Hernia belly: treatment, surgery, prevention
The hernia of the white line is the protrusion of fragments of adipose tissue or internal organs through the defect of the white line of the abdomen, which consists of connective tissue fibers of the muscular fascia and extends from the sternum through the navel to the pubic region.Table of contents:
Causes of a herniated white abdominal line
To understand why the hernia of the white abdominal line appears, the structure of the anterior abdominal wall should be presented. It consists of several layers - if viewed from inside the abdominal cavity to the outside, it is:
- peritoneum - connective tissue film covering the abdominal wall from the inside;
- preperitoneal tissue;
- transverse fascia is a layer of connective tissue that strengthens the abdominal wall;
- abdominal muscles, each of which is covered with connective tissue fascia;
- subcutaneous fatty tissue - its thickness is very different for different people;
All layers, in addition to connective tissue, are rather flimsy - the main role in strengthening the anterior abdominal wall is played by connective tissue elements.
There is no muscle along the median line of the anterior abdominal wall.At this point, the fascia-cases of muscular arrays of the right and left halves of the abdomen are connected. The connection point forms a kind of string in the form of interlocking connective tissue fibers - this is the white line of the abdomen .
It takes part in strengthening the anterior abdominal wall, due to which a person can lift weights( bars, heavy bags from a store, etc.), strain the abdominal press in other cases - all without fearing that in this place throughThe abdominal wall will bulge the abdominal organs.
The white line throughout its entire length is not the same:
- in the direction from the sternum to the navel is wider, but thinner in anteroposterior direction;
- in the direction from the navel to the pubic joint( pubis) - narrower and thicker.
Normally, the width of the white line of the abdomen does not exceed 3 cm. In patients with herniations of the white line, it can reach 10 cm or more. Because of the weakness of the connective tissue lintels of the white line of the abdomen, a discrepancy of the straight muscles develops, which pass on both sides of the midline of the abdomen.
The fragile white line above the navel is more vulnerable when the tension of the press is - the probability of a hernial protrusion in this place is higher than the lower umbilicus.In many cases, the hernia occurs as much under the breastbone.
The main immediate cause of the appearance of hernias of the white line of the abdomen is its weakness, which manifests itself in inadequate physical exertion.This pathology occurs predominantly in men under 30 years of age:
- only started to engage in the gym, but hurrying immediately to overcome the intense physical stress that leads to the strain of the weak abdominal line, the spreading of its fibers and the penetration of fatty tissue and internal organs between them.
Factors that contribute to the attenuation of the white line of the abdomen:
- genetic predisposition to thinning and weakness of connective tissue elements;
- overweight( from 5 extra pounds and more);
- postoperative weakness of anterior abdominal wall.
Any cause that leads to an increase in intra-abdominal pressure is a risk factor for a hernia of the white abdominal line. First of all it is:
- excessive physical activity in the gym;
- work associated with constant lifting and transferring gravity;
- sharp lifting of gravity in the home;
- prolonged delivery;
- chronic constipation;
- respiratory diseases accompanied by a persistent cough;
- accumulation of free fluid in the abdominal cavity;
- frequent injuries of the anterior abdominal wall.
How the hernia of the white abdominal line develops
If the fibers of the white abdominal line do not withstand the pressure increase from the abdominal side, then:
- they part;
- in them micro-bursts are formed.
Over time, these gaps increase in size.Since pressure in the abdominal cavity periodically grows, because of this, its structure( intestine, large omentum) rushes to the place of least resistance.
The lower towards the pubic, the less likely a hernia will be.
Often, when the hernia of the white line of the abdomen is formed gradually, patients can not present any complaints. Sometimes such a hernia is "worn" for years, while not feeling any pain, no discomfort, or abnormalities from the abdominal organs.It happens that patients do not even suspect that they have developed a hernia. It can be detected by chance, when you go to a doctor for something else - especially for overweight patients.In some patients in the early stages of the disease hernial protrusion can be formed only with straining and physical exertion, and in a state of tranquility is not observed.
