Often we do not attach serious importance to a disease that has long been known and causes only periodic discomfort, not at all thinking about the fact that a dangerous enemy is growing and developing inside us, capable of encroaching on our health and even life itself. Hernia can also be attributed to such diseases, which is quite unpleasant, but, according to many people, it is not a dangerous phenomenon at all. However, such judgment can be very costly. Abdominal hernia are among the most common surgical conditions. They affect people of all ages and genders. In official language, a hernial protrusion is the exit of the peritoneum in the form of a bag with the insides contained in it beyond abdominal wall through any defect.

The name "hernia" in Russian it comes from the word “gnaw”, which indicates those unpleasant sensations that are observed during the formation of hernias and manifest themselves in violation (“gnaw”) of integrity abdominal cavity and release of its contents.

The abdominal cavity performs a number of important tasks in the life of the body, including the function of respiration, the regulation of blood circulation and motor activity. gastrointestinal tract. Anatomically, the stomach, intestines, liver, kidneys are, as it were, “suspended” by ligaments in strictly defined places in the abdominal cavity, or, easily adhering to its back wall, require strong support from the front. And the anterior abdominal wall - a complex multilayer anatomical formation, consisting mainly of muscles and dense connective tissue - serves as a real support for the internal organs. One of its functions is to keep the internal organs in a natural position and counteract intra-abdominal pressure, which, under various loads, can range from 5 to 50 mm Hg. With the weakening of the abdominal press, an imbalance occurs between the resistance of the abdominal wall and intra-abdominal pressure. Stretched muscles that have lost their elasticity and elasticity are not able to perform the functions assigned to them by nature. The digestive organs and kidneys lose their support, pull down, lengthening the ligaments, and slip from their places - they sink, squeeze, can twist, which in itself is the cause of many diseases. At the same time, the constant pressure experienced by the abdominal wall from the abdominal cavity causes a gradual weakening and thinning of the tissue layers, mainly in the “weak” places, where a hernia subsequently forms. Hernia formation may go unnoticed, or it may be accompanied by intense pain. After some time, there is a constant increase in the hernia, up to the protrusion of most of the intestine into the hernial sac.

To causes Acquired (not congenital) hernias primarily include weakness of the abdominal wall associated with the anatomical features of the structure: the presence of weaknesses in the so-called "hernial points" (the area of ​​​​the inguinal gap, umbilical ring and white line of the abdomen, femoral canal and others). This also includes defects in the abdominal wall that have arisen after surgery or injury. In this case, hernias are formed gradually and imperceptibly for the patient, without any physical effort or significant stress on his part. They are called "hernias from weakness." The weakness of the muscles of the abdominal wall is to blame for their formation.

There are also common factors leading to a weakening of the abdominal wall of the inguinal region and the occurrence of a hernia in this area: heredity, age-related flabbiness of tissues, weight loss as a result of starvation or illness, obesity, stretching of the abdominal wall during pregnancy, ascites and others.

The main producing factors for the development of a hernia are those that lead to an increase in intra-abdominal pressure: physical overstrain (including playing the wind musical instruments or work as a glass blower)

difficult, prolonged labor

difficult bowel movements and urination

persistent cough (as in chronic bronchitis or whooping cough). In young children, the occurrence of a hernia can provoke prolonged screaming and crying.

Hernias are classified according to the anatomical regions where they are formed: inguinal, femoral, umbilical, white line of the abdomen, as well as rarer types - lumbar, lateral, sciatic, perineal, etc. Let us dwell on the most common types.

Inguinal hernias rank first among other external abdominal hernias in frequency (from 70 to 90% of all abdominal hernias). They are not congenital and can develop at any age, but are more common in men aged 40-60 and older. In older men, inguinal hernias are often bilateral.

Femoral hernias, on the contrary, occur more often in women aged 30-60 years (in 80% of cases). These hernias rarely reach large sizes, but more often than others they are infringed. The contents of the hernial sac in most cases is a loop small intestine, stuffing box. The appearance of such hernias is usually associated with great physical exertion, chronic constipation, pregnancy.

Traumatic hernias occur as a result of abdominal trauma. In this case, a subcutaneous rupture of the underlying muscles, fascia and aponeurosis occurs. Under the influence of intra-abdominal pressure, the parietal peritoneum, together with the internal organs, protrudes at the rupture site, and a hernia is formed. Traumatic hernias occur immediately after injury or in the coming days and can be single or multiple.

Umbilical hernias are relatively rare, in 3-7% of cases, and also mainly develop in women, especially in those who have given birth a lot.

Hernias of the white line of the abdomen are observed quite rarely (in 2-4% of all cases of hernias of the anterior abdominal wall) and develop mainly in men.

Incisional or ventral hernias can occur in any part of the abdomen after surgical operations on the abdominal organs. Their treatment often requires complex plastic surgery and gives a large number of relapses from 20 to 40% (hernias that form at the site of previously operated hernias are called recurrent).

Now about whether all hernias are dangerous, and why? First of all, it is necessary to refute the widespread, but erroneous opinion. There are no safe hernias in principle! The formation of a "hole" in the abdominal wall threatens with a number of complications, the most dangerous of which is the infringement of the contents of the hernial sac in the ring. If at the same time the loop of the intestine or another vital organ turned out to be infringed, then the countdown goes on for minutes - the person is in mortal danger and must be urgently operated on. But the operation in this case does not give an absolute guarantee. If the injured organ is no longer viable, then the volume of the operation can be very traumatic, and the prognosis is not always favorable. Hernias are infringed in approximately 10-12% of cases, more often umbilical, inguinal and femoral.

But even if the hernia is not prone to infringement, then in any case, over time, the hernial ring expands. Then the contents of the hernia go beyond the abdominal cavity. In this case, violations of the functions of organs are possible:
at the exit of the large intestine - constipation,
when the bladder exits - cramps when urinating,
in the presence of a large hernia and the exit of a large volume of organs - respiratory failure,
infringement of the organs located in the hernia.

Sometimes, with postoperative hernias of the anterior abdominal wall, a significant part of the intestine is in the bag, the greater omentum, part of the stomach, and the hernia becomes “giant”. It happens that the patient literally "carries a giant hernia on his hands", not being able to set it into the abdominal cavity. Accordingly, the treatment of such hernias is a difficult problem for the surgeon and a great risk for the patient.

It should also be remembered that in the walls and contents of any large and long-term hernia, inflammatory changes are usually observed, especially if the patient long time wore a bandage. Inflammation leads to a thickening of the hernial sac and its membranes and to the formation of adhesions of the sac with prolapsed entrails, which, of course, is fraught with extremely serious complications.

And, of course, a hernia is a noticeable cosmetic defect, which sometimes worries patients even more than, for example, the possibility of infringement.

But regardless of the type of complication, it must be remembered that any of them requires immediate medical attention, hospitalization, and often emergency surgical intervention by a surgeon.

But how do you know if you have a hernia? A hernia is one of those diseases that quite often the patient himself determines. According to doctors, many patients knew about the existence of a hernia long before the infringement. Moreover, many more than once eliminated it on their own with the help of various manipulations. There are cases when a person had an irreducible hernia long years, and he lives with the habit that the hernial protrusion does not disappear and often aches. However, there are also cases when patients did not even know that they had a hernia until the moment when the infringement occurred. For example, this is possible with congenital protrusions of the peritoneum or the presence of hernial sacs without hernial contents.

