REMOVAL Inguinal hernia
How is the surgery for inguinal hernia
Plastic Surgery – EuroDoctor.ru – 2009
Abdominal hernias can be, depending on the area in which they were formed, inguinal, umbilical, lumbar, abdominal white line, post-operative, etc.
Herniation of the stomach – is going out of the abdominal cavity through a natural or artificial defects in the abdominal wall. Moreover, these bodies are covered with shells of all the abdominal wall. The most common abdominal hernias with bowel loops out, a strand of omentum, sometimes bladder, testis or ovary.
Causes of hernia
Among the main causes of abdominal hernias can be called so-called predisposing factors and produce.
By predisposing factors include the different physical characteristics, genetic predisposition to the formation of hernias, as well as the model, sex and age differences in the structure of the body. For example, often herniated stomach (especially the umbilicus) are encountered during pregnancy, by persons engaged in heavy physical labor, obesity, or malnutrition.
Generating factors – factors that contribute to the increased pressure in the abdominal cavity, or to its sharp fluctuations, resulting in a hernial existing space or weakness of the abdominal wall are beginning to leave the internal organs. It could be weight lifting, straining for chronic constipation or difficulty urinating, and frequent crying or screaming in infancy.
Depending on where in the left hernia, are distinguished:
- Inguinal hernia
- Umbilical hernia
- Abdominal hernias white line
- Lumbar hernia
- Femoral hernia
- Postoperative and other more rare hernia.
The most common inguinal hernia.
Inguinal hernia – this is going out of some of the abdominal cavity through the inguinal canal, which is formed by the inguinal ligament, muscle and fascia abdomen. In men, the inguinal canal is the most important organ – the spermatic cord, which consists of arteries, veins, lymph vessels, nerves, and vas deferens. Women in the inguinal canal passes round ligament of the uterus. The walls of the inguinal canal are arranged so that, in the groin a thin channel is covered with muscles and aponeurosis front and rear – fascia and peritoneum. Under certain conditions, which has already been said, when abdominal pressure increases, the internal organs – intestines, omentum, ovary, and others – pushed to the side wall of the abdomen, and the place where it is weakest, find a way out.
The main feature of abdominal hernias is the integrity of the peritoneum – the thin membrane that covers the entire abdominal cavity.
Manifestations of inguinal hernia
The main sign of inguinal hernia – a bulge in the groin area. It can be at rest when straining to appear, what happens during the recovery of gravity, strong cough, constipation, urination in patients with BPH, etc. In addition to bulge in the groin area, which can be either one or both sides, a sign of inguinal hernia may be a dull ache in the groin as the constant and periodic, during exercise, impaired functioning of the intestines in the form of delays chair.
Diagnosis of an inguinal hernia
Diagnosis of an inguinal hernia, in principle, not difficult. Diagnosis is based on the patient's complaint to the bulge in the groin area, which is associated with physical activity, as well as inspection and testing. To assess the state extended the inguinal canal, the doctor inserts into the outer ring finger channel. Normally, the channel can enter only the tip of the little finger. In addition, a cough test, in which a doctor feels the tremors entered in the inguinal canal with his little finger.
In addition, for the diagnosis of a hernia can be used and the method of ultrasound, however, in most cases, your doctor may do without him, resorting to it only in vague and difficult cases.
Methods of treatment of inguinal hernias
Just worth noting that conservative methods to cure a hernia is not possible. No medication or physical therapy procedures, and the more exercise, can contribute to self-healing defect in the aponeurosis and fascia inguinal canal. Treatment of hernia can only be surgically. Conservative measures may also be used, for example, in severe condition of the patient when surgery is contraindicated. In this case, the patient should always wear a tie (which, however, does not guarantee against complications of inguinal hernia).
Surgical treatment of inguinal hernias
The principle of surgical treatment of inguinal hernia lies in opening the hernial sac, and then released organs are placed back in its place into the abdominal cavity, and then held plastic inguinal canal, which is to create a duplication of – doubling the aponeurotic wall of the inguinal canal.