Symptoms in the abdominal hernia:
- painful protrusion of the midline of the abdomen;Soreness is explained by the fact that in the hernial gates the nervous branches of the preperitoneal fat are trapped;
- nausea and vomiting;
- pain in the place of a hernia with sharp or clumsy movements, bends of the trunk, slopes;
- tenderness at the point of protrusion after eating( especially abundant);Belching; heartburn;
- less often - hiccups( convulsive contractions of the diaphragm).
As the hernia of pain at the site of its localization can vary, from blunt noon, in the form of slow attacks of moderate intensity to prolonged aching strong.Sometimes patients even complain of pains of a "dagger" character.
The following signs indicate the deterioration:
- blood separation during defecation;
- pains increase, become intolerable;
- frequent vomiting;
- inability to direct the contents of the hernia into the abdominal cavity.
Three stages of are identified during the course of the disease:
- formation of lipoma;
- initial stage;
- formed hernia.
First through the defects in the white line of the abdomen penetrates the fatty tissue. The hernial sac starts to form in the next stage - the initial one. At the initial stage, fragments of the intestinal loop or large omentum may appear in the hernial sac.
A full hernia is formed during the third stage - the cleft in the white line turns into full-fledged hernia gates oval or round( in diameter they sometimes reach 10-12 cm), a seal appears and grows in size( initially simply sensitive, then painful). With the total weakness of the white line of the abdomen, multiple hernial structures are often found along it.
Hernia belly white line in most cases does not cause subjective discomfort( if you do not take into account some soreness), patients can "wear" it for a long time, while leading the usual way of life . More unpleasant complications of a hernia:
- inflammation of the hernial sac;
Inflammation of the hernial sac comes about because of its regular irritation( for example, if the clothes are locally pressed).It can be:
- with attachment of an infectious agent.
In both cases, hernial protrusion:
- increases due to tissue edema;
- the skin above it becomes red, hot to the touch;
- is aggravated by soreness.
With progression, suppuration of the hernial sac and its contents is possible.
Coprostasis( stool retention in the intestine due to the ingress of its loop into the hernial sac) with a hernia of the white abdomen is rare.It is observed if the hernial gates reach a large size and pass a loop of the large intestine into the sac.
Infringement is the most dangerous complication of a hernia. The :
- can break into the wall of the intestinal loop( the so-called wall infringement);
- intestinal loop;
- fragment of the large stuffing box.
The mechanism of infringement is simple.Herniated gates are not elastic, they are not able to contract and hold in the bag a fragment of a large omentum or a loop of the intestine.But because of a prolonged stay in the hernial sac, its contents swell, it becomes tight in a small space, and the hernial gates begin to press on it. Because of pressure, the blood supply and innervation of the contents of the hernial sac are impaired, their oxygen starvation occurs, and then the necrosis of the compressed fragments of the intestine or the large omentum.
The signs are indicative of the infringement:
- are common.
Local symptoms of abrasion of the hernia of the white line of the abdomen:
- sharp increase in pain in the area of the hernia;
- strain of hernial protrusion, which can be determined by touch and visually;
- inability to direct a hernial protrusion into the abdominal cavity even in a horizontal position, a sharp pain when trying to restore;
- stiffness of the abdominal muscles in the area of the hernia( they become firm to the touch).
- pallor of the skin;
- occurrence of pain throughout the abdomen;
- abruptly comes nausea, which is immediately accompanied by vomiting;
- presence of blood in the stool;
- inability to recover;
- increased body temperature;May occur as a reflex response of the body, but if the temperature rises to 38-39 degrees Celsius is a poor prognostic sign that indicates an organism's intoxication, which develops due to the necrosis of the contents of the hernial sac and the absorption of necrotic products into the blood.
Even if the infringement of the hernia seems insignificant, it still represents a danger to the life of the patient - irreversible changes in the affected fragments can occur very quickly.