As for hernia symptoms, then, as a rule, even before the appearance of a hernial protrusion, at the very beginning of the development of a hernia, patients complain of pain in the inguinal region, in the region of the oval fossa of the thigh, navel, in the midline of the abdomen. These pains occur when walking or physical exertion (coughing, straining, lifting weights). Usually, some time after the onset of pain, or simultaneously with them, the patient notices a protrusion or swelling in himself. Often, as the hernial protrusion increases, the pain subsides somewhat. The appeared hernia becomes clearly visible to the patient himself and at first easily disappears (self-resets) when taking a horizontal position (if the hernia is not reducible, then it does not disappear in the supine position and when the pelvis is raised). You can also note such symptoms as belching, nausea, constipation, sometimes vomiting, urination disorders - along with pain, they manifest themselves mainly when thin or large intestinal loops enter the hernial sac. The appearance of a hernia may also cause a response of the whole organism and its systems, expressed by anxiety and a general deterioration in well-being. Sometimes in such patients working capacity decreases, they cannot lift even minor weights.

Abdominal hernia (hcrniac abdominalis) - exit under the skin of the abdominal organs, covered with a parietal sheet of the peritoneum, through various openings of the abdominal wall or pelvis.

If, during an injury, the muscles of the anterior abdominal wall and parietal peritoneum rupture, and any organ of the abdominal cavity falls out through the resulting defect, then they speak of prolapse (prolapsus).

Subcutaneous eventration(evcntratio) - divergence of sutures on the peritoneum, aponeurosis and muscles, with an undissolved wound of the skin (after surgical interventions).

There are external and internal hernias.

External hernias(herniae abdominalis externae) - protrusions that exit through holes in the abdominal wall. These holes are often normal anatomical formations, usually filled with adipose tissue, but they can occur as a result of various traumatic injuries or diseases.

By origin, external abdominal hernias are congenital (congenita) and acquired (acquisita).

Internal hernia(berniae abdominalis internae) - entry of abdominal organs into abdominal pockets or diverticula (bursa omentalis, foramen Winslowi, recessus duodenoje-junalis, etc.). Diaphragmatic hernias are also internal.

Internal hernias often cause a picture of intestinal obstruction and are inaccessible to research without opening the abdominal cavity.

The constituent elements of external hernias are the hernial ring, the hernial sac and its contents.

Hernia gate - natural cracks and channels passing through the thickness of the abdominal wall (inguinal, femoral canals, etc.), as well as those acquired as a result of injuries or after surgical interventions.

hernial sac - part of the parietal peritoneum that exits through the hernial orifice. Hernial sacs vary in shape and size. They distinguish the mouth, neck, body and bottom.

content the hernial sac can be any of the organs of the abdominal cavity: more often the small intestine as the most mobile organ, then the omentum, the colon (large) intestine, especially its movable sections - the caecum with the appendix, the transverse colon and the sigmoid.

Classification of hernias by localization: inguinal, femoral, umbilical, white line of the abdomen, xiphoid process, lateral abdomen, lumbar Greenfelt-Lesgaft triangle, sciatic, obturator, perineal.

In the course of the hernia, they are divided into uncomplicated (reducible), complicated (irreducible, strangulated, with symptoms of coprostasis and inflammation).

Uncomplicated hernia

Subjective signs in uncomplicated hernias (hernia libera, s. reponibilis) include pain localized at the site of the hernia, in the abdomen, lumbar region. The appearance of pain usually coincides with the entry of hernial contents into the hernial sac or with the reduction of the hernia. From the gastrointestinal tract, various disorders can be observed: nausea, sometimes vomiting, belching, constipation, bloating.

One of the objective symptoms characteristic of a reducible hernia is a tumor-like formation, either appearing or disappearing in the area of ​​the hernia gate. Hernial protrusion is usually associated with tension in the abdominal press, and in the patient's lying position, it goes into the abdominal cavity on its own or with the help of manual reduction.

With incipient hernias, the protrusion is determined only by a finger inserted into the hernial canal, which feels it as a push when coughing or straining.

According to the degree of development, hernias are distinguished:

1) beginning (incipiens);

2) incomplete, or intracanal (incompleta, intracanalicularis);

3) complete (completa);

4) scrotal (scrotales), which can reach enormous sizes (hernia permagna).

In some cases, to resolve the issue of the presence or absence of a hernia, the patient has to be examined repeatedly in different positions, resorting to additional research methods (long walking, lifting small weights, etc.), since with narrow hernial orifices, the insides enter the hernial sac only with significant physical stress. With large and medium hernias, the hernial opening is relatively easy to determine.

In addition to examination and palpation, when examining a patient with a hernia, it is necessary to use percussion and auscultation. So, the presence of a hollow organ (intestine) in the hernial sac during percussion gives a tympanic sound, and during auscultation - a sensation of rumbling. If there is a dense organ in the hernial sac (for example, an omentum), then percussion gives a dull sound. If there is a suspicion of the presence of a bladder in the hernial sac, an x-ray examination is performed with the introduction of bladder contrast agent.

Treatment of hernias in the absence of contraindications should be only operational. In the surgical treatment of uncomplicated hernias, absolute and relative contraindications are possible. To absolute contraindications are acute infectious diseases or their consequences, decompensated heart disease, malignant neoplasms; relative - early childhood, old age in the presence of chronic diseases, late pregnancy.

A radical operation consists in removing the hernial sac after bandaging it at the neck and narrowing the hernial canal by plastic techniques to strengthen the muscles and aponeurosis of the abdominal wall, depending on the location of the hernia.

Most hernia repair is performed under local anesthesia (can be combined with neuroleptanalgesia), some under anesthesia, which is used mainly for children.

These patients do not require special preoperative preparation. On the eve of the operation, they take a hygienic bath, they shave their belly, pubic and scrotum hair, empty their intestines with an enema. Before delivery to the operating room, the patient must empty the bladder.

The management of the patient in the postoperative period depends on the type of hernia, the nature of the surgical intervention, the presence of complications, etc. It is necessary to take all measures to prevent postoperative complications, especially in the elderly.

After the operation and the discharge of the patient home (with the primary healing of the wound), persons engaged in mental work are issued a sick leave for up to three weeks, then they start work. However, they are not recommended to engage in heavy physical labor for 2-3 months.

Persons of heavy physical labor sick leave can be extended for a month. Then, by decision of the VKK, the patient can be transferred to lighter physical labor for the period provided for by the regulation on the VKK. If patients with postoperative relapses and other complications are unable to perform their professional work, they are referred to the VTEC to establish a disability group.

Despite its significant prevalence in the working population, hernias are rarely the direct cause of disability. In the practice of medical and labor examination, disability due to hernias is established for the elderly in the presence of age-related changes in other organs. In young and middle-aged individuals, the causes of disability are persistent relapses or other postoperative complications.

Conservative methods of hernia treatment are currently used extremely rarely: only when there are contraindications to surgery and the patient categorically refuses it. Such patients are prescribed wearing a bandage. However, the bandage in the area of ​​the hernia injures organs and tissues and does not protect against infringement of the hernia.

Prevention of hernias should be aimed at eliminating the causes of their formation. A.P. Krymov notes two groups of such reasons:

I. Increasing intra-abdominal pressure:

1) disorder of the act of defecation (constipation, diarrhea);

2) cough;

4) difficulty urinating (strictures of the urinary canal, prostate adenoma, phimosis);

5) playing wind instruments;

6) tight tightening of the abdomen;

7) difficult childbirth;

9) hard physical work (lifting weights, carrying loads, working in a half-bent or other uncomfortable position, etc.).

II. Weakening the abdominal wall:

1) pregnancy, stretching and thinning the abdominal wall, especially repeated;

2) diseases that cause weight loss and weakening of the muscles of the body;

3) all kinds of injuries of the abdominal wall.

Physical therapy is a prophylactic agent that prevents the formation of hernias. Sports exercises carried out under the supervision of a doctor strengthen the muscles of the anterior abdominal wall.

To prevent hernia in childhood important proper care for the child. Moments that increase intra-abdominal pressure should be avoided: tight swaddling of infants, tossing up when crying and screaming.

