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Recurrence of an inguinal hernia occurs after surgical treatment as a result of a doctor's mistake or due to postoperative complications. Relapse occurs in every 10 patients. Hernia recurrence is an indication for a second operation, but according to a different scheme. If the defect was previously sutured with tissues, re-treatment will be carried out with the installation of a mesh, most likely using the Lichtenstein method.

It is necessary to distinguish between recurrence and ventral hernia. In the first case, the defect appears in the same place, the disease is completely repeated. Ventral or incisional hernia is a protrusion of organs in the area of a surgical scar. Recurrent hernia is not always associated with surgery, it can be caused by factors before and after surgery. The cause of a ventral hernia is only an operation.

An inguinal hernia may reappear repeatedly, after 2-3 operations. Repeatedly recurring defect is one of the most complex forms disease, and not every experienced surgeon can cope with it.

Why does a hernia recur?

The causes of the recurrence of an inguinal hernia after surgery are divided into 3 groups:

Adverse factors before surgery.
Doctor's mistake during the operation.
Postoperative complications.

Surgeons believe that the main reasons for this are the wrong choice of surgical technique and insufficient examination of the patient. Operation according to all the rules completely eliminates any risks during and after treatment. But if during the preparation period or during the operation the doctor loses sight of something, this will have consequences.

Surgeon V.D. Fedorov, in his works, expresses the opinion that all the factors for the appearance of a hernia that exist before surgery persist after surgical treatment and can provoke a relapse at any time. And the most significant of all causes, the doctor highlights the congenital weakness of the connective tissue.

Most of the recurrences are observed in the first year after the operation. More often this occurs with large, oblique and sliding hernias. A tendency to re-develop the pathology is observed in 30-45% of those operated on, but only 10% of patients actually face this problem after hernia repair. From this we can conclude that a lot depends on postoperative rehabilitation, measures taken by the doctor and the patient's concern for his health.

Risk factors before surgery

An inguinal hernia may not disturb the patient for a long time, but this does not mean that it does not need to be removed. Treatment of the defect is carried out only surgically, both in congenital and acquired forms of the disease. When the operation is delayed for a long time, this will already be a risk factor for relapse.

Self-treatment at home, refusal of examination and herniotomy end in a serious condition, when the operation is already performed urgently. Under such conditions, there is a higher risk of making a mistake, which will lead to postoperative complications and re-illness.

The elderly are at risk, which is associated with age-related changes, degenerative processes in the groin area. Patients with concomitant diseases of the abdominal cavity and the genitourinary system, which are accompanied by constipation, cough, and increased intra-abdominal pressure, may experience a recurrence of the disease.

Insufficient preparation before hernia repair also plays a role in the occurrence of recurrence. When the sanitation of the body has not been carried out, overlooked infectious foci can cause purulent inflammation, as a result of which a hernia appears.

During the operation

The second group of causes of hernia recurrence is associated with the following factors:

wrong choice of technology- strengthening only the anterior abdominal wall with recurrent and direct hernia can lead to re-disease due to the high inguinal gap and deep canal, and in order to avoid such a problem, it is necessary to conduct a series of studies, take into account the pathogenetic features of the disease;
surgeon's mistakes during surgery- suturing with high tissue tension, damage to nerves and blood vessels, insufficient release of hernial contents, and many other actions can provoke a relapse.

The condition for a successful operation will always be high-quality preparation and sanitation. Children and adult patients with an indication for surgical treatment are advised to be examined by several doctors, listen to the opinion of each and trust the opinion of the majority of specialists. The doctor must be aware of past diseases and operations. Some surgical techniques are contraindicated in previous surgical treatment of the gastrointestinal tract and small pelvis.

After operation

Already after the operation, complications can provoke the disease, especially purulent inflammation, bleeding and damage to internal organs.

What complications appear in the early and late period after hernia repair:

wound infection- suppuration occurs when an infection enters during surgery or after it if the rules for caring for a postoperative scar are not followed;
hematoma- appears as a result of rupture of blood vessels;
damage to the spermatic cord- occurs during the extraction of the hernial sac, the error is typical for an inexperienced surgeon, this complication often occurs already during the removal of a repeated defect and threatens with infertility;
thrombosis of the veins of the leg- occurs in older people and young patients who lead little active image life, anticoagulants are used for treatment;
dropsy- the most common complication, treated only by a second operation;
bowel injury- occurs with inaccurate treatment of the hernial sac, the surgeon can also touch the bladder;
hip disorder- happens with improper suturing, in the case of using a rough material, which can lead to bleeding.

Types of relapses

Distinguish between true and false recurrence. In the first case, the disease completely repeats itself. False recurrence occurs when a defect develops in another area or in a different form. True and false direct hernias in the groin are more common, oblique protrusions are diagnosed in a ratio of 1/5.

Repeated inguinal hernia is of the following types:

oblique- surrounded by the spermatic cord, completely repeats the course of the inguinal canal;
straight- medial or suprapubic in the lateral part of the inguinal canal;
lateral- located near the inguinal ring outside the spermatic cord;
suprapubic- happens with insufficient strengthening of the inguinal canal;
intermediate- shaped like a mushroom, located in the inguinal triangle;
complete- with complete destruction of the inguinal wall, the gap of the canal is filled with a large hernia.

Inguinal hernia is more often removed by the Lichtenstein method, and the typical forms of recurrence after this operation are lateral and medial recurrences.

Surgery for repeated inguinal hernia

The method of treatment will depend on the degree of complexity:

First degree- hernia volume up to 100 cm³, Kukudzhanov, Shouldice method.
Second degree– hernia volume up to 300 cm³, Lichtenstein method.
Third degree– hernia volume up to 400 cm³, River method.
fourth degree– hernia volume from 400 cm³, TEP, TABP method.

The choice of technique is determined by the type of plastic surgery performed earlier, the location of the hernia and its condition. A universal operation will be laparoscopic hernioplasty, it can be performed at any stage of the protrusion, with the exception of a strangulated hernia. Lichtenstein surgery and reconstructive obturation hernioplasty are considered reliable techniques.

The operation is performed in two ways - through open and laparoscopic access. Operation through the postoperative scar is carried out by the classical method according to Liechtenstein, by complete reconstructive hernioplasty or partial obturation plasty. The laparoscopic method involves the creation of access to the hernia by three punctures in the abdominal cavity, through which instruments for hernia repair and a camera for visual control are inserted.

Features of different types of operations for recurrent hernia in the groin:

Lichtenstein method- at big size hernial sac and repeated recurrence, performed with suturing of a mesh implant, hospitalization period - up to 3 days;
complete reconstructive hernioplasty- in case of recurrence after plastic surgery with preservation of the structure, during the operation, the implant is fixed with sutures to prevent displacement, the hospitalization period is up to 3 days;
partial hernioplasty- in case of previous plastic surgery of the posterior wall of the inguinal canal, in the case of a small hernia ring, this is the least traumatic method, the patient is discharged from the hospital immediately after the operation;
laparoscopic method- with a bilateral hernia, it involves the introduction of an implant through the abdominal cavity to the hernial orifice from the inside, this is a complex version of the operation, it can only be performed under general anesthesia, therefore, open technique is less often prescribed.

Postoperative rehabilitation

Depending on the type of operation, you will need to stay in the hospital from 1 to 5 days. When the doctor sees that everything is in order and there are no complications, he will give recommendations about the care of the scar and lifestyle in the first weeks after treatment.

If there are any problems immediately after the operation, the doctor finds out whether this may be due to surgery or anesthesia. After identifying the cause, the specialist will prescribe additional treatment that will need to be done at home. If a repeated hernia appeared immediately, a second examination is carried out and a second operation is prescribed.

General rules in the early period of rehabilitation after hernia repair:

daily dressing change and wound treatment with an antiseptic;
diet, exclusion of any physical work;
wearing a bandage for several hours while doing daily activities;
a visit to the doctor in a week for examination and in case of complications.

After the operation, symptoms of complications may appear, with which you need to go to the doctor:

swelling in the groin area does not go away for several days;
severe pain and suppuration of the postoperative wound;
swelling of tissues in the groin with general malaise and fever;
burning, numbness or increased sensitivity of the skin at the site of surgery.

Normal symptoms after surgery will be mild discomfort while walking, slight burning sensation in the groin, and swelling. The condition improves after a few days, but for another 1-2 months you need to exclude physical activity, and always use a bandage during exercise and exercise.

Diet

The diet is essential part postoperative recovery. The diet is prescribed to prevent constipation and bloating, because these disorders lead to an increase in intra-abdominal pressure, and this is a factor in the development of re-hernia.

How to eat the first 2 weeks after hernia repair:

you need to eat in small portions, chewing everything thoroughly;
food should be at a comfortable temperature and not spicy;
it is important to increase the protein content in the diet;
need to drink a lot clean water, but not during meals, but 30 minutes before or after;
the diet may include boiled white meat, cottage cheese, cereals, fish;
fixing and gas-forming products are excluded.

Bandage

The support bandage after the operation can be worn not always and not constantly. It is contraindicated in suppuration of the skin and the first few days after hernia repair. When the wound has healed, the doctor will recommend a treatment belt to wear while doing household chores and exercising. The bandage will reduce pressure on the stitches, preventing them from coming apart, and will also help prevent recurrence.

The belt after the operation must be with soft inserts, let air through and absorb moisture. Before putting on the belt, it must be treated with an antiseptic. It is recommended to wear a postoperative bandage no more than 5 hours a day, it must be removed at night.

Pain is a natural reaction of the body to surgical intervention, but its appearance can also be caused by the development of hematomas, the imposition of too rough sutures. When performing the operation by an insufficiently experienced surgeon or due to the individual anatomical features of the patient, the spermatic cord and nerve endings may be damaged.

A dangerous phenomenon in the postoperative period is the entry of infection into the wound. The pain is also caused by the divergence of the seams as a result of non-compliance with the regimen recommended by the surgeon.

Classification

According to anatomical features, hernias are divided into internal and external. Internal hernias, in turn, are divided into diaphragmatic and intra-abdominal.

Diaphragmatic hernias are formed due to the exit of the abdominal organs into the thoracic region through pathological or natural defects of the diaphragm.

Intra-abdominal hernias are formed due to the entry of an organ or part of it into the pockets of the peritoneum. External hernias are more common - the exit of an organ or part of it from its anatomical location through artificial or natural openings with a parietal sheet of the peritoneum.

It is necessary to distinguish prolapse (eventration) of an organ from a hernia - this is a protrusion of an organ outward through a defect in the abdominal wall. As a rule, the cause of eventration is a violation of the integrity of the peritoneum due to its trauma (wounds, etc.). In other words, this pathology suggests the presence of a hernial sac (parietal sheet of the peritoneum), which is not present during eventration.

UMBILICAL HERNIA IN ADULTS (HERNIA UMBILICALIS ADULTORUM)

An umbilical hernia in adults occurs in 2-3% of all external abdominal hernias. The development of umbilical hernias is more often observed in women (about 80%) over the age of 40 years.

The formation of umbilical hernias in adults is due to congenital defects in the development of the umbilical region. Under adverse conditions, the umbilical ring expands; the tissues surrounding it atrophy; resistance of the ring to intra-abdominal pressure is reduced.

Obesity, repeated pregnancies that occur without observing the necessary regimen, neglect of physical exercises, gymnastics predispose to a progressive increase in hernial protrusion, especially in obese people, in whom it often reaches very large size(rice.

CLINIC AND RECOGNITION

The clinical picture of hernias of the white line is very diverse. Often hernias of the white line are found only during a general examination, before which the patients did not notice the protrusion.

According to I.M.

Talman, out of 109 young men who had a hernia of the white line, only 5 knew about its existence, and according to A.P.

Krymov (1950), out of 88 examined with hernias of the white line, none of them presented any complaints. These data, presumably, refer to the so-called preperitoneal lipomas, which in practice are usually treated as hernias of the white line before surgery.