Another method of treatment of inguinal hernias, as well as postoperative recurrent hernias and large – is to strengthen the anterior wall of the inguinal canal synthetic material – the so-called grid. Material from which made such a grid can be Dacron, Teflon, nylon, etc.
Prior to surgery, the doctor prescribes examination of the patient. It is in the common blood and urine tests, blood test, ECG, ultrasound, if necessary in the field of hernia. It is also recommended to restrict smoking in the weeks prior to surgery. Be sure to tell your doctor if you suffer from any chronic disease and are taking on this medication. On the eve before the operation is prohibited to eat for 8 hours before surgery.
How is the surgery for inguinal hernia
Typically, plastic inguinal hernia is performed under local anesthesia, although in some cases may be used and general anesthesia. Frequently, local anesthesia combined with sedation, the patient did not feel any discomfort during surgery. General anesthesia for hernia is usually used in children, mentally disturbed patients.
The main stages of operation for inguinal hernia
Skin incision – it runs parallel to the inguinal ligament, a little above it.
After exposure of the inguinal canal is cut, and he sought a hernia. In some cases, a hernia can be difficult to find, and then the surgeon asks the patient to strain. That is why surgery for hernia is usually performed under local anesthesia – the patient was conscious.
Once a hernia is found, it is cut, the surgeon assesses the state of it, and if all goes well, then released back to sink organs in the abdominal cavity.
Hernial sac tied, stitched and cut off.
Then begins the plastic inguinal canal. Currently, there are many methods of plastic inguinal canal, but they are all based on creating a duplication of either – double pleats and stitching aponeurosis muscle and fascia, or the suturing a synthetic mesh inguinal canal. This grid is quite strong, inert, that is, the tissues of the body does not react to it, but growing into it.
Cutaneous wound sutured.
Duration of surgery for inguinal hernia can be from hour to hour and a half, depending on the nature of the hernia, the amount of interference, and the flow of the operation itself. It is worth noting that the bilateral hernia, the second hernia operated in just a few months! Simultaneous operation is not done!
The recovery period
After surgery, the patient must lie down for 1-2 days. You should avoid physical exertion. You can get up, usually, only the second or third day. This is due to the fact that physical activity increases abdominal pressure, which may adversely affect the status of surgical wounds. In the early days of the recommended diet – not eating foods that contribute to gas production (sweets, fruit, yogurt, etc.).
Dressings are usually carried out in a few days. Sutures are removed after 10 days. After being discharged from the hospital to be back in 3-4 months to avoid heavy physical exertion, or may be recurrent hernia.
As with any surgery, after surgery for inguinal hernia may be some complications. Here they are:
- Infectious complications of the wound. For their prevention are usually prescribed antibiotics.
- The formation of hematomas. To prevent formation of a hematoma in the postoperative wound immediately after surgery, it is superimposed ice pack and load at 2:00.
- Damage to the nerves. This is a rare complication that is usually associated with the violation of equipment operation. It is noted a violation of the sensitivity of the skin in the scrotum or inner thigh.
- Damage to other parts of the spermatic cord, such as clamping, or the intersection of the vas deferens in men, which may affect subsequent fertility.
- Damage to blood vessels, which take place in the spermatic cord, which can lead to atrophy of the testis.
- Hydrocele – a fairly common complication of surgery for inguinal hernia (10%).
- Damage to the femoral vessels.
- Deep vein thrombosis legs, which is usually observed in elderly and old patients who are likely to lie more than a walk.
- Recurrence of hernia, which may be associated with the violation of the doctor's recommendations, heavy physical exertion.
PLASTIC SURGERY in Germany – Plastic Surgery Clinic OPTIMA
BEAUTY CLINIC IN MOSCOW – UNICLINIC
Department of Plastic Surgery CB 6 RZD – MOSCOW
PLASTIC SURGERY IN MOSCOW – Professor S. GAGARIN
Examination and treatment in GERMANY – Institute "DIAGNOSTIX"
AID IN THE TREATMENT –
Complications of inguinal hernia