INGUINAL HERNIAS

Inguinal hernias (herniae inguinales) are formed within the inguinal triangle, the lower side of which (hypotenuse) is the pupart ligament, the upper (upper leg) is a horizontal line drawn from a point located on the border between the outer and middle thirds of the pupart ligament, to the intersection with a straight line abdominal muscle. The third side of the triangle will be a perpendicular extending from the pubic tubercle to the intersection with the horizontal line indicated above, which corresponds to the outer edge of the rectus abdominis muscle.

The inguinal canal is located obliquely - from top to bottom and towards the middle. It has four walls and two holes. The anterior wall is formed by the aponeurosis of the external oblique abdominal muscle, the posterior by the transverse fascia of the abdomen, the upper by the edges of the internal oblique and transverse abdominal muscles, and the lower by the pupart ligament.

External (subcutaneous) inguinal opening formed by the legs of the aponeurosis of the external oblique muscle of the abdomen, which are attached to the pubic tubercle. Between the legs of the aponeurosis are transverse tendon fibers that limit the upper (lateral) side of the external inguinal ring.

Internal (abdominal) opening The inguinal canal is an opening in the transverse fascia of the abdomen and is located correspondingly to the external inguinal fossa (fovea inguinalis externa). In men, the spermatic cord passes through the inguinal canal, consisting of the vas deferens, spermatic artery, vein, nerve and lymphatic vessels, in women - only the round ligament of the uterus.

Inguinal hernias are divided into oblique and direct. Oblique (external) inguinal hernia(hernia inguinalis obliqua) exits through the external inguinal fossa and is located outward from art. epiga-strica inferior. The course of an oblique inguinal hernia strictly corresponds to the course and direction of the spermatic cord, i.e. the path taken by the testicle as it descends into the scrotum. With oblique inguinal hernias, the internal opening of the inguinal canal, located in the external inguinal fossa, does not coincide with its external opening, but lies 4-5 cm to the side of it. To exit through the opening of the inguinal canal, the hernial sac must pass this oblique path 4- 5 cm, therefore such hernias are called oblique.

Oblique inguinal hernias can be acquired and congenital. With congenital hernias, the abdominal organs enter the non-overgrown vaginal process of the peritoneum with the testicle lying on its bottom.

With congenital inguinal hernias, attention should be paid to the location of the testicle in the hernial sac. The testicle, in the process of descending into the scrotum, does not enter the hernial sac (open abdomino-inguinal process), but only approaches the wall of the abdomino-inguinal process and is covered by the peritoneum.

Direct (internal) inguinal hernia(hernia inguinalis interna, medialis, directa) exits through the internal inguinal fossa (fovea inguinalis media), which is a permanent anatomical formation and is located between the lateral vesico-umbilical ligament and fold a. epigastrica inferior (plica epigastrica).

The internal inguinal hernia has a direct direction due to the fact that the internal fossa (internal hernial ring) is located against the external opening of the inguinal canal. The hernial sac goes in a straight, sagittal direction, and in connection with this, such hernias are called direct inguinal.

With direct hernias, the hernial sac lies medially in relation to the elements of the spermatic cord, therefore they are called internal. With oblique hernias, the hernial sac is located outward, lateral to the elements of the spermatic cord.

According to its etiology, direct inguinal hernias are always acquired and are observed mainly in the elderly.

Sometimes, with sliding hernias, internal organs partially covered by the peritoneum (caecum, bladder) form part of the wall of the hernial sac. The slippage of these organs passes through the retroperitoneal tissue, through the hernial ring.

Sliding inguinal hernias most often irreducible, their hernial ring is larger than usual. Patients with sliding inguinal hernias have constipation, bloating, abdominal pain, in the area of ​​the hernial protrusion during defecation, frequent urge to urinate, and pain radiating to the lumbar region.

X-ray examination is of great importance for the preoperative diagnosis of sliding inguinal hernias. In women, a bimanual examination before surgery helps to make the diagnosis. However, the exact diagnosis of sliding inguinal hernias is most often established during surgery.

During the operation, instead of the hernial sac, you can open a hollow organ, which should always be remembered.

Oblique inguinal hernias descending into the scrotum must be differentiated from dropsy of the testicle, as well as dropsy of the spermatic cord.

Dropsy testis(hydrocaele) develops slowly, without causing any pain. The fluid produced by the serous membrane of the testicle accumulates in the cavity formed by the testicle and its own membrane. As fluid accumulates, the dropsy cavity becomes more and more stretched, becomes tense and does not retract into the abdominal cavity, the testicle and epididymis are not palpated. When feeling the spermatic cord at the external opening of the inguinal canal with hydrocaele, you can freely close your fingers at its upper pole, feeling the vas deferens between them, while with an inguinal-scrotal hernia, you cannot close your fingers.

Differential diagnosis is also carried out by the method of diaphanoscopy. In a dark room, a brightly glowing cystoscope bulb is brought under the scrotum. With dropsy of the testicle, half of the scrotum, stretched from the accumulation of serous fluid, turns into a luminous bright pink flashlight, at the bottom of which the shadow of the testicle that does not let light through is clearly visible.

clinical difference dropsy of the spermatic cord(hydrocaele communicans) from dropsy of the testicle is the phenomenon of emptying the dropsy cavity at night, when the patient is in the supine position, and filling the bag again during the day when walking. In this case, diaphanoscopy also helps to make a differential diagnosis.

In addition, inguinal hernias must be differentiated from dilatation of the veins of the spermatic cord(varicocaele), which is predominantly on the left, where the spermatic vein flows at a right angle into the renal vein. On examination, one can see nodes of intertwining varicose veins running along the spermatic cord, which go high into the inguinal canal. In such cases, patients complain of pain along the spermatic cord, radiating to the lower back, a feeling of heaviness in the lower abdomen.

To resolve the issue of surgical intervention for inguinal hernias, it is necessary to carefully examine the patient, establishing indications and contraindications for surgical treatment.

According to A.P. Krymov, inguinal hernias account for 73.4% of all hernias. More than a hundred methods of surgical interventions for inguinal hernias have been proposed, but few of them have found wide application in surgical practice.

The task of surgical intervention for inguinal hernias is the elimination of the hernial sac and the closure of the hernial ring.

Operations for oblique inguinal hernias. Anesthesia is often carried out locally with a 0.25% solution of novocaine, in excitable individuals it can be combined with neuroleptanalemia, in children it is only general.

Surgical intervention consists of the following stages: an incision of the skin, subcutaneous tissue and superficial fascia 8-12 cm long, 2 cm above the inguinal ligament; dissection of the aponeurosis of the external oblique muscle of the abdomen; separation of the hernial sac from the external flap of the aponeurosis of the external oblique muscle of the abdomen and from the elements of the spermatic cord; opening of the hernial sac and repositioning of the contents into the abdominal cavity; flashing the neck of the hernial sac and cutting off its peripheral part. Plastic surgery of the inguinal canal is carried out according to one of the methods.

When plastics of the inguinal canal, the methods of Girard, S. I. Spasokukotsky, A. V. Martynov, M. A. Kimbarovsky, as well as other methods of operations that the surgeon is well versed in, are more often used.

Girard's way(Girard) is to strengthen the anterior wall of the inguinal canal over the spermatic cord. First, the edges of the internal oblique and transverse muscles are sutured with interrupted silk sutures to the inguinal fold over the spermatic cord, and then, throughout the incision, the internal flap of the aponeurosis is sutured to the edge of the inguinal ligament. The outer flap of the aponeurosis is laid on top of the inner one (like the floors of a double-breasted coat) and sutured to the latter with interrupted silk sutures. On the subcutaneous tissue catgut sutures are applied, silk sutures are applied to the skin. Aseptic bandage on the skin, suspensory.

According to the method of Spasokukotsky the inner flap of the aponeurosis of the external oblique muscle of the abdomen, together with the edges of the internal oblique and transverse abdominal muscles, is sutured to the pupart ligament with one row of interrupted silk sutures, and the outer flap of the aponeurosis is sutured over the inner one. Many surgeons use the mixed Girard-Spasokukotsky method.