Complaints of patients suffering from hernias of the white line are reduced to pain in the protrusion, aggravated by palpation and tension of the abdominal press. Patients also note nausea, belching, heartburn, a feeling of pressure in the epigastric region.

Through the crevices and openings of the xiphoid process, peritoneal lipomas can protrude. True herniotiform process are rare, so the observation of P. I. Tikhov (1914) is instructive at the present time.

A 40-year-old patient was admitted with complaints of persistent pain of a "gastrointestinal nature". In the region of the xiphoid process, there was a protrusion the size of a walnut. During the operation in the xiphoid process, a hole 2 dosm in diameter was found and

The size of the protrusion with diastasis and its edges are well defined during examination.

Hernias of the lunate line are rare, usually on one side, less often on both, and sometimes reach a significant size (Fig. 37). For 1008 operations of hernias of various localization, I. A. Petukhov once observed a hernia of the lunate line. I. I. Bulynin described one case of a hernia of the semilunar line for 716 operations for hernias.

Symptoms

Aching pain, accompanied by a slight burning sensation, is considered the norm. The development of pathology in the rehabilitation period is signaled by the appearance of bleeding, edema in the area of intervention.

A dangerous symptom is an increase in body temperature, itching, suppuration in the area where the suture is applied. A feeling of heaviness in the scrotum area, its asymmetry is also considered a reason for carrying out diagnostic measures.

If a hematoma appears at the suture site or the testicle turns black, you should immediately contact the surgeon.

Principles of hernia treatment

A congenital hernia can only be corrected by surgery. When a pathology appears in adults, it is possible to be treated conservatively or surgically, depending on the presence of indications and contraindications for the first or second method.

In addition, prolonged wearing of the bandage provokes the development of atrophy of the muscles of the abdominal wall and aggravation of the pathology.

Operative techniques for the treatment of hernia are of two types: by open access or laparoscopic.

Indications for conservative treatment

Presence of contraindications to surgical treatment in children and adults.
Recurrence of the disease (hernia) after surgery.
The patient has a large hernia requiring several operations. The bandage is used during the time interval between surgical interventions.

Indications for surgical treatment

The presence of an uncomplicated hernia is an indication for elective surgery.
Infringement of the hernial sac requires emergency surgical intervention.
Recurrent hernias.
Postoperative hernias.
The development of the adhesive process.

Contraindications for surgery

Temperature after surgery

Vacation and work regime after operations for abdominal wall hernias are determined by the nature of the surgical intervention, the general condition of the patient, his age and the work performed. Before discharge from the hospital, the patient should be instructed in detail about the mode of work and life in the first months after the operation.

This circumstance is very important to prevent stretching of the fragile postoperative scar. With significant physical stress, the load of the abdominal press in the areas of the abdominal wall, according to the site of the operation, and with a decrease in the physiological tone of the entire abdominal wall.

of all layers of the abdominal wall occurs in conditions unfavorable for regeneration. Such a stretched inelastic scar is further prone to stretching, which is one of the reasons for early relapses in the first 6-10 months after surgery.

In the practical work of the surgeon, the norms of vacations lasting approximately from 1 to 2 months and transfer to work not associated with severe physical stress for periods of 2 to 6 months are adopted, depending on the type of work and the nature of the surgical intervention.

For small epigastric and small umbilical hernias, young and middle-aged people should be granted leave after surgery for a period of 2-3 to 4-5 weeks, depending on the nature of the work. With significant epigastric and umbilical hernias in the elderly and especially in the obese, the duration of sick leave is determined individually and averages 2-3 months.

The working capacity of these patients depends on the nature of their work, and the duration of their stay in light work varies from about 2 to 6-8 months. After operations for oblique inguinal hernias in patients engaged in physical labor, the vacation period is from 4 to 6 weeks, followed by a transfer to work not associated with severe physical stress for 1-2 months.

After operations for direct inguinal hernias, due to their greater tendency to recurrence, the terms of release from work should be extended to 6 weeks from

subsequent transfer for 2-3 months to work not associated with severe physical stress. During operations for incisional hernias in each case, determining

postoperative hernia, type of plastic closure of the defect - auto- or alloplasty), as well as the profession of the patient. Vacation terms 2-3-4 months, transfer to light work -

The incision is made according to middle line, its length is from 6-Scm. The beginning of the incision is made 2 cm above the base of the xiphoid process and below its apex 2-3 cm to provide sufficient access to the process, since the skin in the region of the xiphoid process is inactive and its edges are difficult to move apart. To release the neck of the hernial sac

or the bases of the preperitoneal wen with wire cutters, the xiphoid process is removed, then the nature of the protrusion is clarified. In the presence of a hernial sac, the latter is opened, its cavity is inspected, followed by bandaging of the neck and cutting off the sac. The preperitoneal wen is isolated throughout, its leg is bandaged. The dissected tissue is sutured in layers.

Indications for surgery for the divergence of the rectus muscles should be very


limitedly after a comprehensive examination of the patient and a prospective assessment of the nearest
and long-term results of the operation. From operations performed without opening the vagina
rectus muscles, the technique of A.V. Martynov is anatomically justified. Ellipse cut
remove excess skin. The aponeurosis of the external oblique muscle is exposed in both directions. On everything
throughout the diastasis, the aponeurosis is dissected 1 cm from the edge of the sheath of the left rectus muscle
		open				A cavity is formed			unequal
peritoneal-aponeurotic			flap; the edges			capture	several		clips,
pulled to the side. The edges of the sheaths of the rectus muscles protrude; starting from the top, to the edges
vaginas	impose			SeamsSuch	way, direct			bring together
contact without opening their vaginas. The free edge of the aponeurosis at the right vagina
the rectus muscle is applied in front and sewn along the entire length of the incision to the aponeurosis
sheath of the left rectus muscle (Fig. 19).

Various incisions are used: oblique (V. I. Larin, V. Ya. Machan), pararectal (N. I. Truten, S. L. Kolyu-bakin), transverse (T. S. Sikharulidze).

The most advantageous from an anatomical point of view is an oblique pararectal incision, which spares

nerves of the anterior abdominal wall and their branches, which is of exceptional importance for the long-term results of the operation. With hernial protrusions that are poorly palpable and small in size, especially with significantly pronounced fatty tissue, it is recommended to outline the localization of the hernial protrusion before surgery, which will facilitate the operation performed under local anesthesia.

In strangulated hernias, dissection of the aponeurosis must be performed after capturing the wall of the hernial sac and dissecting it with an examination of the strangulated organs.

The dissection of the aponeurosis is made in the direction of the fibers, which facilitates the further closure of the defect. When isolating the hernial sac, it is necessary to keep in mind the direct contact with the hernial orifice and the neck of the sac.

Epigastrica inferior, the pulsation of which can be determined by feeling. The stump of the hernial sac must be immersed under the transverse fascia and put on the edges of its seams for more reliable strengthening of the abdominal wall in this area.

This is followed by layer-by-layer suturing of the muscles and areas of dissected aponeuroses. The aponeurosis of the external oblique muscle, which is usually somewhat stretched, should be doubled.

Chapter XV Neuropathic and Pathological Hernias

In the lateral sections of the abdominal wall, protrusions of the hernial type are sometimes observed, developing after paralysis of one or more muscles of the abdominal wall. This type of hernial protrusion is called neuropathic hernia (hernia neuropatica); the last are observed seldom and develop at children more often.

One of the reasons for their formation is a malformation of the abdominal wall (underdevelopment of muscles), paralysis of the muscles of the abdominal wall as a result of poliomyelitis (Fig. 38).

These protrusions of the abdominal wall increase in size when standing, straining, coughing. When palpating the abdominal wall, a “weak” area without typical hernia gates is determined. The edges of the weak area are soft, pliable, somewhat worn. pain

(pseudohernia). Neuropathic hernias are not prone to infringement. The issue of surgery in each case is decided after a comprehensive discussion of the indications and contraindications for active intervention, taking into account severe muscle atrophy over a significant extent of the abdominal wall and the effectiveness of the operation.

Surgery weakens the body, so most patients experience an increase in temperature during the recovery period. Depending on the complexity of the intervention, the installation of the mesh, the age of the patient and his general condition, the temperature increase can last 7-30 days from the moment of the operation.

Such a condition is considered normal and does not interfere with the planned discharge of the patient from the hospital.

If the temperature rise is accompanied by severe pain, burning, aggravated by physical activity, attempts to sit down or turn around, then there is a risk of developing inflammation. The process is accompanied by the release of pus, blood from the wound, redness of the area around the seam, swelling.

The reason may be infection during surgical procedures, poor-quality suture treatment, or rejection by the body of an established foreign body. It is more often recorded in elderly patients with infringement of a hernia.

To relieve pain and fever, a course of antibiotics is prescribed. Before discharge from the hospital, in addition to being referred for tests, the patient also receives a referral to the ultrasound room, where, after the study, the likelihood of fluid accumulation in the area of the established foreign body is excluded.

The presence of fluid requires a puncture to clarify the nature of the accumulated substance. If pus is detected, a second operation may be required.

In other cases, anti-inflammatory, analgesic drugs, antibiotics are prescribed.

The operation of hernia repair today is not as traumatic as it used to be. It is performed in most cases by laparoscopy - through a probe, with minimal incisions up to 2 cm and reliable hernia repair using synthetic materials.

Therefore, complications after inguinal hernia surgery in men develop mainly after discharge from the hospital, and most of them occur through the fault of the patient himself. The most common consequences are:

prolonged pain syndrome;
swelling of the testicle and scrotum;
hematoma of the scrotum;
suppuration of the wound;
eruption (divergence) of seams;
recurrence of a hernia (repeated exit).

All of them are associated, as a rule, with early physical activity, non-compliance with diet and personal hygiene rules, refusal to wear a bandage or its early termination. They can be prevented by strictly observing certain rules and recommendations of the doctor.

To avoid serious consequences after discharge, do not ignore the recommendations of your doctor

In the early postoperative period, while in the hospital, the man follows the established regimen and diet, and all this is controlled by medical personnel. The main problems begin after discharge: these are various temptations in nutrition, and the desire to complete some accumulated business, and the desire to see friends, and, to be honest, the desire for intimacy after abstinence.

It should be remembered that for a successful outcome of the operation, it is necessary to adhere to certain taboos - temporarily, for a period determined by the doctor. This period will depend on the nature and complexity of the operation, the age of the patient and the characteristics of his tissues - whether they are sufficiently elastic or loose, for example, as in elderly and obese patients.

Diet Features

After a laparoscopic intervention, eating is usually allowed after a few hours. In the hospital, they usually give light pureed food in the form of cereals, soups, soufflés, then the diet is gradually expanded.

Upon arrival home, the principles of nutrition should be such that, firstly, it does not cause bloating, secondly, it does not contribute to constipation, and thirdly, it is not too high in calories and excess so that extra pounds are not gained. All of the above leads to an increase in intra-abdominal pressure, stretching of the abdominal wall, and can lead to rupture of the sutures and recurrence of the hernia.

Prevention of complications

To prevent the development of undesirable effects after the operation, compliance with all the recommendations of the surgeon allows. In the first few hours, the patient must ensure maximum peace of the affected area. It is not worth rushing to be discharged from the hospital as soon as possible, the patient should avoid exceeding the recommended dose of physical activity.

An important condition for rehabilitation is diet.

Its task is to ensure comfortable digestion without causing diarrhea, constipation or gas formation. The diet provides for a five-time meal, the basis of which is protein. It is recommended to cook dishes from buckwheat, fat-free cottage cheese, chicken fillet.

Perform lungs physical exercise is allowed no earlier than 2 weeks after the operation, but heavy loads and weight lifting of more than 5 kg are prohibited for another 6 months.

In men, the hernia extends into the scrotum, and in women, into the subcutaneous space around the labia majora.

The most common inguinal hernia occurs in children. Boys suffer the most. Usually it sticks out on one side. It occurs 3 times more often on the right than on the left. After 10 years, the disease rarely develops. The main surgical complication of the "acute abdomen" is strangulated inguinal hernia.

