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Inguinal hernia: symptoms, causes, surgery to remove

Inguinal hernia - the process of entering the inguinal canal of the abdominal cavity, covered with a parietal( parietal) leaflet of the peritoneum.This loss occurs through a congenital or acquired breach of the abdominal wall.In men, the hernia emerges into the scrotum, and in women - into the subcutaneous space around the large labia.

The most common inguinal hernia is observed in children.Most of all it affects the boys.Usually it protrudes from one side.This happens 3 times more often on the right than on the left.After 10 years, the disease develops rarely.The main surgical complication of the "acute abdomen" is precisely the injured inguinal hernia.

Contents: About the structure of the inguinal canal Mechanism of development of congenital inguinal hernia How does the acquired inguinal hernia arise Varieties of inguinal hernia Symptoms of inguinal hernia, how outwardly it looks What is an inguinal hernia detriment Diagnosis and examination of inguinal hernia Treatment of inguinal hernia
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About the structure of the inguinal canal

Image 2427

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

In the appearance of a hernia, a special role is played by a specific anatomical formation - the inguinal canal, which accepts hernial contents.This is a small gap( about 4.5 cm), located in the groin between the muscles, connective tissue fascias and ligaments.Its origin lies in the abdominal cavity, then it goes forward, down, inside.And the external opening is located outside the groin, surrounded by a strengthening group of muscles.Women have a round uterine ligament in the area of ​​this canal, men have elements of the spermatic cord, including vessels, nerve tissue, vas deferens.

Image 2428

Mechanism of development of congenital inguinal hernia

Testicles in male embryos develop in the abdominal region.Their habitual location during the first three months of pregnancy is behind the peritoneum.Toward the fifth month, the emerging testicles begin to descend and approach the entrance to the inguinal canal, enter it and, until the seventh month, slowly move along it, forming the so-called "vaginal process".With normal development on the ninth month, the testicles of the boy completely enter the scrotum together with the stretched peritoneal "pocket" that keeps the message to the abdominal cavity.

When a child is born, it "closes", then grows.But sometimes there is a malfunction, and the passage from the abdomen to the scrotum remains open.This anatomical defect is the first "bell", signaling the possibility of inguinal hernia development.With increasing intra-abdominal pressure, the loops of the intestine and even some organs may fall into this process.

Pahovaja-gryzha-u-detej1

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

Congenital inguinal hernia is a defect of the developing fetus.It has been formed since birth.

Image 2429

How the acquired inguinal hernia

Acquired inguinal hernia appears due to heavy loads and due to abdominal pathology, its weakening.

The factors contributing to the emergence and development of hernias are:

  • premature pregnancy, as a result of which the vaginal process with other organs has not yet completed its development cycle and has remained "open";
  • heredity, the presence of a hernia among family members and close relatives;
  • presence of anatomical weakness of abdominal wall muscles;
  • is overweight, causing increased stress on the abdominal organs;
  • injuries in the groin, which provoked loosening of the ligament apparatus;
  • severe emaciation.The absence of fatty interlayers in the canal leads to the formation of empty volumes, into which the outer layer of the peritoneum can be pushed;
  • pregnancy, which often results in increased intra-abdominal and mechanical pressure on the organs, intestines, which promotes the formation of a hernia;
  • hypodynamia, in which flabby and atrophied muscles are unable to perform their functions, as a result of which the peritoneum, without encountering muscle resistance, can be "pushed" into the channel;
  • physical overloads, creating a constant increased pressure in the abdominal cavity;
  • is a chronic, severe cough, providing additional stress on the "weak" sites of the peritoneum;
  • bowel disease, accompanied by permanent constipation, which also cause an increase in pressure.

Varieties of inguinal hernia

Disease is classified according to the location of the hernial sac.

Pathology:

  • inguinal - hernia enters the inguinal canal, but does not extend beyond the level of the external opening;
  • - the hernial contents descends into the scrotum, reaching the spermatic cord;
  • inguino-scrotal - the hernial contents reach the level of the testicle( it happens only in men);
  • Types-inguinal hernia oblique - in this form the contents of the hernial sac pass through the entire inguinal canal.In men, the seed cord enters its structure along with the vas deferens and vessels.Can be congenital and acquired;
  • straight - passes into the inguinal canal, without touching the inner hole, through the abdominal wall, directly from the inguinal fovea closer to the midline.It occurs in men and women, usually as a result of overexertion;
  • combined - is rare.Consists of 2 or more hernial sacs on one side.Each hernia has its hernial gates.The oblique and direct protrusion is most often observed;
  • interstitial direct hernia - the second version of the name - subcutaneous.Hernial protrusion is located in the structure of the external oblique muscle.Hernia does not fall into the scrotum, but enters the subcutaneous tissue of the aponeurosis of the external oblique muscle.The hernial sac is defined on the thigh, in the perineum;
  • sliding is the most dangerous kind.It is characterized by an additional protrusion of the inner peritoneum.It is formed both from the parietal peritoneum and from the visceral tissues covering the slipping organ.In the hernial sac, not only the small intestine, but also the cecum, the bladder wall, the uterus, the tubes, the ovaries, and other organs can enter.