Martynov's method is reduced to the formation of duplication from the sheets of the dissected aponeurosis: the inner flap of the aponeurosis of the external oblique muscle of the abdomen is sutured to the pupart ligament, the outer one is laid over the inner one and sutured to the latter.

According to the Kimbarovsky method the internal flap of the dissected aponeurosis of the external oblique muscle of the abdomen and the underlying muscles are sutured from the outside inward, retreating 1 cm from the edge of the incision: for the second time, the needle is passed only through the edge of the internal flap of the aponeurosis, going from the inside outwards, then the edge of the pupart ligament is sutured with the same thread; over the inner flap, the outer flap of the aponeurosis is sutured.

Operations for direct inguinal hernias. With direct inguinal hernias, the hernial sac usually has a wide base, so the neck of the sac is stitched with an internal purse-string suture, and the sac is excised farther than the ligature.

Plastic surgery of the inguinal canal is carried out by the Bassini method or by the N. I. Kukudzhanov method.

Bassini method(Bassini) is as follows:

1) the spermatic cord is taken up and outward;

2) with interrupted silk sutures, the edge of the internal oblique and transverse muscles is sutured together with the underlying transverse fascia to the inguinal ligament;

3) in the region of the pubic tubercle, the edge of the sheath of the rectus abdominis muscle is sutured with 1-2 sutures to the pupart ligament and periosteum of the pubic bone;

4) after tying all the sutures in turn, the spermatic cord is placed on the created muscle bed;

5) over the spermatic cord, the edges of the aponeurosis of the external oblique muscle of the abdomen are sutured with a number of interrupted sutures.

At the core Kukudzhanov's method lies the principle of strengthening the posterior and anterior walls of the inguinal canal; in the region of the internal hernial orifice, the preperitoneal fatty tissue is sutured with several sutures, the spermatic cord is retracted anteriorly, the transverse fascia is sutured with two mattress sutures with capture into the sutures of the iliac-pubic and inguinal ligaments, the rectus sheath and aponeurotic fibers of the internal oblique and transverse muscles are sutured to the medial iliac region -pubic and inguinal ligaments. The spermatic cord is placed in place and the edges of the dissected aponeurosis of the external oblique muscle of the abdomen are sutured over it in the form of a duplicate.

Operations for congenital inguinal hernias. With congenital inguinal hernias, two methods of surgical interventions are mainly used - without opening the inguinal canal (according to Roux - Oppel) and with opening the inguinal canal.

According to the Ru-Oppel method after dissection of the skin and subcutaneous tissue, the hernial sac is isolated and opened, the hernial contents are set into the abdominal cavity. The hernial sac brought into the wound is tied up at the neck, cut off, the stump is immersed in the preperitoneal tissue. The external opening of the inguinal canal is sutured with two or three silk ligatures. Interrupted sutures are placed on the anterior wall of the inguinal capal, capturing the aponeurosis of the external oblique muscle of the abdomen and the underlying muscles slightly above the inguinal canal, and on the other hand, the inguinal ligament. This method is used for small initial hernias, both congenital and acquired.

At method with opening the inguinal canal access to the hernial sac is the same as for acquired oblique inguinal hernias. Along the spermatic cord, fascia cremasterica is cut along with the fibers of m. cremaster and fascia spermatica interna, allocate the anterior wall of the hernial sac and open it at the neck. The hernial contents are pushed into the abdominal cavity, the posterior wall of the hernial sac at the neck is separated from the elements of the spermatic cord, and then dissected in the transverse direction. The neck of the selected part of the hernial sac is stitched with a silk ligature, bandaged and cut off, the testicle is brought into the wound along with the rest of the hernial sac. The latter is excised and twisted around the testicle and spermatic cord, stitching it with rare interrupted sutures. If the hernial sac is larger, then it is excised over a large extent, leaving the peritoneum only on the spermatic cord and testicle. Plastic surgery of the inguinal canal in one of the ways.

A hernia is nothing more than a protrusion of internal organs through a pathological defect that forms in the tissues. Most often, patients with pathology in the abdomen become patients of the surgical department. In this case, intestinal loops or parts of other organs exit through the defect. Separately, spinal hernias are distinguished, which have a completely different clinic and the cause of formation. But abdominal hernias have many similar symptoms.

Abdominal hernias are more common than other types of protrusion

Almost all forms proceed for a long time without any complaints. At the same time, under certain conditions, a complication may arise, and the most common is infringement. The condition is an emergency and requires immediate surgery. Otherwise, peritonitis or sepsis, life-threatening conditions, may develop.

In order to determine the pathology in oneself, it is important, first of all, to find out what hernias are and how they manifest themselves. Protrusions differ in localization. Based on this, a symptom complex of one form or another is determined.

The most common are external hernias of the abdomen. Only ¼ is internal.

More common is an external hernia bulge

The main cause of the pathology is an increase in internal pressure. The condition of muscle tissue and connective tissue is also important. In men, an inguinal hernia is most often diagnosed, but in women, an umbilical hernia is common. There are other types of hernia in the groin and abdomen.

Inguinal hernia

As already mentioned, the most common in men are inguinal hernias. They can be acquired, but sometimes congenital forms are also detected. In this case, the defect is formed in the region of the inguinal canal. In some cases, in men, the hernial sac descends lower and reaches the scrotum. If the pathology develops in women, then there is a possibility of spreading to the area of ​​the labia.

There are two types of this pathology:

• Oblique - implies the passage of parts of organs through the anatomical opening, namely the inguinal canal. In this case, the diameter of the defect changes gradually. Accordingly, the initial, canal and inguinal form is distinguished. With progression, an inguinal-scrotal form or a straightened form may develop.

Inguinal hernia can be congenital or acquired

• Direct - in this case, the defect is located along the inguinal canal, that is, it does not pass through it. With this development, the organs do not reach the scrotum.

This pathology often proceeds without any clinic. The only complaint is the presence of a protrusion in the groin area. It will be characteristic that it increases during weight lifting. In children, this form is often congenital and is determined in the first months of life. By the year it can pass on its own. If it doesn't, the scheduled operation is performed. The hernia does not cause any discomfort to the child.

femoral hernia

No less often femoral hernias are diagnosed. But unlike the case described above, this form is more typical for women. In most cases, a bilateral defect is detected, but the presence of a right or left-sided defect is not excluded. The main difference between the form is that in this case the hernia is located in front of the thigh.

Uncomplicated femoral hernia goes unnoticed for a long time

Pathology also causes little discomfort, and only with an increase in size or the development of complications, pain appears.

Umbilical hernia

This form is especially often diagnosed in female patients. On the initial stage pathology in the absence of complications, the protrusion is easily reduced. At the same time, it is possible to palpate the edges of the hernial ring and assess its size. In the presence of a major defect, the following complaints appear:

• soreness in the protrusion area due to circulatory disorders and pinched nerve endings;
• nausea, and sometimes vomiting, due to impaired bowel function due to the fact that its loops penetrate the hernia ring;

An umbilical hernia is easily determined by palpation

• external changes in the form of a visually noticeable protrusion that interferes with the wearing of tight-fitting clothing.

Hernia of the white line of the abdomen

This form is more typical for men. Appears precisely in the area of ​​​​the position of the strip of connective tissue. It has minimal elasticity, and with tissue weakness or increased pressure, defects form first of all here.

Depending on where exactly the defect was formed, the following forms are distinguished:

• supraumbilical;
• paraumbilical;
• subumbilical.

Hernia of the white line of the abdomen to the touch is a soft protrusion

Pathology rarely worries patients. They are mainly treated due to the fact that a protrusion appears on the abdomen that is soft to the touch. With progression, pain, nausea, and stool disorders may join. In the hernial sac with a given location of the hernia, there can be both intestinal loops and adipose tissue. The last option is the safest.