About the structure of the inguinal canal

The internal cavity of the abdomen is lined with peritoneum - a thin connective tissue film. It "wraps" the walls, and almost all the organs in the abdomen.

In the appearance of a hernia huge role plays a specific anatomical formation - the inguinal canal, which receives the hernial contents. This is a small gap (about 4.5 cm) located in the groin between the muscles, connective tissue fascia and ligaments. Its beginning lies in the abdominal cavity, then it goes forward, down, inward. And the outer opening is located outside in the groin, surrounded by a strengthening group of muscles. In women, the round uterine ligament enters the region of this canal, in men, elements of the spermatic cord, including vessels, nervous tissue, and vas deferens.

The mechanism of development of congenital inguinal hernia

The testicles in male fetuses develop in the abdomen. Their usual location during the first three months of pregnancy is behind the peritoneum. Closer to the fifth month, the forming testicles begin to descend and approach the entrance to the inguinal canal, enter it and slowly move along it until the seventh month, forming behind them the so-called "vaginal process". With normal development at the ninth month, the boy's testicles fully enter the scrotum along with a stretched peritoneal "pocket" that maintains communication with the abdominal cavity.

At the birth of a child, it "closes", then overgrows. But sometimes there is a failure, and the passage from the abdomen to the scrotum remains open. This anatomical defect is the first "bell" signaling the possibility of developing an inguinal hernia. With an increase in intra-abdominal pressure, intestinal loops and even some organs can “fall through” into this process.

The formation of an inguinal hernia in girls is similar to the process of hernia formation in boys described above. In developing female embryos, the uterus is located above the usual place. In the process of development, it descends to its “own” place along with the fold of the peritoneum, forming the same “vaginal process”, the non-overgrowth of which subsequently provokes a hernia.

Congenital inguinal hernia is a malformation of a developing fetus. It is formed from birth.

How does an acquired inguinal hernia occur?

Acquired inguinal hernias appear due to heavy loads and in connection with the pathology of the abdominal press, its weakening.

Factors contributing to the occurrence and development of hernias include:

premature pregnancy, as a result of which the vaginal process with the rest of the organs has not yet completed its development cycle and remains "open";
heredity, the presence of a hernia in family members and close relatives;
the presence of anatomical weakness of the muscles of the abdominal wall;
excess weight, causing increased stress on the abdominal organs;
injuries in the groin area, which provoked a weakening of the ligamentous apparatus;
severe weight loss. The absence of fatty layers in the canal leads to the formation of empty volumes into which the outer layer of the peritoneum can be pressed;
pregnancy, which often results in increased intra-abdominal and mechanical pressure on organs, intestines, which contributes to the formation of a hernia;
hypodynamia, in which flabby and atrophied muscles are unable to perform their functions, as a result of which the peritoneum, without encountering muscle resistance, can “push through” into the canal;
physical overload, creating a constant high pressure in the abdominal cavity;
chronic, severe cough, providing an additional load on the "weak" places of the peritoneum;
bowel diseases, accompanied by constant constipation, which also cause an increase in pressure.

Varieties of inguinal hernias

The disease is classified according to the location of the hernial sac.

inguinal - a hernia enters the inguinal canal, but does not go beyond the level of the external opening;
cord - hernial contents descend into the scrotum, reaching the spermatic cord;
inguinal-scrotal - hernial contents reach the level of the testicle (only in men);
oblique - in this form, the contents of the hernial sac passes through the entire inguinal canal. In men, the spermatic cord enters its composition along with the vas deferens and vessels. Can be congenital and acquired;
direct - passes into the inguinal canal, without affecting the internal opening, through the abdominal wall, directly from the inguinal fossa closer to the midline. It occurs in men and women, usually as a result of overexertion;
combined - rare. Consists of 2 or more hernial sacs on one side. Each hernia has its own hernial orifice. Most often there is a simultaneous oblique and direct protrusion;
interstitial direct hernia - the second version of the name is subcutaneous. The hernial protrusion is located in the structure of the external oblique muscle. In this case, the hernia does not descend into the scrotum, but enters the subcutaneous tissue of the aponeurosis of the external oblique muscle. The hernial sac is determined on the thigh, in the perineum;
sliding - the most dangerous type. It is characterized by an additional protrusion of the internal peritoneum. It is formed both from the parietal peritoneum and from the visceral tissues covering the sliding organ. Not only the small intestine, but also the caecum, bladder walls, uterus, tubes, ovaries, and other organs can enter the hernial sac

Symptoms of an inguinal hernia, how it looks externally

The main features include:

The appearance of a protrusion in the groin area, which increases with coughing, sneezing, any physical exertion, as well as when in an upright position.
The existing swelling in most cases, when pressed with fingers, returns to the peritoneal cavity. At the same time, a characteristic rumbling is heard.
There is usually no pain. Sometimes it can appear in the groin and radiate (give) to the lumbar region.
When the fallopian tubes or ovary fall out, pain develops during menstruation.
With a sliding form of inguinal hernia that captures the bladder, symptoms of dysuric disorders (pain in the lower abdomen, frequent and (or) painful urination).
When it enters the hernial sac of the caecum - flatulence, cramps, constipation
When forming the inguinal-scrotal form of a hernia - an increase in the scrotum from the side of education.

In the supine position, the hernia seems to hide and outwardly becomes invisible.

What is infringement of an inguinal hernia

This is one of the unpleasant and frequent complications of the disease. The part of the intestine that has fallen into the hernial sac (or the fallopian tube and ovary - in girls and women, the spermatic cord - in boys and men), is pinched in the inguinal canal, there is a violation of trophism and blood circulation, which can subsequently provoke necrosis (death) of tissues.

The causes of this situation can be problems in the work of the intestines, flatulence, a sharp overstrain with an increase in pressure in the intraperitoneal space.

The patient complains about:

intense pain in the groin;
tension and density of the hernia;
the impossibility of repositioning the protrusion;
symptoms of intoxication: pallor, nausea, retching, stool retention.

In this case, after examining a doctor, immediate hospitalization and surgical intervention are required.

Diagnosis and examination of inguinal hernia

Any suspicion of a hernia that has appeared is a reason to contact a surgeon.

The doctor in the patient's standing position examines the hernial protrusion, feels it (palpation), makes a straining test, then a cough test. Evaluates the symptom of a jolt. Finger examination finds the outer opening of the canal. Sometimes this hole can be identified without a hernial sac, in surgery this symptom is called "weak groin".

Additionally, an ultrasound of the scrotum, canals, abdominal cavity and pelvic organs is performed, in which the hernial sac with all anatomical formations and hernial contents is determined, the size, position and condition of the inguinal canal are assessed.

Highly important information can be obtained by x-ray examination with the introduction of a contrast agent. Also, to clarify the location in the intestinal hernia, irrigoscopy (examination of the large intestine) and cystoscopy (X-ray imaging of the bladder) are performed.

Treatment of inguinal hernia

Self-healing of an inguinal hernia without surgery does not happen. The surgical method is the only way to get rid of this pathology.

Surgical treatment is not carried out:

debilitated patients in old age;
with severe types of exhaustion (cachexia);
in case of severe illness;
during pregnancy;
to prevent the return of a hernia after removal.

Treatment and prevention of inguinal hernia by wearing a bandage

In case of existing contraindications, wearing a bandage is applied to the operation. Also, this type of treatment is indicated with preventive purpose people who, by the nature of their activities, are faced with physical overload.

A bandage for an inguinal hernia and its size is selected by the doctor individually for each patient. These devices can be double-sided or left-right.

Note: the use of a bandage does not cure an inguinal hernia, but serves as a means of preventing prolapse of the intestines and organs into the hernial sac and prevents infringement.

After selecting a bandage, you should follow the rules for wearing it:

wear it only in the supine position;
keep an eye on the inserts. They must correspond to the place of the hernial protrusion.

Important: the use of a bandage is contraindicated in case of infringement of a hernia and in diseases of the skin in contact with it.

Surgical treatment of inguinal hernia

As mentioned above, there are no alternatives to surgical treatment of inguinal hernias. If there is an infringement, the operation is done on an emergency basis. In other cases, a planned surgical intervention is indicated after the preparation of the patient.

The preparation process includes examination of the patient, the appointment of a clinical analysis of blood and urine. Before the operation, the patient is not allowed to eat or drink. It is also necessary to treat existing chronic diseases in order to minimize the risk of complications (for example, prostatitis, adenoma).

To the question that worries many patients: “Is it worth doing an operation for an inguinal hernia?” answers d.m.s. Short I.V.:

Methods of surgical operations:

laparoscopy - suturing a hernia with an endoscope through a puncture of the abdominal wall using a mini-camera, micro-endoscopic instruments and with the installation of a mesh;
operative hernia repair. Apply various techniques surgical treatment of inguinal hernia (Bassini, Matrynova, Ruggi, etc.)

General steps of an inguinal hernia surgery:

isolation of the hernial sac and its separation from the tissues;
incision of the bag with the reduction of the contents;
cutting off the bag and plastic restoration of the integrity of the wall,
suturing gate and surgical wound.

Surgical treatment of inguinal hernia in children

In children, the removal of an inguinal hernia is carried out under general anesthesia (narcosis). The most commonly used operative access is about 1.5 cm long. The hernial sac is separated from the spermatic cord, then stitched and excised. At the same time, the bag is inspected for the presence of abdominal contents in it. The outer opening of the canal in a child is not strengthened.

A pediatric surgeon tells about the causes of the formation of inguinal hernias in children, the symptoms of hernia incarceration in children and treatment methods:

Emergency surgery to remove a strangulated hernia

The danger of this complication is that necrosis (necrosis) may occur in the strangulated intestine or other organ, due to impaired blood circulation in the tissues. This leads to a life-threatening condition, and sometimes to the death of the patient.

When treating an inguinal hernia complicated by strangulation, the surgeon has to carefully examine the strangulated organ after dissection of the hernial sac. If there are signs of necrosis, the affected area is removed, the ring in which the infringement was, is dissected. The operation then proceeds as planned. After such an operation, the patient must be prescribed antibiotics for several days.

What is a recurrent inguinal hernia

In some patients, inguinal hernias reappear. Relapses occur in 5-10% of cases.

The causes of a new hernia can be:

operation errors and incorrectly selected type of plastic surgery;
non-compliance with recommendations in the postoperative period: intense physical overload, weight lifting, etc.;
coughing;
diseases accompanied by constipation;
suppurative processes in the area of the postoperative suture;

In men, a recurrence of an inguinal hernia occurs due to untreated adenoma before a planned operation.

Preventive measures to prevent the development and progression of inguinal hernias

To prevent the possibility of the appearance and development of acquired inguinal hernias, you need:

lead an active lifestyle with normal physical activity;
eat foods with a sufficient content of vegetable fiber;
during hard work and activities associated with lifting weights, wear a bandage;
treat chronic diseases accompanied by a severe cough;
monitor your weight, prevent alimentary obesity;

The appearance of inguinal hernia in pregnant women is prevented by wearing a bandage.

Stepanenko Vladimir Alexandrovich, surgeon

Clinical manifestations of inguinal hernia in men

According to the location of the hernial sac, there are:

proper inguinal - the sac is located in the inguinal canal,
cord - the sac is located in the scrotum above the testicle,
testicular - the sac is located around the testicle.

According to the anatomical structure, inguinal hernias are divided into:

a straight line that passes through the abdominal wall past the inguinal canal,
oblique, passing through the inguinal canal along with the spermatic cord and testicular vessels,
combined - a hernia consists of various hernial sacs.

By origin, protrusions are divided into acquired and congenital. The former are found in adult men, and the latter in boys.

Hernias are infringed and uninjured. Injured represents acute condition, which threatens human life and requires urgent medical attention.

Causes

The reasons for the formation of inguinal hernias in men are the following:

weakness of the walls of the inguinal canal, inguinal ring and connective tissue;
weight lifting;
intense physical activity;
injuries and damage to the abdominal muscles;
disease of the prostate gland and other organs of the urinary system;
weak abdominal muscles;
disorders of the digestive tract, manifested by indomitable vomiting or persistent constipation;
pathology of the respiratory system, accompanied by a cough.