In most cases, the diagnosis of a hernia of the white line of the abdomen does not represent difficulties - hernial protrusion:
- is determined visually during examination of the midline of the abdomen;
- is felt in the patient's calm state or when performing actions that lead to an increase in intra-abdominal pressure - coughing, straining.
Diagnosis can be difficult with excessive patient weight. In this case, to detect the hernia, it is necessary to completely expose the anterior abdominal wall and to study literally every half a centimeter.Sometimes such a hernia can be detected with a narrow thin hard object, which will help to grope hernia gates.
Operation with a herniated white abdominal line
Radical relief from the belly of the white abdominal line can only be achieved with the surgical method in the surgical hospital. Any conservative methods( wearing a bandage, attaching coins to a hernia, rubbing bulging with various drugs, lotions, ingesting folk "protivogryzhevyh" means, manual therapy, breathing exercises, etc.) do not give any effect, and sometimes they can even aggravate the situation and causeComplications. The hernia of the white line of the abdomen is a consequence of a physical defect in the tissues, which, under the influence of these methods, used by patients who do not lose hope, will not overgrow.
The operation to eliminate the hernia of the white line of the abdomen is called hernioplasty. Approximately 300 varieties of such operations have been developed, but only the attending physician( operating surgeon) can choose an option suitable for a particular patient, taking into account the tissue properties, the structure of its anterior abdominal wall and the features of the white abdominal line.
- the contents of the hernial sac are inspected and inserted into the abdominal cavity;
- removes tissues that have formed a hernial sac;
- the location of the defect is strengthened so that there is no re-occurrence of a hernia.
Strengthening of the compromised area of the abdominal cavity can be performed using:
- of the patient's own tissues;
- specially designed artificial materials that cover the defect, like patches.
Advantage of the patient's own tissues for plastics:
- rapid engraftment due to the natural composition;
- no risk of rejection.
- weakness of own tissues and, as a consequence, the possibility of relapse;
- with large hernias of biological material may not be enough to cover the defect.
In surgery, synthetic prostheses and nets are increasingly used to strengthen hernial defects.
Materials for them are designed to ensure that they do not cause an allergic reaction of the body.Over time, such prostheses and nets germinate with a connective tissue so that it is impossible to distinguish them from biological tissues.
Advantages of artificial "patches":
- strength, as a result of which the possibility of developing relapse is significantly lower than when strengthening the hernia with the patient's own tissues;
- the ability to strengthen tissues at any size of the defect.
- individual intolerance may occur.
Hernioplasty is performed routinely, but without delay, to avoid complications of a hernia that may occur at any time. With an injured hernia, surgical intervention is carried out urgently - first remove the necrotic tissue, then perform strengthening of the anterior abdominal wall in the place where the hernia appeared.
The operation can be performed using one of the following methods:
- open method;
- with a laparoscope;
- using paraperitoneal technique.
Open method( with a traditional incision of the anterior abdominal wall) is used when:
- can not apply other methods;
- large hernias;
- complicated hernias.
With laparoscopic operation , the surgeon makes several holes in the anterior abdominal wall, through them, using a laparoscope, removes the hernial sac, introduces and fixes the "patch" - the reticular prosthesis.
Thanks to laparoscopic technique:
- hernioplasty is less traumatic than usual surgery;
- , the risk of recurrence of hernia is minimized( as there will be no weakness in the anterior abdominal wall that occurs after large incisions);
- requires less time and effort for postoperative patient recovery.
After laparoscopic surgery, the rehabilitation period is reduced to ten days, after which the patient can return to the usual way of life( but with measured physical loads).
With paraperitoneal intervention , the peritoneum, as with traditional laparoscopy, is not punctured, the abdominal cavity remains uninvolved in the operation.
Advantages of the method:
- are the same as for laparoscopy( no incision, less rehabilitation period);
- surgical instruments are not inserted into the abdominal cavity, its structures are not injured.