Despite the fact that hernias in this area do not reach large sizes, they are often complicated by infringement.

When treating this form, it is important to note that it especially often occurs in parallel with diseases such as cholecystitis, peptic ulcer and so on.

A dangerous complication of a hernia can be infringement

Postoperative hernia

Separately allocated postoperative hernia. This pathology can be provoked by violations in the technique of performing the operation, infection of wounds, and so on. Also important is the condition of the muscular layer of the abdomen, compliance with all recommendations after surgery and the presence or absence of concomitant pathologies.

Such a hernia is determined especially easily. There is a scar in the protrusion area from a previous intervention. For certain reasons, it becomes thinner, the inner layers of muscle tissue weaken and internal organs penetrate through the formed defect. Especially often, according to this scenario, hernias develop in overweight patients, with reduced immunity, as well as against the background of pathologies of the digestive and respiratory organs.

Incisional hernias appear in immunocompromised patients

Internal hernia

If all of the listed hernias can be determined visually, then internal ones develop imperceptibly for the patient and are diagnosed only during a complete examination. For this, an X-ray or CT scan is prescribed. Of all the existing ones, the most frequently identified are diaphragmatic hernia when parts of the internal organs pass through the anatomical holes in the diaphragm. Specialists distinguish the following classification of abdominal hernias with an internal location.

rare forms

But this is not all hernias that can be diagnosed in a patient. Separately allocated muscle. In this case, the protrusion is formed in the area of ​​torn fascia. That is why this pathology is more common in people professionally involved in a particular sport. The reason for the gap may be:

• sharp blows to the muscles;
• excessive loads;
• consequences of surgical procedures;
• hereditary predisposition.

Muscle hernias appear with excessive physical exertion

Very rarely, hernias of the xiphoid process, obturator, perineal or sciatic are detected. They have their own characteristics and are quite difficult to diagnose:

• A hernia of the xiphoid process is formed in the area of ​​the anatomical opening next to the xiphoid process. Through it, the digestive organs can penetrate into the lung cavity.

Pathology is especially difficult in terms of diagnosis, since in its clinic and examination results it has many similarities with tumors.

• Obturator hernias occur in older women. Outwardly, such a pathology may not manifest itself in any way, but there are still some complaints. First of all, it is pain in the region of the obturator nerve. Often, pain radiates to the leg, groin.

Lumbar hernia is visually invisible and is detected only in a certain position of the body

• Lumbar hernia is also rare. Most often localized on the side of the abdomen. It is revealed only if the patient is laid on his side. In the position on the sore side, the defect is invisible.
• Sciatic hernias are more often noted right-sided. In this case, the defect is formed in the region of one of the three holes in the pelvic region. It is noteworthy that the form is found predominantly in men.
• Perineal hernia, on the contrary, is detected more often in women. Outwardly, it can be confused with the sciatic or inguinal. Accurate diagnosis is carried out by vaginal examination.

A vaginal examination is required to diagnose a perineal hernia.

All of these pathologies apply to adult patients, but children also have a hernia, and in this case it has its own characteristics. First of all, it can be congenital and acquired. The first are detected immediately in the delivery room, and sometimes it is possible to diagnose pathology using ultrasound even during gestation. But still, it is the acquired one that is detected in the first months of a baby’s life more often.

The most common are umbilical and inguinal hernias. The first are formed due to increased pressure and weakness of the ring. Detected during the first three months of life. Pathology manifests itself in the form of an increase in protrusion in the navel. This form does not cause the child much discomfort, provided that there is an uncomplicated hernia.

Inguinal are more typical for boys. In this case, there is a non-closure of the natural opening through which the organs penetrate the skin. Diagnosed predominantly oblique inguinal hernia. In the presence of such a disease up to 1-3 years, expectant management is carried out. Further, if the pathology persists, a planned operation is prescribed.

Inguinal hernias are more common in boys

Despite the fact that hernias in children do not cause much discomfort, they should definitely be consulted by doctors. The fact is that there is always the possibility of complications. With any hernia, it is a pinching, dangerous with peritonitis and tissue necrosis. Even the inguinal can have its own characteristics. So, it is often combined with a pathology such as dropsy of the scrotum, which also requires surgical intervention. Its need can only be determined by the surgeon.

The appearance of any changes, for example, an increase in protrusion, pain, redness of the skin, is an indication for an emergency visit to a doctor.

What causes hernias

So, there are many abdominal hernias, each of which differs in position, the likelihood of complications, and so on. But the reasons are often almost the same. Their clarification is an obligatory part of the diagnosis, since only by eliminating the causes it will be possible to completely get rid of the pathology. Even a timely operation can give a relapse of the disease if the causes of its development are not eliminated.

Patients with varicose veins are prone to hernias

There are two reasons for the formation of a hernia:

• tissue defect;
• increase in pressure.

These reasons can be attributed to almost any hernia. The tissue defect can be either congenital or acquired. Hereditary predisposition is especially clearly visible. It can be suspected by the presence of diseases such as varicose veins, hemorrhoids and flat feet. Acquired injuries include injuries, previous operations, illiterately planned workload.

An increase in pressure, as a rule, in the abdominal cavity occurs when there is both pathological processes, as well as physiological ones. The former include inflammatory processes, diseases of the digestive system, tumors, and so on. Physiological can be considered pregnancy, the process of childbirth, straining when emptying the intestines and sneezing.

There is a high risk of hernia during pregnancy

In the presence of tissue weakness, sometimes a prolonged cough is enough to form a defect.

When identifying a hernia, it is especially important to accurately determine the cause of its formation. If it is a chronic cough, then it should be dealt with in the first place, even before surgery. If there is a pathology associated with the failure of the connective tissue, then this problem should also be eliminated. In addition, this fact must be taken into account when drawing up a plan for the operation.

Establishing diagnosis

It is possible to determine a hernia both with the help of an examination and through instrumental research, but, for example, internal ones are detected only after a full examination of the patient. The diagnostic plan includes the following steps:

• questioning the patient for complaints;

Diagnosis of pathology begins with the collection of anamnesis

• assessment of hereditary burden;
• identification of concomitant pathologies;
• examination of the patient;
• palpation of the protrusion in different positions of the body;
• performing ultrasound, CT and x-rays.

Only on the basis of all the data it will be possible to make an accurate diagnosis. In this case, pathologies with similar symptoms should be excluded. First of all, these are tumors, lipomas, abscesses, lymphadenitis, dropsy, cryptorchidism, and so on.

An accurate diagnosis can be made after an ultrasound

Why treat a hernia

Hernia in most cases proceeds without complaints. Sometimes even a large protrusion does not cause discomfort, except for an external defect. But this does not mean that the pathology can not be treated. At any time, with a sharp movement, it may be pinched. As a result, the blood supply to the tissues is disrupted, which subsequently leads to tissue necrosis. This is accompanied by pain, nausea, weakness, and in the absence of timely assistance, symptoms of intoxication join.

A strangulated hernia, regardless of its position, is an absolute indication for surgery.

Treatment of pathology outside the stage of exacerbation or in the absence of complications can be performed in two ways:

• Conservative medicine is used in children under five years of age and in adults with contraindications to the operation. It consists in wearing a bandage, performing massage and exercise therapy. In this case, constant monitoring by a doctor is important.

Conservative treatment of a hernia involves wearing a bandage

• Surgical treatment is used in all forms. Only with its help it is possible to completely eliminate the defect, and with the right choice of technique for performing the intervention, it can also prevent the formation of a relapse. For this reason, the choice of a surgeon for hernia surgery should be especially careful.

Often, hernias are disguised as other pathologies, which greatly complicates the diagnosis. Therefore, if any discomfort or induration occurs, you should consult a doctor, and not wait for the onset of pain and other symptoms.