Symptoms

Symptoms in men differ at different stages of the disease.

At the beginning of the pathology, a hernia is a small protrusion in the groin. It disappears in the supine position and is clearly visible when a person is standing or exercising.
The hernia is reduced by normal pressing, while a characteristic rumbling is heard. After reduction through the skin, you can feel the expanded inguinal ring.
A densely elastic formation of a rounded or elongated shape is visually determined.
Pain in the groin is usually aching and pulling. Its intensity and duration depends on the complexity of the hernia.
In the groin area, there is often a burning sensation, which intensifies after physical exertion.
The patient experiences discomfort while walking and a feeling of fullness in the lower abdomen.
If the hernia reaches a large size, then there is pain in the lower abdomen and lower back.
The symptom of "cough push" is characteristic when straining and coughing.
In the absence of timely treatment, side effects may develop - fever, heart palpitations, nausea.
In the later stages, complications such as frequent urination and disruption of the intestines join.

Inguinal hernia in boys is a congenital pathology that develops in the womb during the period when the testicles move from the abdominal cavity to the scrotum. Symptoms are very characteristic and allow parents to suspect a pathology in a child. These include:

the presence of a protrusion in the groin,
a decrease in the size of the formation in the supine position, an increase in size with an increase in intra-abdominal pressure,
rumbling during reduction of a hernia,
absence of pain and discomfort.

Diagnostics

The main diagnostic method for detecting inguinal hernia is ultrasound. With the help of ultrasound, the contours of the inguinal opening and the hernial sac itself are determined. This method allows you to identify infringement or other complication of the pathology. For additional information, radiography is used. The form of a hernia and its zonal placement in the groin are clearly visible on x-rays.

Among the laboratory methods of research are obligatory general analysis blood, stool and urine tests. Particular attention should be paid to the leukocyte formula and the erythrocyte sedimentation rate.

Infringement is one of the most common complications of inguinal hernia, in which intestinal loops or omentum are pinched in the inguinal ring, blood circulation is disturbed in them and necrosis develops. Infringement of a hernia occurs as a result of intense physical exertion, severe coughing, sneezing, vomiting.

Symptoms of infringement in men:

sharp pain in the lower abdomen, aggravated by pressing on the protrusion,
general weakness and lethargy,
inability to self-repair a hernia,
blood in stool
nausea and vomiting without relief.

The symptoms of a pinched inguinal hernia in children are different from those in adults. This is due to a more intense blood flow in the children's intestines and a relatively weak compression of the organs trapped in the inguinal ring. Despite this, the reaction of children to the infringement of a hernia can be very violent - with a rise in body temperature, nausea, vomiting and impaired consciousness.

Incarcerated inguinal hernia is a dangerous condition that requires urgent surgical intervention! The operation is performed in the classical way with an incision in the affected area or laparoscopically using abdominal punctures. If the operation is not carried out in a timely manner, then severe complications may develop - necrosis of the strangulated organ or inflammation of the abdominal cavity.

Self-reduction of a strangulated hernia can be fatal.

Relapses

Recurrence of an inguinal hernia is its re-formation at the site of removal. Relapse is a postoperative complication that occurs when the recovery period is not managed correctly, weight lifting, increased motor activity, early exit to work. Sometimes a doctor prescribes a bandage to prevent recurrence.

The main symptoms of relapse: pain, dysfunction of the intestines and urinary organs.

Causes and methods of treatment of recurrent inguinal hernia

An inguinal hernia may reappear repeatedly, after 2-3 operations. A repeatedly recurring defect is one of the most complex forms of the disease, and not every experienced surgeon can cope with it.

Why does a hernia recur?

The causes of the recurrence of an inguinal hernia after surgery are divided into 3 groups:

Adverse factors before surgery.
Doctor's mistake during the operation.
Postoperative complications.

Surgeon V.D. Fedorov, in his works, expresses the opinion that all the factors for the appearance of a hernia that exist before surgery persist after surgical treatment and can provoke a relapse at any time. And the most significant of all causes, the doctor highlights the congenital weakness of the connective tissue.

Risk factors before surgery

Self-treatment at home, refusal of examination and herniotomy end in a serious condition, when the operation is already performed urgently. Under such conditions, there is a higher risk of making a mistake, which will lead to postoperative complications and re-illness.

During the operation

The second group of causes of hernia recurrence is associated with the following factors:

wrong choice of technique - strengthening only the anterior abdominal wall with recurrent and direct hernia can lead to re-disease due to the high inguinal gap and deep canal, and in order to avoid such a problem, it is necessary to conduct a series of studies, take into account the pathogenetic features of the disease;
surgeon's mistakes during the operation - suturing with high tissue tension, damage to nerves and blood vessels, insufficient release of hernial contents, and many other actions can provoke a relapse.

The condition for a successful operation will always be high-quality preparation and sanitation. Children and adult patients with an indication for surgical treatment are advised to be examined by several doctors, listen to the opinion of each and trust the opinion of the majority of specialists. The doctor must be aware of past diseases and operations. Some surgical techniques are contraindicated in previous surgical treatment of the gastrointestinal tract and small pelvis.

After operation

Already after the operation, complications can provoke the disease, especially purulent inflammation, bleeding and damage to internal organs.

What complications appear in the early and late period after hernia repair:

infection of the wound - suppuration occurs when an infection enters during the operation or after it if the rules for caring for the postoperative scar are not followed;
hematoma - appears as a result of rupture of blood vessels;
damage to the spermatic cord - occurs during the selection of the hernial sac, the error is typical for an inexperienced surgeon, this complication often occurs already during the removal of a repeated defect and threatens with infertility;
thrombosis of the veins of the lower leg - occurs in older people and young patients who lead an inactive lifestyle, anticoagulants are used for treatment;
dropsy - the most common complication, treated only by a second operation;
damage to the intestine - occurs when careless processing of the hernial sac, the surgeon can also touch the bladder;
violation of the femoral joint - occurs when the suturing is incorrect, in the case of using a rough material, which can lead to bleeding.

Types of relapses

Repeated inguinal hernia is of the following types:

oblique - surrounded by the spermatic cord, completely repeats the course of the inguinal canal;
direct - medial or suprapubic in the lateral part of the inguinal canal;
lateral - located near the inguinal ring outside the spermatic cord;
suprapubic - happens with insufficient strengthening of the inguinal canal;
intermediate - shaped like a mushroom, located in the inguinal triangle;
complete - with complete destruction of the inguinal wall, the canal gap is filled with a large hernia.

Inguinal hernia is more often removed by the Lichtenstein method, and the typical forms of recurrence after this operation are lateral and medial recurrences.

Surgery for repeated inguinal hernia

The method of treatment will depend on the degree of complexity:

First degree - hernia volume up to 100 cm³, Kukudzhanov, Shouldice method.
Second degree - hernia volume up to 300 cm³, Lichtenstein method.
Third degree - hernia volume up to 400 cm³, Rivera method.
Fourth degree - hernia volume from 400 cm³, TEP method, TABP.

Features of different types of operations for recurrent hernia in the groin:

Lichtenstein method - with a large size of the hernial sac and repeated recurrence, it is performed with suturing of a mesh implant, the hospitalization period is up to 3 days;
complete reconstructive hernioplasty - in case of recurrence after plastic surgery with preservation of the structure, during the operation the implant is fixed with sutures to prevent displacement, the hospitalization period is up to 3 days;
partial hernioplasty - with previously performed plastic surgery of the posterior wall of the inguinal canal, in the case of a small size of the hernia ring, this is the least traumatic method, the patient is discharged from the hospital immediately after the operation;
laparoscopic method - with bilateral hernia, involves the introduction of an implant through the abdominal cavity to the hernial orifice from the inside, this is a complex version of the operation, it can only be performed under general anesthesia, therefore, open technique is prescribed less frequently.

Postoperative rehabilitation

If there are any problems immediately after the operation, the doctor finds out whether this may be due to surgery or anesthesia. After identifying the cause, the specialist will prescribe additional treatment that will need to be done at home. If a repeated hernia appeared immediately, a second examination is carried out and a second operation is prescribed.

General rules in the early period of rehabilitation after hernia repair:

daily dressing change and wound treatment with an antiseptic;
diet, exclusion of any physical work;
wearing a bandage for several hours while doing daily activities;
a visit to the doctor in a week for examination and in case of complications.

After the operation, symptoms of complications may appear, with which you need to go to the doctor:

swelling in the groin area does not go away for several days;
severe pain and suppuration of the postoperative wound;
swelling of tissues in the groin with general malaise and fever;
burning, numbness or increased sensitivity of the skin at the site of surgery.

Diet

Diet is the most important part of postoperative recovery. The diet is prescribed to prevent constipation and bloating, because these disorders lead to an increase in intra-abdominal pressure, and this is a factor in the development of re-hernia.

How to eat the first 2 weeks after hernia repair:

you need to eat in small portions, chewing everything thoroughly;
food should be at a comfortable temperature and not spicy;
it is important to increase the protein content in the diet;
you need to drink a lot of clean water, but not with meals, but 30 minutes before or after;
the diet may include boiled white meat, cottage cheese, cereals, fish;
fixing and gas-forming products are excluded.

Bandage

The belt after the operation must be with soft inserts, let air through and absorb moisture. Before putting on the belt, it must be treated with an antiseptic. It is recommended to wear a postoperative bandage no more than 5 hours a day, it must be removed at night.

Inguinal hernia in men: consequences after surgery

After surgery to remove an inguinal hernia, some complications sometimes occur. There are many reasons for their occurrence - from the mistake of the surgeon who performed this operation, to the physiological characteristics of the patient's body. And, despite the fact that the operation to remove the hernia is nothing complicated, the consequences of this procedure can be the most serious.

Occasionally, patients initially present with ilioceliac nerve injury. This can happen if the man has already undergone surgery before. So if we are talking about the re-formation of a hernia, then the doctor must know about all the diseases from which the patient suffered before. After all, broken nerves lead not only to a strong pain syndrome, but also to atrophy of muscle tissues.

The structure of the inguinal hernia

Inguinal hernia in men consequences after surgery

There are several possible postoperative complications, let's get acquainted with them in more detail.

Table. Possible consequences after operation

Damage to the spermatic cord

Infection in the wound

Thrombosis in the legs

Bulging hernia in the groin

As noted earlier, complications can occur through the fault of not only the surgeon, but also the patient himself. That is why it is so important to follow all the recommendations of the doctor, as well as strictly observe the rehabilitation period. Let's take a look at this period.

Video - Important points of the postoperative period

How long does rehabilitation take?

Surgery to treat an inguinal hernia in men

The duration of the rehabilitation period largely depends on the anesthesia used by the surgeon. So, if the anesthesia is local, then rehabilitation will take a little time: after a couple of hours the patient is released from the hospital, but on condition that there are no complications. Although the patient must still return there regularly for dressings, during which the progress of recovery will be monitored. The first dressing should be carried out in the evening (as a rule, such operations are done in the morning), and you should not worry if discharge appears at the same time - there is nothing to worry about. But in the case of general anesthesia, the initial stage of rehabilitation can take one to two days.

This is followed by an outpatient rehabilitation period, which can be one or two weeks. For this period, rest, proper nutrition, and also the fact that the patient spends a lot of time in bed are important. In addition, he should regularly visit a doctor who can identify complications and, if necessary, make adjustments to treatment.

One week after surgery

Note! During the period of postoperative rehabilitation, any physical activity should be excluded. After some time, the patient is prescribed special exercises that reduce the risk of hernia recurrence and the development of complications.

The attending physician may prescribe the wearing of a special bandage, although today such devices are used less and less, because modern surgical methods provide reliable fixation of the hernia site through mesh implants. Therefore, such a bandage will only be beneficial at first, until the pain disappears and physical activity is restored.

