Inguinal Hernia: Causes, Symptoms, Treatment
Protrusion into the intermuscular or subcutaneous tissuethe parietal peritoneal sheet along with the internals through a defect in the muscular layer of the abdominal wall is called a hernia. Hernial protrusion, as a rule, is constantly increasing in size. The most formidable and often occurring complication is the infringement of the hernia, which occurs as a result of a pressure jump inside the peritoneum, a sharp contraction of the muscles that surround the protrusion, as well as a large accumulation of stool and gases.
There are several types of hernias that are accepteddivide by the place of their localization. Hernias are inguinal, umbilical, hernia of the white abdominal line, femoral, postoperative (ventral) and diaphragmatic. Inguinal hernia is located directly in the inguinal canal, femoral - along the large vessels of the inner side of the thigh. The umbilical hernia passes through the outlet of the vessels and the umbilical ring. The diaphragmatic hernia passes through the aperture opening, and the abdominal hernia passes through the muscle layers of the abdomen.
The main cause of hernias islow elasticity of the walls of the abdominal cavity, leading to the appearance of a defect. The risk factors that can be triggered by inguinal hernia include conditions that increase the pressure inside the peritoneum, as well as the load on the abdominal wall. These include: obesity, chronic cough, the need to press on defecation or urination, lifting weights, pregnancy, frequent intensive sneezing, weakened from the birth of the abdominal wall. Inguinal hernia is much less common in women than in men, inguinal hernia protrusions account for 80-90% of all cases of hernia formation.
The main signs of inguinal hernia are protrusionin the area of the appearance of a hernia, especially at the time of physical effort, with the vertical position of the body, as well as a clear designation of hernial gates during palpation. Patients are concerned about pain in the area of a hernia and abdomen, inconvenience in walking, and dyspepsia.
Diagnosis of inguinal hernias reduces to examinationpatient in an upright position, to form an idea of the asymmetry of inguinal areas. If there are protrusions of the abdominal wall, the size and shape of the hernia, as well as its consistency, is determined.
For the prevention of complications, inavoiding recurrences in the postoperative period, as well as to provide local compression of the area of hernial protrusion, a bandage for inguinal hernia is used.
Currently, the following methods are used to treat inguinal hernias: surgery, Bassini plastic, PHS plastic, endoscopic hernioplasty, plug and patch technique.
The operation involves traditional access to the abdominal cavity and plastic by a two-dimensional Teflon mesh or polypropylene implant in the back wall of the inguinal canal.
Bassini plastic surgery is plastic with its own tissues. Its essence is reduced to three provisions: the movement of the spermatic cord, the creation of the inguinal canal, the closure and fascia of the muscles of the hernia gates.
Plastic with the use of PHS - the use of a complex three-dimensional prosthesis, consisting of a connector, suprafascial flap and subfascial flap.
Endoscopic hernioplasty consists in the formation, with the help of a special instrumental and hardware complex, of the posterior wall of the inguinal canal through laparoscopic access.
When using the "plug and patch" technique."cork and patch" is the usual access to the inguinal canal, as a rule, the opening of the hernial sac is not performed. The inguinal hernia is immersed inwards with a "cork" obturator from a polypropylene mesh in the form of a shuttlecock. The upper part of the obturator is directed towards the hernial sac, and its base is fixed to the surrounding tissues with several sutures. At the same time, the back wall of the channel is strengthened by a "patch" in the form of a grid.
The choice of technique depends on the type and size of the hernia, as well as on the age and health of the patient.