You will learn more about the types of hernias and the features of their treatment from the video:

Abdominal hernia - migration of internal organs under the skin or to other parts of the abdominal cavity as a result of a defect in the muscle layer. Hernias form at the weakest points of the abdominal wall. In the absence of complications, the protrusion is painless and easily reduced, unlike a complicated hernia. Treatment of pathology is possible only surgically.

What is a hernia of the abdomen

An abdominal hernia is a protrusion of organs located in the abdominal cavity through the anterior wall of the abdomen. In some cases, there is a movement of organs and intestinal loops into the lumen of the mesentery or diaphragm. Pathology is most often detected in men. This is about 80% of all cases. The remaining 20% ​​are women and children.

Classification

The classification of abdominal hernias is based on several features - anatomical, etiological and clinical.

Location

The following types of hernias are distinguished: external - the hernial sac extends beyond the anterior abdominal wall, internal - the organs move into the lumen of the mesentery or diaphragm, i.e., do not go beyond the boundaries of the abdominal cavity.

Localization

There are such types of formations as:

• inguinal;
• umbilical;
• paraumbilical;
• postoperative (typical for women);
• epigastric hernia (location area - midline of the peritoneum);
• ventral - located in the lower part of the anterior abdominal wall);
• femoral.

The volume of the hernial sac

For a complete hernia, the exit of the hernial sac with all its contents outside the anterior abdominal wall is typical. With an incomplete hernia, the hernial sac extends only beyond the abdominal cavity.

The choice of tactics to get rid of the problem depends on the type of hernia.

Reasons for development

There are many reasons for the formation of a hernia. But the main ones are considered to be the following: weakening of the muscular corset of the walls of the abdominal cavity, defects in the walls of the abdomen, caused by trauma or surgery. Factors that can provoke hernial protrusions include:

• age-related flabbiness of tissues;
• predisposition at the genetic level;
• sudden weight loss due to illness or an overly strict diet;
• the presence of extra pounds - all stages of obesity;
• overstretching of the walls of the peritoneum during gestation;
• difficult childbirth;
• prolonged cough;
• frequent constipation;
• playing wind instruments.

Provoking factors are any conditions accompanied by a sharp increase in intra-abdominal pressure. Therefore, the cause may be hard physical work or power sports. Sometimes the pathology develops for no reason.

Signs and symptoms

The symptoms of a hernia that has formed on the abdomen are quite specific, which allows you to quickly recognize the condition. This is a protrusion of the hernial sac - the formation can reach a significant size and soreness. Pain can appear at the beginning of the development of pathology. Increased during movement, as well as against the background of deep breaths, coughing. If the primary symptoms of abdominal hernia are standard, then such types as inguinal and perineal have characteristics.

Perineal hernia of the abdomen in women is accompanied by a feeling of pressure, heaviness and general discomfort in the rectal area, disturbances in the process of urination, skin defects in the area of ​​the hernial protrusion, pain when trying to take a sitting position, intestinal obstruction.

The formation of an inguinal hernia of the abdomen in men is indicated the following symptoms: the appearance of a round tumor in the scrotum or inside it, soreness, sensation strong pressure in the area of ​​the hernial sac, sharp, gradually increasing pain.

These signs allow you to differentiate the problem

Depending on the area of ​​localization of the hernia of the abdomen, there are specific signs. The clinical picture depends on which of the abdominal organs filled the hernial sac.

• Intestinal loops. The condition is accompanied by symptoms intestinal obstruction. There are constipation, bouts of nausea, acute pain. The body temperature rises.
• Bladder. Characterized by problems with urination.
• Hernia of the white line of the abdomen. Manifested as a protrusion of the anterior abdominal wall during tension, pain in the epigastric region.
• Navel. Signs of an umbilical hernia are bouts of nausea, soreness during palpation of the hernial sac.
• Groin. A hernia in this area is characterized by increasing pain in the groin and lower abdomen.
• Femoral hernia. A typical sign of pathology is an increase in pain in the lower abdomen when a person tries to fully straighten up. Problems with urination are not ruled out.

Help determine the type of hernia differential diagnosis. Diagnosis solely on the basis of current symptoms is unacceptable.

Features of pathology in childhood

Typical signs of the condition in children are soreness, discomfort, visible protrusion, which decreases in the supine position. Symptoms indicating the formation of a hernia are as follows: soreness in the area of ​​the protrusion, digestive problems - bouts of nausea ending in vomiting, stool fixation, urination disorders if the bladder is in the hernial sac.

Diagnostic studies

Inguinal, femoral and umbilical hernias are easily recognizable hernial tumors. But the perineal, sciatic and education in the region of the obturator foramen require clarifying studies.

A typical sign of a hernia is a "cough push". During a cough, the formation reacts to it with a tangible push, which is well felt with a palm applied to the tumor. Complementing the diagnosis is the possibility of digital examination of the hernial orifice.

To confirm a hernia of the white line of the abdomen, the following methods are used:

• x-ray of the stomach and duodenum;
• gastroscopy;
• radiology with the use of a contrast agent;
• Ultrasound education.

Treatment

Treatment of abdominal hernia in adults in most cases is performed surgically. Wearing a bandage is considered as a palliative way. It is practiced in case of impossibility of performing the operation due to age or other indications.

As a rule, uncomplicated hernias are operated on as planned. The patient is preliminarily full examination on an outpatient basis

The method of hernia repair in each case is selected individually. The choice depends on many factors, in particular, the form of hernia, pathogenesis, the condition of the abdominal wall and the volume of the hernial sac. As a preparation for the operation of ventral hernias, the patient is tightly bandaged for 2 weeks, which is the prevention of a sharp increase in intra-abdominal pressure.

Strangulated hernia requires urgent hospitalization of the patient. The hernia has to be removed during an emergency operation. The early postoperative period - the first two days - involves adherence to bed rest. In addition, the patient is recommended a diet, but it does not provide for serious restrictions. Foods that stimulate increased gas formation and can cause constipation are excluded from the diet.

Wear a bandage for one to two weeks and minimize any physical activity for the next 4 weeks.

Conservative methods

Conservative treatment regimens are practiced when it is impossible to perform an operation, in particular, in pregnant women. The patient is assigned to perform a special gymnastic complex and sessions of therapeutic massage, the use of a bandage, adherence to the principles of dietary nutrition, and medication.

Treatment of abdominal hernia in children

Most often in newborns, an umbilical hernia is detected. Its average size reaches 3–4 cm. Infringement of the formation is extremely rare. In this area, there are no muscles that can pinch the hernial sac during contraction.

Treatment of a hernia in newborn babies depends on the volume of education. Surgery is recommended in exceptional cases

To strengthen the muscle corset of the child, the baby should be laid out on the stomach as often as possible and perform gymnastics daily. If the recommendations are followed, by the third or fifth year of a child's life, the hernia will pass on its own. If the hernial sac has not disappeared by the age of 6, then the child will be recommended surgical treatment. Removal of a hernial formation in children is carried out at the age of 5-6 years. This is the optimal period.

There are a number of symptoms, with the development of which it will not be possible to avoid surgery. It:

• bloating, accompanied by an increase in the volume of the hernial sac and a change in its color;
• bouts of hematemesis;
• constipation, the presence of blood in the stool;
• inability to correct the protrusion;
• severe pain - they will be indicated by the crying of the child;
• increase in the size of the hernial sac;
• increased sensitivity of the navel, swelling.

Folk remedies

Treatment without surgery folk methods practiced if the implementation of surgery is not possible. It is important to understand that this format of therapy is a temporary measure to help alleviate current symptoms. You can do compresses.

Pour oak bark chips (1 tsp) with boiling water (200 ml) and cook in a water bath for 10 minutes. In the finished broth you need to soak soft tissue, squeeze out excess liquid and apply to the surface of the formation. The compress needs to be changed every 3 hours.