Bandage for inguinal hernia

Nutrition in the postoperative period

Thanks to a properly composed diet, possible complications can be avoided, and the rehabilitation itself will be faster. The patient is advised to eat only liquid food, and he should eat slowly, in small portions (at least four times a day). The main condition is that the food should be rich in protein, because it is the main "building material" human body allowing you to recover as quickly as possible.

A lot of protein is found in the following foods:

Note! You should also exclude from the diet some foods that disrupt the normal functioning of the digestive tract and provoke gas formation.

It is necessary to give up a number of products for a while

So, the patient should give up sweets, yoghurts, dairy products and fruits. A specific menu should be prescribed by a doctor. Finally, for the duration of rehabilitation, you need to give up cigarettes, alcohol and coffee, sour fruits, and soda.

About physical activity

Two weeks after the surgical procedure, you can start gently and gradually return to your previous activity, although heavy weights should not be lifted for about another six months. If you violate these recommendations, then the hernia may return, but doctors also do not advise spending all the time in bed. When the pains disappear and the man feels that his strength is returning to him, you can start walking a little and doing simple physical exercises.

Rehabilitation after hernia removal

Light gymnastics combined with special stimulating exercises will allow the body to quickly return to its previous shape. There are quite a few such exercises, the most popular of them are listed below.

The patient gets on all fours, bends all the limbs, leaning on the elbows and knees. Then he alternately raises his left, then his right leg.

Fours exercise

The patient lies down on a previously laid mat, hands are placed along the body. Then he raises his straightened legs (about 45 degrees) and alternately crosses them (exercise "Scissors"). The number of repetitions increases over time.

By the way, the “Bicycle” is also performed in the same position: the man raises his bent legs and imitates the rotation of the pedals.

The patient lies on his side, his hand stretches forward and puts his head on it. The legs must be straight. You need to try to lift one of them, after several repetitions the side changes.

Side lying exercise

The patient puts his feet shoulder-width apart and performs squats (may be incomplete), after which he does two or three push-ups. If traditional push-ups are too difficult, then you can lean on your knees.

Push-ups from the knees

Note! All these exercises must be performed regularly, but you also need to monitor your well-being. A man should not feel any pain or discomfort.

The number of repetitions should increase daily, in the future, other exercises can be included in the complex.

Video - Hernia in the groin

As a result, we note that postoperative complications after hernia removal can be the most serious, but if the operation is performed by an experienced qualified surgeon, they may not appear. Of course, even professionals sometimes make mistakes, but the probability is still reduced. At the same time, it is necessary to follow all the doctor's recommendations regarding the rehabilitation period, since some of the complications (for example, recurrence of a hernia) arise precisely because of this.

Inguinal hernia in men

Already the first symptoms of an inguinal hernia in men indicate that the disease must be urgently treated with conservative therapy or surgery, otherwise it can lead to serious consequences. The disease is an exit into the slit-like interval of various organs of the abdominal cavity due to the delamination of the muscles in the groin area. A hernia can be acquired or congenital. In the inguinal zone, it is one of the most common.

What is an inguinal hernia in men

With this disease, the walls of the abdominal cavity weaken, because of which they can no longer hold the internal organs in place. One of the weak points in this area is the inguinal canal. It is a gap through which the spermatic cord passes. It lasts from the deep inguinal ring to the superficial one, from where, under certain conditions, the abdominal organs protrude.

What does it look like

The first sign of this pathology is the appearance of a swelling in the inguinal region, which changes in size. In the supine position, it may disappear. When the position is changed, the swelling reappears. The same happens when coughing, going to the toilet and during physical exertion. The size of the protrusion can be either very small, about the size of a walnut, as shown in the photo, or reach larger dimensions.

Symptoms

In addition to a protrusion in the lower abdomen, in the pubic area, a hernia in the groin can also manifest itself in a number of other signs. The patient is concerned about minor pains that pass quickly, so the person simply does not pay attention to them. Inguinal hernial protrusion is accompanied by other symptoms:

flatulence;
belching;
constipation;
frequent urination;
burning in the groin area;
swelling and pain in the scrotum;
heaviness and pressure in the groin.

In the early stages, the pathology does not cause pain. For this reason, many patients go to the doctor already at an advanced stage. The presence or absence of pain is determined by the complexity of the developed pathology. Some patients complain of a burning sensation that worsens after exercise. Others experience tingling and dull pain. With a significant increase in protrusion can increase

First signs

A slight swelling in the groin area is the first sign. Over time, it gradually increases. Against this background, the following symptoms may occur:

change in size and shape of swelling during physical exertion;
burning in the groin area;
It's a dull pain;
discomfort when walking;
feeling of fullness in the lower abdomen.

Causes

A hernia in men can be congenital or acquired. In the first case, the pathology is formed even inside the womb. Acquired develop as a result of weakening of the muscles of the peritoneum. The causes of this pathology are:

connective tissue changes with age;
consequences of surgical interventions on the abdominal cavity;
muscle weakness as a result of systemic diseases;
a condition of long-term increased intra-abdominal pressure during work associated with weight lifting, obesity, constipation or prolonged coughing;
sedentary lifestyle.

Forms of the disease

Depending on the location of the hernia in the groin in men, it can be right- or left-sided or bilateral. They are also reducible and irreducible. In the first case, the protrusion may disappear due to slipping back into the abdominal cavity. When the hernial sac is already soldered to the contents, it becomes irreducible. Taking into account the features anatomical structure pathology can be:

oblique. It happens acquired or congenital inguinal hernia. Its contents are located along the inguinal canal inside the spermatic cord. Canal, cord and inguinal-scrotal hernia in men are varieties of oblique inguinal.
Straight. Such a hernia can only be acquired. The protrusion of the peritoneum in this case is outside the spermatic cord and passes through the inguinal gap.
Direct interstitial, or subcutaneous. Here, the hernial sac does not descend into the cavity of the scrotum, but is located in the subcutaneous tissue of the aponeurosis of the external oblique muscle.
Combined. That type of hernia is very complex in terms of anatomy. It consists of several hernial sacs.

What is dangerous inguinal hernia in men

The most dangerous thing happens when a hernia in the groin in men is pinched. Then the contents of the hernial sac are compressed. This condition is dangerous, because the infringement reduces the flow of blood to the intestines or the movement of the contents through it stops. There is no longer any talk of repositioning a hernia here. Due to circulatory disorders, it externally becomes red-violet or blue-purple. This is a reason for immediate surgical intervention. Pinched hernia threatens men dangerous complications, such as:

complete cessation of blood flow in the restrained loops, their necrosis;
intestinal obstruction;
self-poisoning of the body;
peritonitis.

Inguinal hernia in men: clinic, diagnosis, consequences of surgery

Inguinal hernia is a pathological protrusion of the peritoneum into the region of the inguinal canal. It ranks first among all hernias of the abdominal cavity. The disease is more typical for men than for women (5:1). Completely eliminated only by surgery.

What happens to organs with a hernia

Organs from the small pelvis "fall through" into the inguinal canal. The inguinal canal is a triangular-shaped cavity through which the spermatic cord normally passes in men, and the round ligament of the uterus in women. Unpleasant sensations appear when an organ is infringed in this cavity.

In the inguinal canal can penetrate:

With muscle spasm and sudden compression of the hernial sac, blood flow is disturbed, tissue innervation suffers (conduction of impulses from the brain to tissues and organs). This causes symptoms of the disease:

Symptoms

pain in the area of hernial protrusion;
swelling of soft tissues;
discomfort during movement;
with infringement of the intestinal loop - constipation;
when the bladder enters the hernial orifice - no urination, pain over the pubis.

Hernias are divided into congenital and acquired. The latter occur against the background of a muscular defect in the anterior abdominal wall.

Causes of acquired hernias:

sudden weight loss;
operations on the abdomen (removal of the gallbladder, appendicitis, uterus, resection of the stomach or intestinal loop, caesarean section);
age-related changes in the connective;
sports household injuries;
severe diseases of the internal organs.

What happens if you refuse the operation?

Infringement of the hernial sac may occur.

intense physical activity or any tension in the abdominal muscles;
coughing;
sneezing,
vomit.

Violation of the potency of the disease.

This is due to malnutrition of the spermatic cord and testis. If timely surgical treatment is carried out, then a complete restoration of erectile function is possible.

Clamping of the femoral-genital nerve during incarceration of the hernia causes intense aching pain in the groin. Unpleasant sensations are aggravated when walking, as well as during the act of defecation. If you experience these symptoms, contact your surgeon.

Pain in lumbar, in the presence of a hernial protrusion, is associated with an inguinal hernia.

Postoperative consequences

Surgery for an inguinal hernia usually takes place under local anesthesia. It is considered easy, because. does not require large incisions and is often performed as a laparotomy (using "pricks").

Each operation can lead to complications. To avoid them, you need to carefully follow the doctor's recommendations in the postoperative period:

take prescribed medications;
observe bed rest;
gently start physical activity;
Healthy food.

Consequences caused by impaired healing.

Hematoma. After plastic surgery of an inguinal hernia in men, a hematoma of the penis and testicles may be found. It occurs due to incomplete or improper healing of the operated vessels. If the formation does not grow in size, then after a while the hematoma will resolve.

Otherwise, see a doctor! You will need another operation to stop the bleeding. It will be either a puncture (a simple injection) to remove encysted blood, or a full-fledged operation if you need to stop bleeding from a large vessel.

Hernia recurrence - repeated protrusion of the peritoneum. Such a consequence of an inguinal hernia operation in men is possible with improper rehabilitation. And also in case of violations during the operational process.

Consequences that affect the performance of other organs.

Injury to the bowel loop occurs when the intestinal wall is not properly repositioned.

Such a complication is characteristic of emergency hospitalization with a strangulated hernia. The surgeon may incorrectly assess the viability of the intestine, and then set the necrotic organ into the abdominal cavity. As a result, peritonitis develops.

Damage to the femoral joint is caused by a violation of the integrity of large vessels during hernia repair (femoral artery and vein, great saphenous vein of the thigh). The risk is reduced with a healthy lifestyle.

Deep vein thrombosis of the lower extremities occurs if supportive therapy was not performed correctly in the postoperative period, or the patient did not wear compression stockings. Thrombosis affects elderly patients. In the treatment of the disease, anticoagulants are used:

Postoperative violations of potency.

Testicular edema (dropsy) is an accumulation of serous fluid in the scrotum. This complication is not treated conservatively, so surgery is required.

Infection of the postoperative wound is a severe consequence of the removal of an inguinal hernia, rare in men with proper care. Symptoms: redness, severe swelling of the seam, fever. With such manifestations, combined antibiotic therapy is prescribed.

Change in the sensitivity of the penis (increase or decrease) - happens due to nerve damage during the operation. There is numbness of the skin of the scrotum, the anterior surface of the thigh. After a few months, as the nerve tissue recovers, the complication resolves on its own.

Complications that violate the ability to fertilize.

Damage to the spermatic cord (or its vessels, nerves) is possible if there is a medical error. Due to damage to the cord itself, spermatogenesis is disrupted, which leads to infertility. If the surgeon is experienced enough, the likelihood of such complications is minimal (try to choose a doctor of the highest or first qualification category).

Damage to the vascular system causes testicular atrophy. It decreases in size and then loses its function.

So that with an inguinal hernia in men, such consequences after the operation do not become a reality, you need to choose a highly qualified doctor.

Help in choosing a doctor

Carefully read the reviews about the selected clinic on the Internet.
Meet with the surgeon in person before the operation.
Pay attention to how carefully the doctor questions and examines you.
Pays due attention to preoperative preparation.
Is the doctor ready to advise you after the operation.
As far as he himself is confident in a positive result.

The sperm freezing service before the operation is a 100% way to leave behind offspring, even if difficulties arise during the hernia repair.

When is intimacy possible after hernia repair?

If the rehabilitation proceeds without complications, and you strictly follow all the recommendations of the surgeon, intimacy is possible in 2-3 weeks. Sexual contact should be as gentle as possible, pressure on the wound should not be allowed.

discrepancy, suppuration of the seam;
displacement of the mesh covering the hernial orifice;
increased pain, swelling;
hematoma formation.