- implementation difficulty( in particular, the introduction and fixing of the "patch").
Gerniopastiku perform anesthesia, in the absence of complications, the operation lasts an average of 1 hour.Sutures are removed for 7-8 days( sometimes according to indications - by 10-12).
If infringement of the hernia leads to necrosis of the tissues, and this, in turn, provoked intoxication of the body-conservative therapy is also carried out, which includes: parenteral administration of antibiotics;
- infusion therapy - parenteral administration of saline solutions, protein preparations, if necessary blood components;
- general restorative( including vitamin-) therapy.
Rehabilitation period after removal of a hernia of the white line of the abdomen
In order not to spoil the effect achieved by the operation, after it the patient should adhere to the following recommendations:
- wear an abdominal bandage( the duration of wearing will be determined by the doctor);
- in the first 2-3 months avoid physical exertion, especially weight lifting;
- 2-3 months after the operation should begin to perform exercises that will help strengthen the abdominal muscles.It is not recommended to select the exercises yourself - you should consult a physician at the exercise gym;
- even if the hernia has been successfully operated, but the patient has a problem of excess weight, it must be urgently eliminated;
- adheres to specially developed food rules.
- The food should be fractional, small portions, 4-5-6 times a day;
- should avoid products that provoke gas and constipation;
- the diet should include non-rough and fiber-free, easily digestible products;
- recommends the use of soups, liquid porridges and mashed potatoes.
The warning of the hernia of the white line includes the following measures:
- physical activity dosing, in which the abdominal press is operated, in proportion to its own physical fitness;
- Avoiding weight lifting;
- regular exercise classes to strengthen the abdominal muscles( morning exercises, exercises in the gym);
- adherence to the principles of a balanced, healthy diet that would facilitate regular bowel movement;
- revealing the causes of excess kilograms and normalizing body weight;
- timely cure of diseases accompanied by cough;
- Avoiding injuries to the anterior abdominal wall;
- implementation of all recommendations of doctors( including the use of abdominal bandage) during pregnancy and during the postoperative period;
- wearing an abdominal bandage.
Abdominal bandage is an elastic knitted tape up to 20 cm in width.It is attached to the elastic pad, which is placed in the area of the hernial protrusion.
The bandage does not heal a hernia.With prolonged wearing, on the contrary, it can help to create it , since it begins to perform the function of abdominal muscles, which, as a result of inactivity, weaken, diverge even more, which promotes the appearance of a hernia.
Wearing a bandage is recommended in the following cases:
- to people with untrained or weakened( eg, after a prolonged recumbency) abdominal muscles;
- to hard manual workers;
- for weightlifting professionals;
- during pregnancy;
- in the postpartum period;
- in the stage of lipoma;
- before surgery for a hernia to prevent bulging;
- after operations to maintain weakened abdominal muscles( to prevent re-development of the disease) and reduce pain in the seam area;
- if there are contraindications to the surgical treatment of the herniated hernia( in particular, in weakened patients, elderly people and patients who are contraindicated for surgical intervention for health reasons - for example, in severe cardiovascular diseases).
In order for the bandage to help, rather than do harm, it is necessary to take into account such recommendations:
- should be worn in the reclining position;
- it is necessary to correctly regulate the coverage of the abdomen with a bandage - so that it fits tightly around the body and delicately presses hernial protrusion, but does not press on the tissue and does not cause inconvenience;
- with the already formed hernia, hernia protrusion before putting on first need to be moved lightly into the abdominal cavity, then put on the bandage; is categorically contraindicated for repositioning by putting on a bandage;
- pads to place in the area of the hernial protrusion.
With a timely detection and surgical treatment of a hernia, the prognosis is generally favorable. In case of non-observance of medical recommendations, relapses of a hernia of the white abdominal line occur in 25-40% of cases.
If the prediction is more severe, the outcome depends on the timeliness of the operation.
Kovtonyuk Oksana Vladimirovna, medical reviewer, surgeon, consulting physician