Lightly beat off a leaf of fresh cabbage and spread it with thick sour cream. Apply to the hernia, fix and leave overnight. The duration of the course is a full calendar month. Boil larch bark (5 tablespoons) with boiling water (1 l) in a thermos and leave overnight. In a warm infusion, a cloth is moistened, applied to the surface of the formation and covered with a film. From above they warm with a scarf and leave it all night. The compress is used twice a day until the pain is completely eliminated.

You can prepare means for oral administration. Kupena (2 tablespoons) pour milk (500 ml). Boil after boiling on minimum heat for 7 minutes. Infuse the product for 1 hour and filter. Drink 2 tablespoons four times a day. Pour clover (1 tablespoon) with boiling water (250 ml). Insist 1 hour and drain. Take 1/3 of a glass before meals.

Possible complications

Complications are formed in case of late appeal to doctors for help.

• Obstructive intestinal obstruction. It develops due to crushing or bending of the gastrointestinal loop (fecal infringement).
• Strangulation ileus. Accompanied by death and rupture of the intestine due to compression of the vessels of the mesentery and subsequent disruption of blood flow in the strangulated part of the intestine (elastic strangulation).
• isolated necrosis. The condition is characteristic of Richter's hernia.

A number of complications require urgent surgical intervention

Prevention

Prevention of congenital hernia is not possible, but to reduce the likelihood of development pathological condition can. Recommendations will be as follows:

• Rejection of bad habits. This is especially true for smoking. Since the almost constant cough that accompanies it causes a strong tension in the muscle layer of the anterior abdominal wall.
• Timely elimination of intestinal pathologies.
• Balanced diet. The menu should contain a lot of foods rich in vegetable fiber.
• Refusal or restriction of physically strenuous work.
• The fight against excess weight.

Prevention also becomes physical education, aimed at strengthening the muscular corset of the peritoneum. Newborns should not be swaddled too tight to avoid hernia formation.

Forecast

The prognosis for uncomplicated abdominal hernia is quite favorable. Timely surgical treatment allows a person to return to their usual way of life in the shortest possible time. Re-formation of the condition occurs in no more than 3–5% of all cases.

In the photo you see what a hernia of the abdomen looks like

The outcome of the infringement that occurred depends on two factors: the state of the organs in the hernial sac, the duration of the operation. If a person delays receiving surgical care, then even after a successful operation, a fatal outcome is not ruled out. Abdominal hernia is a serious pathology that can cause severe complications. That is why, when the first signs appear, it is necessary to obtain qualified medical advice.

“The navel is untied”, “the stomach is torn” - and in the 21st century you can find such statements among the population regarding this pathology. For many people, the diagnosis of "hernia" is heard, but few know what it means.

Consider what kind of disease it is and from what it appears. What are its symptoms, methods of diagnosis and treatment.

This is the protrusion of internal organs under the outer integument of the body or into another cavity through the “weak spots” of the anterior wall of the abdomen: defects in the parietal peritoneum, muscle aponeuroses, and tissues that have undergone surgery.

The internal organs "pave" their way to unusual places through natural or artificial, formed as a result of pathological processes, holes in the abdominal wall.

More often (up to 80% of cases), men suffer from this pathology, the remaining 20% ​​are children and women.

The main causes of the disease are:

• A sharp increase in intra-abdominal pressure.

This condition is provoked by frequent constipation, prolonged coughing, heavy physical exertion, straining during labor.

• Decrease in muscle tone and elasticity.

It occurs in the elderly, young children, with certain diseases. Also, a decrease in muscle tone is observed with low physical and motor activity, repeated pregnancies, and obesity.

• Congenital weakness and underdevelopment of connective tissue.

Often this is a hereditary predisposition, or one of the manifestations of systemic autoimmune pathologies.

• Congenital anomalies of development and delay in the formation of the anterior abdominal wall.

Developmental anomalies are visible to the naked eye immediately after the birth of the child, he appears already with existing congenital hernias.

• Postoperative complications.

The divergence of the edges of the tissues sewn during the operation or a defect in them.

What does a hernia look like on the abdomen

The above factors contribute to the fact that the internal organs - intestinal loops, the greater omentum, as well as any abdominal organ, exit through the weak points of the abdominal wall located in the navel, inguinal ring, and white line of the abdomen.

This leads to the appearance of a protrusion, bumps, roundness under the skin. The newly appeared formation increases in size with straining, laughing, coughing, crying, and decreases in the supine position.

If the process is not complicated, then the protrusion can be set with the fingers, but with movements and slight physical effort it reappears.

The resulting hernia has the following components or anatomical elements:

• The gate is an opening in the aponeurosis, fascia, muscle, through which protrusion of organs occurs outside the abdominal cavity.
• The hernial sac is a part of the peritoneum that exits through the gate along with the insides.
• Contents - a large omentum or a small, sigmoid colon, bladder, uterus and its appendages, as well as any mobile organ located in the area of ​​​​the hernial sac.

If the contents are completely reduced back through the gate into the abdominal cavity, these are reducible hernias.
If the insides can only be partially corrected or not at all - irreducible.

If the contents get stuck at the exit site, we are talking about strangulated hernias that require urgent surgical intervention.

What are abdominal hernias

There are several classifications of this broad concept.

According to their origin, they are:

• Congenital.
• Acquired. From effort and increased intra-abdominal pressure, postoperative, traumatic, associated with muscle atrophy.

By clinical course:

• Uncomplicated (reducible).
• Complicated (irreducible, restrained).

By localization:

• External - swelling formations, often rounded, visualized under the skin.
• Internal - protrusions occur deep into the chest cavity or into pockets, peritoneal crevices.

Depending on the localization of the pathology relative to the anatomical formations on the patient's body, the following types of hernias are distinguished:

Inguinal

They occupy a leading position among other types of pathology - up to 76% in the structure of all hernias, the male sex accounts for 90-97% of all cases of their development in the inguinal region.

They are congenital - with non-closure of the vaginal process of the peritoneum and are more common in children, as well as acquired:

• Oblique - pass through the external inguinal fossa, more typical for children and middle age.
• Straight - pass through the internal fossa, are located at the root of the scrotum above the inguinal ligament in the form of a rounded formation, are often bilateral, especially in old age.
• Sliding - they have an organ (bladder or caecum) as one of the walls of the hernial sac, when they occur, urination or defecation disorders, frequent urges, and pain may occur.

Inguinal protrusions occur suddenly, often against the background of excessive physical exertion, or form gradually. On examination, they are better visualized when the patient is in a vertical position; in a horizontal position, uncomplicated hernias can be easily reduced.

To clarify the diagnosis after reduction, the doctor necessarily conducts a digital examination of the inguinal canal, with a hernia, its ring and walls will be significantly stretched.

femoral

In the general structure, they occupy 5-7% and are more common in women due to the lower strength of the inguinal ligament and the better anatomical severity of the vascular and muscular lacunae.

The semicircular shape and location along the inner surface of the upper third of the thigh under the inguinal ligament are most characteristic of this type of formation.

umbilical

They often occur in children of the first six months of life due to underdevelopment of the abdominal wall and weakness of the transverse fascia; they also occur in adults.

Predisposing factors contribute to the disease in childhood: prolonged crying, crying, diseases that can lead to an increase in intra-abdominal pressure (whooping cough, diphtheria).

feature this disease in young children is the possibility of self-healing before the age of 3-4 years, this is due to the development and strengthening of the muscles. In adults, pineal protrusions in the navel appear more often with repeated pregnancies, the absence exercise and training of the abdominal muscles, with severe obesity.

You should be wary when diagnosing a formation in this area: sometimes a node in the navel area can be a metastasis of stomach cancer. Therefore, diagnostic measures for the differentiation of pathology should be carried out in full.

Hernias of the white line of the abdomen

In 60% of cases, they occur in men due to the weakness of the aponeurosis, there are gaps in it filled with adipose tissue, through which internal organs easily pass under the skin.

They can be supra-, sub-, and paraumbilical. Accordingly, the hernial contents may bulge above, below, or right in the center of the navel.