Rehabilitation after excision of a hernia

The duration of the recovery period depends on anesthesia.

If local anesthesia was chosen, the person is already after 3-4 hours may go home.
If the operation was performed under general anesthesia, the patient gains strength only after 1-2 days. In that case, the man discharged on the third day.

Bandage.

Antibiotics

In the first 5 days after surgery, the doctor prescribes oral antibiotics to rule out infections.

Anticoagulants are also prescribed to prevent thrombosis (Heparin).

Seam processing

To process the seam, antiseptic solutions are used (brilliant green, furacillin). If inflammation appears, the doctor will prescribe an antibiotic ointment (Levomekol, Gentamicin, Baneocin).

To avoid complications, weight lifting (from 2 kg) is excluded for the first three weeks. You should also avoid sudden movements, turns, tilts.

Physiotherapy

Note! Before starting exercise, check with your doctor.

After hernia repair, you can do light gymnastics. This will tone the lower abdominal press, avoiding the recurrence of the disease.

Exercises are carried out daily. Initially for 3-5 minutes, but gradually increase the time to half an hour. Training scheme:

Lying leg raise. Perform 5-7 times, then a break.
"Scissors" lying down for 30 seconds. Rest 2-3 minutes.
Lying on your back for 1 minute "turn the bike." Break 3 minutes, then 3 more sets.
Incomplete squats 10 times, then a break.

Gradually, you can increase the number of approaches and reduce the rest between them.

Diet after hernia repair

The right diet will speed up recovery. For the first few days, it is better to eat only liquid and pureed food in small portions. On day 4-5, you can switch to a normal diet.

Eat as many foods rich in protein and fiber as possible. The diet should include:

lean boiled meat (chicken, beef);
seasonal vegetables (raw or steamed);
dairy products, especially cottage cheese;
fruits and berries;
various cereals (buckwheat, millet, oatmeal, barley);
Fish and seafood;
nuts and dried fruits.

It is better to exclude alcohol and coffee, as well as smoking, from the diet.

Prognosis of the disease and prevention of relapses

The prognosis after the operation is favorable. Inguinal hernia in men is a serious disease, the symptoms and consequences of which often disrupt the normal rhythm of life.

But after surgical treatment, the person completely gets rid of the problem. To improve the quality of life after surgical treatment, strictly follow the recommendations of the doctor.

It is important to drink completely all prescribed drugs, follow a diet. When the state of health improves - go to physiotherapy exercises. This regimen will avoid recurrence of a hernia, perfectly strengthens the body and improves well-being.

An inguinal hernia is a pathological formation that is more common in men. The disease is dangerous, can cause serious complications. Therefore, the treatment of a hernia should not be postponed. You can get rid of it with the help of an operation that is performed under general or local anesthesia. After the operation, it is important to strictly observe all the rules of the rehabilitation period.

Re-exit of the abdominal organs through the inguinal canal after a previously performed hernioplasty. It is manifested by the presence of a protrusion in the area of the post-hernioplasty scar, pulling pains in the groin, discomfort when walking, dyspeptic and dysuric disorders. It is diagnosed with the help of a physical examination, herniography, sonography of the inguinal canal, MRI of the groin area. Tension-free methods of open and endosurgical hernioplasty are recommended for treatment. In rare cases of an unfavorable course of the disease in elderly patients, the inguinal canal is eliminated.

ICD-10

K40 Inguinal hernia

General information

Recurrent hernia formation is one of the most frequent complications of inguinal hernioplasty operations. When using tension methods of hernia repair, recurrence of the disease occurs in 15-30% of patients, the transition to prosthetic techniques has reduced this figure to 1-5%. Men are more susceptible to the disease, which is associated with a greater prevalence of primary groin hernias in males and the anatomical features of the structure of their inguinal canal. A loop of the small intestine, the greater omentum, less often the bladder, blind, sigmoid, descending colon, ureter, kidney, in women, the ovary, uterus usually enter the cavity of the hernial sac of recurrent protrusion. The relevance of timely diagnosis of the disease is due to the risk of infringement.

Causes of recurrent inguinal hernia

The re-formation of a hernial protrusion in the groin is facilitated by the technical nuances of the previous hernioplasty, the course of the postoperative period, and the individual characteristics of the patient. Specialists in the field of herniology, general surgery, gastroenterology associate the formation of recurrent hernia with the presence of such etiological factors as:

medical errors. Recurrent hernia formation is most often caused by the wrong choice of the hernia repair method without sufficient consideration of the anatomical features of the structure of the inguinal canal, the duration of the defect, and the premorbid characteristics of the patient. The cause of repeated hernia can also be violations of the technique of the operation, leading to incorrect comparison or tension of the stitched tissues.
Features of the postoperative period. The probability of divergence of the seams, the occurrence of other types of insolvency of the walls of the inguinal canal after the performed herniotomy increases with the development of a purulent-inflammatory wound process. The normal course of the recovery period is hampered by early loads - lifting heavy loads, intensive sports with tension in the abdominal press.
Reaction to the installed allograft. Recurrent hernias with prosthetic methods of inguinal hernia repair are rarely diagnosed, but the increasing popularity of the method has led to an increase in the total number of such complications. Repeated hernial protrusion is formed with chronic inflammation in the area of fixation of the synthetic prosthesis to the tissues or the occurrence of an autoimmune reaction to the implant material.
Preservation of prerequisites for hernia disease. If there are reasons that provoked the development of a primary inguinal hernia, a late recurrence is likely. The risk group includes elderly patients, asthenic physique, suffering from diseases in which abdominal pressure increases (constipation, prostate adenoma, urethral strictures, bronchopulmonary pathology with persistent cough).

According to observations, an important role in the formation of recurrent hernia is played by the presence of a patient with congenital systemic connective tissue dysplasia. Among patients with repeated hernia formation, 45-47% have bilateral inguinal hernias, hernial protrusions of other localization (umbilical, femoral, esophageal openings of the diaphragm). 19-20% of patients suffer from varicose veins of the lower extremities, 3.5-4% - mitral valve prolapse, up to 5% - bladder diverticula, diverticulosis of the small intestine. In 7-8% of patients, striae are found on the skin.

Pathogenesis

The mechanism of formation of recurrent inguinal hernia depends on the previously used method of hernia repair. With tension methods of hernioplasty, the destruction of the restored tissues is usually facilitated by eruption with ligatures. The pathogenesis of hernia recurrence after inguinal canal plasty with a synthetic implant is based on the displacement of the prosthesis or its detachment from the fixation points. The choice of technique for strengthening the anterior wall of the canal in case of weakness of the posterior one, insufficient suturing of the transverse fascia, the use of a torn aponeurosis of the abdominal muscles for plastic surgery, leaving a wide inguinal gap, other tactical and technical errors during execution various kinds hernioplasty contributes to re-herniation with the formation of a new hernial sac in the most weakened zone of the canal.

Classification

Recurrent hernial protrusions of the groin belong to the category of acquired, classified as type IV of the modern systematization of inguinal hernias. Based on the characteristics of the anatomical passage through the structures of the inguinal canal, direct (IVa), oblique (IVb), femoral (IVc), combined (IVd) repeated hernias are distinguished. Like other hernial formations, they can be reducible and irreducible, uncomplicated and complicated. Taking into account the mechanism of hernia formation, there are the following types recurrent hernias according to their localization inside the inguinal canal:

Lateral recurrence. The hernial defect is located next to the deep inguinal ring. Recurrent hernia formation is caused by a violation of the technique of sheathing the spermatic cord.
median recurrence. The hernia enters the inguinal canal in its middle part. Recurrence is associated with rupture of the aponeurosis or divergence of the sutures between it and the pupart ligament.
Medial recurrence. The protrusion comes out under the skin from the external inguinal opening. Occurs when the front wall is strengthened instead of the weakened back. It is detected in 50-51% of patients.
Total relapse. It develops as a result of complete destruction of the posterior wall of the canal. Differs in large size and location along the entire length of the postoperative scar.
False relapse. It manifests itself as a direct recurrent hernia in patients who were operated on for an oblique hernia many years ago. It is found in 20-22% of cases of re-herniation.

Symptoms of recurrent inguinal hernia

The recurrence of the disease is most often observed during the first 3 years after hernioplasty. The main sign of a recurrent hernia is the appearance of a protrusion in the area of the postoperative scar, which at the initial stages can spontaneously retract into the abdominal cavity. There are constant pulling pains in the groin area, discomfort when walking. As the hernia increases, dyspeptic disorders progress (nausea, loss of appetite, chronic constipation, feeling of incomplete emptying of the intestine). When a part of the bladder enters the hernial sac, dysuric phenomena develop, pain during urination. The general condition of patients with recurrent inguinal hernia is usually not disturbed.

Complications

Under the condition of constant traumatization of a recurrent hernia, a plastic inflammatory process may occur with the formation of adhesions, the fusion of the contents of the hernial sac with its walls. The long course of the disease causes a violation of the motor function of the intestine, retention of feces, which is fraught with the development of acute intestinal obstruction with severe pain in the abdomen, lack of stool, flatulence, and repeated vomiting. The most serious complication is infringement of the inguinal hernia, which leads to impaired blood supply in the intestinal loop, its necrosis, in the absence of timely assistance, is often complicated by peritonitis.

Diagnostics

The diagnosis is not difficult in the presence of a typical protrusion in the inguinal region and anamnestic information about hernioplasty. Difficulties may arise with the development of pain syndrome of unknown origin, which is not accompanied by the formation of a palpable formation, which requires additional diagnostic measures. To verify the diagnosis of recurrent inguinal hernia, the most informative are:

Physical examination. With the help of palpation, the doctor can determine the presence of a tumor-like formation in the area of the postoperative scar, which increases during coughing or straining. A digital examination of the inguinal canal is carried out, a positive symptom of a "cough shock" is detected.
Herniography. With the introduction of a contrast agent into the peritoneal cavity using a special needle with a mandrel, it is possible to detect a hernia of any size, including with its atypical localization. To improve the visualization of the hernial sac, a Valsalva test is performed - the patient is asked to strain at the time of the radiograph.
Ultrasound of the inguinal canal. During an ultrasound examination, the localization and size of a recurrent hernia are assessed, and the organs located in the hernial sac are visualized. With the help of sonography, it is possible to study in detail the features of the anatomical structures of the inguinal region in order to choose the most rational method of hernioplasty.
MRI of the groin. Magnetic resonance imaging has a high sensitivity and specificity, in 94% of cases it can reliably exclude other muscle-tendon, abdominal and andrological pathologies. The method is used when other instrumental studies are insufficiently informative.

Laboratory blood and urine tests have low diagnostic value, changes in indicators are observed only with the development of complications of recurrent hernia. To exclude pathology from the pelvic organs, an ultrasound examination is performed. Performing irrigoscopy, radiography, MSCT of the abdominal cavity allows you to assess the condition of the digestive tract. Differential diagnosis is made with femoral hernia, inguinal lymphadenopathy, tuberculous cold abscesses, in men - with hydrocele, varicocele, hematocele, lipoma of the spermatic cord, in women - with a cyst of the round ligament of the uterus. In addition to an examination by a herniologist surgeon, the patient is recommended to consult a gastroenterologist and an oncologist.

