on blood vessels, making them more prone to leakage. Bleeding disorders, such as hemophilia, von Willebrand disease, or platelet function disorders, impair the body’s natural clotting ability. Additionally, liver or kidney dysfunction can compromise the production of clotting factors, further elevating bleeding risk.
Physical activity too soon after surgery can disrupt the healing tissues and cause new bleeding. Straining, heavy lifting, or engaging in strenuous exercise can put undue pressure on the surgical site. Surgeons typically provide specific instructions on activity limitations, often advising against lifting anything heavier than 10-20 pounds for several weeks, with a gradual return to normal activities.
Forceful actions like coughing or sneezing can also contribute to hematoma formation. These actions transiently increase abdominal pressure, which can potentially lead to minor bleeding at the surgical site. To mitigate this, patients are often advised to support their incision with a pillow or their hands when coughing or sneezing, which helps to reduce the strain on the healing tissues.