Traumatic and postoperative

Postoperative formations occur in the scar area due to:

• Divergence of the edges of the stitched aponeurosis.
• defect in it.
• Suppuration of the wound.
• Excessive physical exertion that is unacceptable in the postoperative period.

The exit of internal organs can occur due to trauma and rupture of muscles, fascia, aponeurotic layer.

Rare species

• Hernia of the xiphoid process - are formed due to a defect in the final section of the sternum.
• Lateral (lunate line) - arise due to a defect in the part of the aponeuroses transverse muscle and the outer edge of the rectus abdominis.

The classification of this pathology is very extensive, but it will not be difficult for an experienced surgeon to diagnose the disease, both by its external manifestations and by clinical symptoms.

Lateral hernia

Refer to rare species and they also have the name of a hernia of the lunate (spigelian) line. This line passes through the aponeurosis of the transverse abdominis muscle and the edge of the rectus muscle. It is in this area that the entrance gate is formed and the contents emerge.

A feature of the pathology is that the hernial sac is located not subcutaneously, but under the aponeurosis of the external oblique muscle of the abdomen, i.e. in fact, it is an interstitial formation.

Often these bulges are confused with tumors of internal organs and other pathologies; diagnosis can be difficult.

Internal hernia

Pathology in which the internal organs move in the abdominal cavity into pockets, crevices and openings of the parietal peritoneum, or into the chest cavity (diaphragmatic hernia). The place of exit of the hernial sac may be the gaps of the peritoneum that were not sutured during the operation.

The symptoms of this type of protrusion are similar to the clinic of acute intestinal obstruction (it is with this diagnosis that patients most often end up on the operating table): sharp cramping abdominal pain, vomiting, bloating, impaired peristalsis, stool retention and gas discharge.

Symptoms and signs of abdominal hernia

The clinical picture of this disease may depend on whether the disease is complicated or not.

Symptoms of an uncomplicated hernia

The main complaint in patients with an uncomplicated pathology is the presence of an uncharacteristic protrusion on the abdomen. It is usually painless, rounded, soft elastic consistency, pliable.

Its dimensions increase in the standing position, when the patient assumes a horizontal position, the formation can spontaneously disappear or be painlessly reduced by light pressure of the fingers.

With an increase in intra-abdominal pressure: laughing, coughing, crying, straining - the protrusion takes its previous position and may increase slightly in size.

Patients may complain of discomfort when walking, pulling, aching pain. If the formation is formed abruptly with excessive physical activity, at the time of the release of the cargo contents, patients note a short-term severe pain in the area of ​​​​the resulting protrusion.

Symptoms of a strangulated hernia

If an infringement occurs in the hernial orifice, an acute surgical pathology develops with bright clinical picture. A condition in which you can not hesitate, but you need to urgently deliver the patient to the surgical department.

There are 5 main signs by which infringement can be suspected:

• Sharp pain.
• Irregularity of content.
• Tension, protrusion seal.
• Lack of transmission of a cough impulse - if the patient is asked to cough, then the impulse is not transmitted to the protrusion.
• Severe pain on palpation.

If one of the above signs appears in patients with a previously uncomplicated pathology, you should immediately contact a surgeon.

How does a hernia hurt

The pain syndrome experienced by the patient can be different in severity. The exit of the hernial sac will be accompanied by intensive, severe pain, if it is formed extremely quickly at the moment of transcendental physical effort, injury to the abdomen.

With an uncomplicated process, there is no pain as such, discomfort or pulling discomfort may occur when walking, laughing, coughing in the area of ​​swelling.

The development of infringement leads to the occurrence of unbearable, cramping pains that become constant, excruciating. The patient does not find a place for himself, tosses about in bed. Any attempts to touch the enlarged, tense, dense protrusion intensify the already sharp pain sensations.

If the hernia is formed gradually, in old age, getting used to unpleasant moderate manifestations of pain, patients may not complain of soreness or discomfort.

Diagnosis of the disease

The diagnosis is established on the basis of an assessment of the symptoms by a doctor, examination, palpation.

Of the instrumental methods use:

• Plain radiography of the abdominal organs.
• X-ray of the passage of barium through the intestines
• OBP ultrasound.
• CT scan of the anterior abdominal wall.

In severe, complicated clinical cases, doctors resort to endoscopic examination and perform diagnostic laparoscopy.

But it is often not difficult for experienced surgeons to diagnose external hernia already according to the results of an external examination, palpation and questioning of the patient.

Treatment of the disease

The main method of treatment is surgical. It is surgery that prevents the development of complications: infringement, inflammation.

The exception is: up to 3-4 years, conservative treatment is possible. Bandages with a pelota are used, frequent laying out of babies on the tummy.

In patients for whom, for one reason or another (late pregnancy, pathology of the heart, lungs, kidneys in the stage of decompensation), surgical intervention is delayed or contraindicated, it is recommended for umbilical hernia wearing a bandage, which serves as a mechanical protection for the released internal organs, prevents their further advancement or infringement.

In all other cases, with uncomplicated pathology, a planned surgical intervention is performed. If the disease is complicated by infringement, the operation is performed on an emergency basis.

Operations to remove a hernia

There are certain stages of surgical intervention for uncomplicated hernias:

• Exposure of the hernial sac, its dissection.
• Separation of the formation from the surrounding tissues and its opening.
• Reposition of contents into the abdominal cavity.
• Cut off the bag.
• Plastic surgery and strengthening of the abdominal wall near the exit gate with local tissues or special materials (mesh).

Access to the intervention site can be classical or laparoscopic (currently most often used for inguinal and femoral formations).

Endoscopic minimally invasive interventions are less traumatic, easier to tolerate, and allow the patient to quickly return to normal life and recover after surgery.

If the patient has developed complications, the prolapsed and strangulated intestinal loops have become dead, then the volume of surgical intervention increases significantly: surgeons will not only have to get rid of the hernia, but also determine the viability of the intestine, resect dead areas, and restore the integrity of the organ. This is enough complex operation requiring high qualification of medical workers.

Plastic or restoration of the strength of the aponeurosis, fascia and muscles in those places that turned out to be weak and through which the internal organs fell out, is carried out both with their own tissues by stretching and stitching them, and with special surgical meshes.

The use of polypropylene meshes in hernioplasty has proven itself because:

• Differs in high durability and reliability.
• Does not dissolve or break down.
• Does not cause rejection by the body.
• Hypoallergenic.
• Reduces the percentage of recurrences of hernias.
• Performs the function of mechanical protection for life.

For each type of pathology, surgical interventions have been developed that have their own characteristics and techniques. The scope and choice of surgical treatment, the tactics of plastic surgery and its method, is determined by the attending physician on an individual basis.

Treatment with folk remedies

Many patients are afraid of surgery and try to turn to alternative medicine in the hope of getting rid of this ailment. Such methods of treatment in this case are not justified and risky.

It is not worth delaying a visit to the doctor, because the disease at any time can be complicated by infringement - an emergency condition that, without surgical intervention, can cost a life.

Folk remedies as symptomatic therapy are allowed only if the doctor, for one reason or another, temporarily does not recommend the operation, and also if the specialist has "given the go-ahead" for the use of methods from the people.

• Sheet sauerkraut apply to the affected area, preferably overnight.
• Grass hernia 100g. steam with boiling water and leave for about 2 hours. Apply steamed grass in the form of a compress to the bulging area.
• Wrap oatmeal boiled in water in cheesecloth and apply to the place of protrusion overnight. Repeat at least 5 times.
• Drink once a day on an empty stomach a glass of boiled water with the addition of a tablespoon of linseed oil.
• Grind plantain seeds, steam with boiling water, drink 1 tablespoon 3-4 times a day for three weeks.

If the patient decides to try one or another method on himself traditional medicine, then it is imperative that you first consult with your doctor so as not to cause more harm to the body instead of benefit.