Treatment of recurrent inguinal hernia

Elimination of a re-formed hernial defect is performed surgically. Features of surgical interventions for recurrent hernia are high trauma, the need deep penetration in the inguinal region for reliable strengthening or reconstruction of specific structures of the canal, the widespread use of alloplastic materials. When choosing a hernioplasty method, the causes of recurrence, the condition of the walls, the deep and external inguinal openings, and the age of the patient are taken into account. The recommended interventions are:

Open extraperitoneal alloplasty. Indicated for men of reproductive age with previous anterior wall plasty. The posterior wall of the canal is strengthened with a mesh allograft. At the same time, the spermatic cord experiences minimal damaging effects, which helps prevent testicular atrophy and preserve fertility. As an alternative, a complete reconstructive obstructive inguinal hernioplasty is used.
Partial obturation hernioplasty. It is recommended for patients with previous posterior wall plasty and small hernial orifices. It is characterized by low invasiveness, the possibility of carrying out under local anesthesia, a short rehabilitation period. It involves obturation (filling) of the hernial orifice with a modeled part of the prosthesis and preventing, due to this, the exit of the abdominal organs into the lumen of the canal.
Operation Liechtenstein. The method of choice for repeatedly recurrent inguinal hernia, large abdominal wall defects, combined formations. The advantages of the intervention are the absence of tissue tension due to the installation of a mesh prosthesis of a suitable area, a low risk of recurrence (up to 1%). With a significant destruction of the canal, its auto- or alloplastic reconstruction is recommended as an alternative operation.
Elimination of the inguinal canal. It is prescribed in exceptional cases for patients of senile age, who have repeatedly performed hernioplasty. The first stage of the operation is orchiectomy and removal of the spermatic cord on the side of the recurrent hernia, after which the hernia orifice is sutured according to the standards for the treatment of postoperative hernias. A radical approach prevents repeated hernioplasty interventions.

Regardless of the previously used methods of plastic surgery public methods if indicated, they can be replaced by endosurgical techniques (TAPP, TEP). At the stage of preoperative preparation, the patient is recommended to wear a special bandage, to exclude factors that can increase intra-abdominal pressure, to give up physical activity, to prevent constipation and coughing.

Forecast and prevention

The outcome of the disease depends on the presence of concomitant pathology in the patient and the timeliness of diagnostic measures. The prognosis is relatively favorable with a small inguinal hernia that occurs without complications. The risk of multiple recurrence ranges from 18% to 43% depending on the type of surgery performed. Prevention of recurrent hernias includes a careful choice of the method of hernia repair, taking into account the anatomical features and condition of the tissues, the prevention of the development of postoperative purulent-septic complications, the treatment of diseases accompanied by an increase in intra-abdominal pressure, and the limitation of physical activity.

A hernia is called the exit of the abdominal organs under the skin through the weak points of the abdominal wall. The outgoing organs are located in the hernial sac formed by the peritoneum (the inner lining of the abdominal wall). The hernial sac is formed during the formation of a hernia.

Hernias reduce physical performance, create discomfort the more, the greater its size.

Danger to life is an infringement in the hernial orifice of the internal organs (hernia).

What are hernias?

The main types of hernias are: INGUINAL (the most common), FEMORAL, UMBILICAL, WHITE LINE.

Hernias that occur in the area of postoperative scars are called POSTOPERATIVE VENTAL HERNIAS.

Hernias that occur at the site of previously operated hernias are called RECORDED (repeated).

Who can get a hernia?

A hernia can occur in any person, regardless of gender and age.

How does a hernia occur?

The abdominal wall, consisting of muscles and aponeuroses, performs a number of functions, one of which is holding the internal organs in a natural position and counteracting the intra-abdominal pressure they create.
Under the influence of intra-abdominal pressure in the most weak points a defect (hernial orifice) may form in the abdominal wall, into which a hernia enters. This can be facilitated by predisposing factors such as excessive exercise, severe coughing, and constipation.
The formation of a hernia may go unnoticed, or it may be accompanied by intense pain.
In the future, under the influence of the same factors, a gradual increase in hernia occurs, up to the exit of most of the intestine into the hernial sac.

Can a hernia disappear without surgery?

Large inguinal-scrotal hernia before surgery.
(See View after surgery)
Unfortunately, neither on its own, nor under the influence of gymnastics or drugs, the hernia will disappear.
Over time, the hernia only increases in size, reducing the ability to work and increasing the risk of complications.

The only way to cure is to perform an operation (hernioplasty).

Wearing bandages only prevents the exit of internal organs through the hernial orifice into the hernial sac, but does not eliminate the hernia and does not guarantee against complications (infringement). In addition, wearing a bandage often makes it difficult to perform the subsequent operation.

Why is it better to perform the operation in a specialized institution?

The maximum experience of surgeons in the treatment of this disease.
Ability to use the entire spectrum modern technologies and methodologies.
Minimal risk of hernia recurrence and other complications.
Possibility of operation on an outpatient basis.

What types of operations are there to eliminate inguinal hernias?

More than 300 methods of inguinal hernia repair are known. But they can all be summarized into three groups:

Plastic with own tissues. This is the oldest group of methods, born in the second half of the 19th century, it is the most extensive and widespread. Its essence is to close the hernial ring with the patient's own tissues (muscles, fascia and aponeuroses) in one way or another.
The frequency of hernia recurrence after these operations varies from 2% to 15% depending on the condition of the patient's tissues, the method of hernioplasty and the correctness of its choice.
The main disadvantages are severe pain in the first days after surgery due to tissue tension and long periods of physical rehabilitation.

Intensive physical labor is contraindicated for at least 3 months after surgery.
Laparoscopic plasty methods. These are plasty methods that are performed under the control of a laparoscope - a device that allows using a mini-video camera to eliminate a hernia from the abdominal cavity without cutting the skin over the hernia. They were born in the early 80s of the twentieth century with the advent of video technology. In most cases, the abdominal wall defect is closed from the inside of the abdominal cavity with a synthetic mesh prosthesis.
The frequency of hernia recurrence after this repair is 2-5%, which is determined by the type of hernia and the preparedness of surgeons.
Important advantages of these methods are low invasiveness, which means a slight pain syndrome after surgery, short rehabilitation periods (up to a month with physical labor), as well as the possibility of performing bilateral plastics and, if necessary, combined operations in the abdominal cavity through the same punctures of the abdominal wall.

Serious disadvantages of this group of methods include the need for general anesthesia (anesthesia), the need to introduce gas into the abdominal cavity to create an operative space (dangerous in patients with lung and heart diseases), technical complexity and high cost of equipment.
Methods of “tension-free” plasty of the patient’s own tissues have existed since the second half of the 60s of the twentieth century. They are distinguished from methods of plasty with their own tissues by the use of “patches” made of synthetic materials to close the hernial orifice. Over the past 10-15 years, these methods have been gaining more and more popularity, which has become possible due to the creation of perfect synthetic materials and the development of new methods for closing the hernia orifices, which practically guarantee the patient from the occurrence of hernia recurrence.

The result of surgery for a giant inguinal-scrotal hernia.
(See View before surgery)
The recurrence rate does not exceed 1% in specialized clinics, regardless of the type of hernia.
Despite the skin incision over the hernia, pain after surgery is minimal, because. no tension on own tissues.
Intensive physical labor is possible one month after the operation, household physical activity is not limited. This allows such operations to be performed on an outpatient basis.

A positive point is also the possibility of performing the operation under local or spinal anesthesia, which is especially important for the elderly and patients with heart and lung diseases.
Due to its reliability and simplicity, hernioplasty according to the I.L. Lichtenstein method has received the greatest prevalence. It is applicable for any type and size of inguinal hernias.

What method of hernioplasty is preferred for inguinal hernia?

Studies on this subject are presented in the article "Modern approaches to the treatment of inguinal hernias".

What tests should be done before surgery for an inguinal hernia?

Determination of blood group and Rh factor.
General blood analysis.
Biochemical analysis of blood, including blood sugar.
Samples for hepatitis, syphilis and HIV infection.
ECG.
Prothrombin and blood clotting.

Abdominal ultrasound.
General urine analysis.
X-ray (or fluorography) of the chest.

What is needed before the operation?

The night before, you need a cleansing enema or taking the drug "Fortrans" according to the instructions.

On the morning of the operation, you need to shave (for inguinal hernias) the lower half of the abdomen, pubis, scrotum and the upper third of the thigh on the side of the hernia.

Do not eat or drink on the morning of the operation.

If you have varicose veins of the lower extremities or if you are over 50 years old, you must bring elastic bandages for your legs.

What problems are possible after surgery for an inguinal hernia?

A hernia recurrence after the operation is possible, but its probability, with the right choice of the operation method and the proper qualification of the surgeon, does not exceed 1%. With “tension-free” plastic surgery, a lifetime guarantee against recurrence is possible.

Suppuration of the surgical wound after the intervention is the most unpleasant. It lengthens the rehabilitation period, requires a visit to the doctor for dressings, and increases the risk of hernia recurrence. Despite the observance of all the rules of asepsis and the high qualification of the surgeon, this complication occurs in 1.5-2% of patients, which is determined by the individual ability of the patient's body to resist infection.

Other complications are possible, but they are rare and do not affect the outcome of the operation.

After plastic surgery of giant inguinal-scrotal hernias, the scrotum remains enlarged for a month, its skin is edematous. This is not a complication and does not create discomfort. This is the natural reaction of tissues to the removal of a large hernial sac. Additional treatment is not required.

How to behave in the first time after surgery for an inguinal hernia?

Walking is possible almost immediately after the operation (except in cases with the use of spinal anesthesia, then it is necessary to wait 3-4 hours). With plastic “without tension”, the patient can leave the hospital 2-3 hours after the operation, including driving his car.
Within two weeks after the operation, you should not lift a load of more than 5 kg. Then physical activity can be gradually increased.
Normal physical activity is possible one month after the operation.
With plastic surgery with own tissues, the rehabilitation period increases to 2-3 months. Physical activity is determined individually.

Treatment of comorbidities

If you have chronic bronchitis or bronchial asthma with a strong and frequent cough, a tendency to constipation, then treatment of these conditions is necessary, since, perhaps, they were the prerequisite for the occurrence of a hernia.

Taking medications

In case of plastic surgery using synthetic mesh prostheses (laparoscopic or "without tension"), anti-inflammatory drugs (Dicloran or Diclofenac 75 mg x 2 times a day with meals) must be taken within a week after the operation.
If necessary, and in agreement with the doctor, it is possible to take non-narcotic painkillers in tablets, capsules or suppositories.

The dressing is necessary the next day after the operation (the dressing may get moderately wet with bloody discharge).
With a favorable course of the postoperative period, more dressings are not required until the removal of sutures (day 7).

If you have any questions about the course of the postoperative period, you should contact one of the operating surgeons by phone.

What happens to a synthetic mesh prosthesis in the long term after surgery?

During the first month after the operation, a synthetic mesh prosthesis, most often made of polypropylene, sprouts with connective tissue fibers. Over time, a dense connective tissue layer up to 1.5 mm thick is formed, which is based on a mesh prosthesis.

Thanks to the prosthesis, the formed connective tissue remains plastic, but not subject to stretching, which is important for the prevention of relapse.

View of the histological preparation one and a half years after the operation.

How often and why do inguinal hernias recur?

Relapses occur in 2-10% of patients operated on for inguinal hernias.

The probability of recurrence depends on the type of inguinal hernia, the correct choice of the plasty method, and the presence of factors contributing to the development of hernia recurrence.
These factors include wound festering, early and inadequate exercise, severe coughing or constipation after surgery.

What are the features of operations for recurrent inguinal hernias?

Operations for recurrence of inguinal hernias are technically more complex and require highly qualified surgeons. This is due to the fact that:

The operation is performed in scar tissue (scars after the previous operation).
The anatomical structures of the inguinal region are “destroyed” much more than during the primary operation.
Anatomical relationships are not clear in advance, because. often the method of the previous plasty is not known.
The right choice of plastic surgery method has crucial for the development of hernia recurrence with repeated plastic surgery.

Therefore, operations for recurrent inguinal hernias are best performed
in specialized institutions.

How often do hernia recurrences occur with repeated plasty?

With repeated inguinal hernioplasty, relapses occur much more often than with primary hernioplasty. This is determined by the same factors as after the primary operation, but primarily depends on the correct choice of hernioplasty method.

After plasty with own tissues, relapses occur in 10-25% of cases, depending on the technique used.

After laparoscopic surgery, the recurrence rate does not differ from that in primary plasty - up to 5%.

After plasty according to the I.L. Lichtenstein method, the recurrence rate is not more than 1%.

What method of plastic surgery is preferable for recurrence of inguinal hernia?

The choice of the method of recurrent inguinal hernia repair should be made by a specialist.

Most preferred are laparoscopic techniques and “tension-free” plastics, for example, according to I.L. Lichtenstein.

What examinations and preparations are necessary before surgery for recurrent inguinal hernia?

It is advisable to have an extract from the medical history about the type of previous plastic surgery.
Otherwise, the preparation does not differ from that in primary operations.

How to behave in the first time after surgery for recurrent inguinal hernia?

With plastic surgery with own tissues, physical activity is limited for 6 months.

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Even the most professionally performed operation can come to naught as a result of various violations in the postoperative period. Any hernia of the abdomen after surgery needs a certain period of recovery necessary for complete and lasting fusion of tissues, and inguinal hernia in men is the most due to its anatomical features.

The role of the recovery period after removal of the inguinal hernia

The operation for inguinal hernia in men has its own nuances, due to the peculiarities of the structure of the inguinal canal. An extremely important element passes through it - the spermatic cord, through which spermatozoa are ejected, as well as blood vessels and nerves. All this is adjacent to the hernial protrusion, which is removed during surgery.

It is important not only not to damage these delicate structures, but also to provide them with maximum rest in the postoperative period, to exclude stress, squeezing, and trauma until complete healing and tissue restoration. Otherwise, very undesirable consequences can develop, leading to impaired patency of the cord, impaired blood circulation, spermatogenesis function, and even loss of fertility (ability to conceive).

Tip: do not be afraid of surgery for an inguinal hernia due to the possibility of complications. The “younger” and smaller the hernia, the easier the intervention and the less likely it is to develop its consequences.

Possible complications after surgery

prolonged pain syndrome;
swelling of the testicle and scrotum;
hematoma of the scrotum;
suppuration of the wound;
eruption (divergence) of seams;
recurrence of a hernia (repeated exit).

All of them are associated, as a rule, with early physical activity, non-compliance with diet and personal hygiene rules, refusal to wear a bandage or its early termination. They can be prevented by strictly observing certain rules and recommendations of the doctor.

What should the patient know and observe in the postoperative period

To avoid serious consequences after discharge, do not ignore the recommendations of your doctor

Diet Features

Upon arrival home, the principles of nutrition should be such that, firstly, it does not cause bloating, secondly, it does not contribute to constipation, and thirdly, it is not too high in calories and excess so that extra pounds are not gained. All of the above leads to an increase in intra-abdominal pressure, stretching of the abdominal wall, and can lead to rupture of the sutures and recurrence of the hernia.

Whole milk, bean dishes, fresh white bread, fresh cabbage, grapes should be excluded from the menu, leading to bloating

For regular bowel movements, you need to consume a sufficient amount of vegetable fiber in the form of boiled and stewed vegetables, fresh fruits, boiled cereals (buckwheat, oatmeal). You can protect yourself from weight gain by limiting pasta, flour and confectionery products, potatoes, and eating low-fat meat and fish. There should be a sufficient amount of greenery, it contains trace elements necessary for wound healing.

Among fats, unrefined vegetable oils should be preferred, they improve metabolism. Of great importance is the frequency of food intake - up to 5-6 times a day in small portions, as well as sufficient fluid intake - mineral water, fruit and vegetable juices.

Limitation of physical activity

Within 2 months it is not recommended to lift weights of more than 5 kg, you should also avoid running, jumping, bending and sharp turns of the body. Mandatory physical exercises - general hygiene and special exercise therapy (therapeutic exercises). At first, these will be breathing and general tonic exercises, then their volume is gradually expanded, adding a load on the abdominal muscles to improve their blood circulation, maintain a good condition of the press and more reliable formation of a postoperative scar.

You should also refrain from sexual intercourse for the first weeks, they can lead to the development of a hematoma, testicular edema, and even eruption of sutures.

Tip: The duration of restrictions on food and exercise should always be agreed with your doctor. They depend on the nature of the operation (laparoscopy or laparotomy), on the age, build and health of the patient.

Wearing a bandage

Support bandage after hernia repair is recommended to reduce pressure on the abdominal muscles, especially in obese and elderly men. Special bandages for inguinal hernias are used - left-sided, right-sided and bilateral, with a seal (pellot) at the level of the opening of the inguinal canal.

The bandage is selected individually in size, it is prescribed by a doctor, and it must be put on immediately before assuming a vertical position, that is, while getting out of bed. The duration of wearing the bandage is also determined by the specialist. Excessive passion for wearing a bandage can also do harm. As a result of squeezing the tissues of the abdomen, inguinal region, their blood circulation is disturbed and muscle atrophy gradually develops, which can lead to a recurrence of the hernia.

Personal hygiene

After a minimally invasive hernia repair, the patient, as a rule, is discharged already on the 2-3rd day, still with sutures. Until they are removed, you can not wet the wound, especially take a bath or go to the pool. If the bandage is removed, the skin around the wound should be treated daily with 5% iodine tincture or brilliant green solution. Be sure to keep the body clean and change underwear daily. You can not be in dusty conditions, in a hot room, so that the skin does not sweat. If there is irritation on the skin in the wound area, it should be treated with a special baby powder or zinc paste.

If all the recommendations mentioned above are followed, postoperative rehabilitation will be successful, without consequences. And regular exercise in the future and maintaining a normal body weight will only strengthen the effect of the operation.

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for self-treatment. Be sure to consult a doctor!

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The term "hernia" implies the exit of an organ or part of it beyond the anatomical location through a pathological or physiological opening under the skin, into the muscle space or into adjacent anatomical cavities. After surgical treatment of an inguinal hernia, a period of rehabilitation begins. The speed of the patient's return to normal life depends on the correct selection of restorative techniques.

Classification

According to anatomical features, hernias are divided into internal and external.
Internal hernias, in turn, are divided into diaphragmatic and intra-abdominal.

Diaphragmatic hernias are formed due to the exit of the abdominal organs into the thoracic region through pathological or natural defects of the diaphragm.

Intra-abdominal hernias are formed due to the entry of an organ or part of it into the pockets of the peritoneum.
External hernias are more common - the exit of an organ or part of it from the area of \u200b\u200bits anatomical location through artificial or natural openings with a parietal sheet of the peritoneum.

According to the anatomical localization, the following types of hernias are distinguished:

umbilical;
inguinal;
femoral;
xiphoid process;
white line of the abdomen (including epigastric);
arcuate line;
lateral (spigelian or semilunar line);
lumbar (Pti triangle, Grifeld-Lesgaft rhombus);
obturator;
perineal;
ischial.

Inguinal hernia

Inguinal hernia refers to violations of the abdominal wall. This is a pathological protrusion of the peritoneum with internal organs into the space of the inguinal canal.

The inguinal canal is a tunnel 4-6 cm long, in which the round ligaments of the uterus pass in women, and the spermatic cords in men. This department is located in the lower inguinal region. In the case of a loose fit of the muscles to the spermatic cord or ligaments of the uterus, an inguinal gap is formed in this area, which is an important link in the formation of an inguinal hernia.

direct and oblique inguinal hernias;
congenital and acquired;
infringed and reducible (not infringed);
unilateral and bilateral.

Principles of hernia treatment

Conservative treatment is reduced to wearing a special bandage that returns the hernial contents to the anatomical site and protects the patient from pinching the hernial sac. Such therapy is prescribed according to certain indications, since it is not able to save the patient from the disease, but only alleviates the condition. In addition, prolonged wearing of the bandage provokes the development of atrophy of the muscles of the abdominal wall and aggravation of the pathology.

Operative techniques for the treatment of hernia are of two types: by open access or laparoscopic.

Indications for conservative treatment

Presence of contraindications to surgical treatment in children and adults.
Recurrence of the disease (hernia) after surgery.
The patient has a large hernia requiring several operations. The bandage is used during the time interval between surgical interventions.

Indications for surgical treatment

The presence of an uncomplicated hernia is an indication for elective surgery.
Infringement of the hernial sac requires emergency surgical intervention.
Recurrent hernias.
Postoperative hernias.
The development of the adhesive process.

Contraindications for surgery

Complications

Damage to internal organs (walls of the bladder, intestines).
Violation of the integrity of blood vessels.
Damage to the nerves (ilio-hypogastric and ilio-inguinal) in the postoperative period is the cause of a pronounced pain syndrome, and later, due to muscle atrophy, can provoke a relapse of the disease.
Deformation of the spermatic cord in men.
Excision of the vas deferens in men with the development of aspermia.

In the early postoperative period:

In the late postoperative period:

Hernia recurrence.
Violation of the spermatogenic and hormonal function of the testicles or the secretory function of the prostate gland with a decrease in sexual and reproductive functions.

Rehabilitation

After surgical treatment, a period of rehabilitation follows. The well-being of the patient and the speed of returning to his usual everyday and working life depend on the correctness of the construction of methods for restoring the body.

The patient can walk immediately after the operation, and during surgical procedures under spinal anesthesia - after 3 hours, but in the absence of contraindications, with the permission of the surgeon and the rehabilitation specialist.

When carrying out a planned operation without complications under local anesthesia, the patient can be discharged after 2-3 hours.

Within 2 weeks after the manipulation, it is necessary to limit weight lifting to 5 kg, and after a month you can already return to normal activity.

If the plastic was performed with own tissues, the rehabilitation period is extended to 2-3 months.

exercise therapy

The indication for the appointment of physiotherapy exercises is preparation for surgery and rehabilitation after it.

In the early postoperative period (before the removal of sutures), the tasks of physiotherapy exercises are:

prevention of adhesive process;
prevention of complications;
formation of an elastic scar;
improvement of the cardiovascular and respiratory systems;
stabilization psycho-emotional state patient.

Contraindications for physiotherapy exercises

In the preoperative period:

serious condition of the patient;
acute cardiovascular failure;
development of peritonitis.

In the absence of contraindications, physiotherapy exercises are prescribed from the first hours after the end of the operation.

First, respiratory gymnastics complexes are performed, then exercises for the limbs are added to them.

After extensive operations in the first few days, the patient may be prescribed bed rest. In this case, therapeutic exercises are performed lying on the bed. After the permission of the surgeon and the rehabilitation doctor, the starting position changes to half-sitting and sitting.

In the supine position, exercises are done for the respiratory and cardiovascular systems, for the upper and lower extremities, both dynamic and static. Then light gymnastics for the abdominal muscles is added, then turns of the body are turned on, and for the deep muscles of the perineum, alternation of contraction and relaxation is practiced.

Be sure to remember that during this period it is necessary to use a bandage to prevent the development of postoperative complications.

Tasks of physical therapy in the late postoperative period (up to 2-3 weeks):

During this period, exercises are prescribed with additional gymnastic equipment: balls, sticks, against the gymnastic wall, etc. motor complexes are performed for all joints and muscle groups.

The tasks of physiotherapy exercises in the late postoperative period (3 weeks after the operation until the patient's working capacity is restored):

training of the cardiovascular and respiratory systems of the body;
adaptation to increasing physical activity;
rehabilitation of the patient.

During this period, complexes of therapeutic gymnastics are used, aimed at general strengthening of the body, as well as training the abdominal muscles, walking, gentle sports, skiing.

Massage

In addition to exercise therapy in the postoperative period, it is necessary to prescribe massage in order to prevent postoperative complications associated with physical inactivity (pneumonia in debilitated individuals, muscle atrophy).

Massage is carried out segmentally on the spine, as well as on the abdomen for the prevention of intestinal atony and ends in the lower extremities.

Physiotherapy

With the formation of an infiltrate or phlegmon in the area of operation, UHF and laser therapy are prescribed through a clean bandage.

During the dressing, ultraviolet irradiation of the wound and surrounding tissues is carried out.

With the formation of adhesions in the abdominal cavity and to restore the normal tone of the intestines, centimeter therapy, diadynamic therapy are prescribed. inductothermy, laser therapy. as well as dirt. paraffin and ozokerite treatment.

The patient must remember the importance of the exact implementation of the recommendations and instructions of doctors for a successful recovery after surgical treatment of an inguinal hernia.

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