organs Symptoms of inguinal hernia, as it looks

The main features are:

  • Appearance in the groin groin area, increasing with coughing, sneezing, any physical strain, and also when in the vertical position.
  • The available swelling in most cases when you press it with your fingers returns to the cavity of the peritoneum.At the same time, a characteristic rumbling is heard.
  • Pain usually does not.Sometimes it can appear in the groin and irradiate( give) to the lumbar region.
  • When the fallopian tubes or ovary develop, tenderness in menstruation.
  • With the sliding form of inguinal hernia, an exciting bladder - symptoms of dysuric disorders( abdominal pain, frequent and( or) painful urination).
  • If you get into the hernial sac of the cecum - flatulence, rubbers, constipation
  • When forming the inguinal and scrotal form of the hernia - an increase in the scrotum from the side of the formation.

In the supine position, the hernia is hiding and outwardly becomes invisible.

What is the infringement of the inguinal hernia

This is one of the most unpleasant and frequent complications of the disease.The intestinal tract( or the fallopian tube and ovary in girls and women, the spermatic cord in boys and men) that are trapped in the inguinal canal becomes a violation of trophism and blood circulation, which can subsequently provoke tissue necrosis( dying).

The causes of this situation can be problems in the work of the intestine, flatulence, a sudden overstrain with increased pressure in the intraperitoneal space.

The patient has complaints about:

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

In this case, after the examination of the doctor, immediate hospitalization and surgical intervention is required.

Diagnosis and examination of inguinal hernia

Any suspicion of a hernia that appears is an occasion to appeal to a surgeon.

A doctor in the position of a patient standing examines hernial protrusion, conducts his palpation, makes a test with straining, then a cough test.Assesses the symptom of the push.Finger research finds the outer opening of the canal.Sometimes this hole can be determined without hernial sac, in surgery this symptom is called "weak groin".

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

Very important information can be obtained by X-ray examination with the introduction of contrast medium.Irrigoscopy( examination of the large intestine) and cystoscopy( X-ray imaging of the bladder) are also performed to clarify the location of the intestinal hernia.

Treatment of inguinal hernia

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

Operative treatment is not performed:

  • to attenuated patients in senile age;
  • for severe depletion( cachexia);
  • in case of serious diseases;
  • during pregnancy;
  • for preventing the return of a hernia after removal.

Treatment and prevention of inguinal hernia by wearing a bandage

Image 2430 In case of existing contraindications, a bandage is worn.Also this type of treatment is shown with a preventive purpose to people who, by the nature of their activities, face physical overload.

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

Note: does not cure an inguinal hernia, but serves to prevent intestinal and organ prolapse into the hernial sac and prevents infringement.

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

  • wear it only in the supine position;
  • , make sure that the inserts are in place.They must correspond to the site of the hernial protrusion.

Important: the use of a bandage is contraindicated in the event of infringement of the hernia and in diseases of the skin that come into contact with it.

Surgical treatment of inguinal hernia

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

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

On the question of many patients: "Is it worth doing an operation for inguinal hernia?" Answers the doctor of medical sciences.Korotkiy IV:

Methods of surgical operations:

  • laparoscopy - suture of the hernia endoscope through the abdominal wall puncture with the help of a mini-camera, microendoscopic instruments and with the installation of a mesh;
  • operative hernia repair.Various methods of operative treatment of inguinal hernia are used( Bassini, Matrynova, Rudzhi, etc.)

Image 2431 General stages of the operation of inguinal hernia removal:

  • excision of the hernial sac and separation from tissue;
  • cross-section of the bag with content control;
  • bag clipping and plastic wall integrity restoration,
  • gate suturing and operating wound.

Surgical treatment of inguinal hernia in children

In children, inguinal hernia removal is mandatory under general anesthesia( anesthesia).Most often, operative access is about 1.5 cm long.The hernial sac is separated from the spermatic cord, then sutured and excised.At the same time, the bag is checked for presence of abdominal contents in it.The external opening of the canal in the child does not become stronger.

The reasons for the formation of inguinal hernia in children, the symptoms of infringement of hernia in children and the methods of treatment tells the children's surgeon:

Emergency surgery to remove the strangulated hernia

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

In the treatment of inguinal hernia, complicated by infringement, the surgeon must carefully examine the injured organ after dissecting the hernial sac.In the case of existing signs of necrosis, the affected area is removed, the ring in which it was infringed is dissected.Then the operation continues in the planned order.After such an operation, the patient must prescribe antibiotics for several days.

What is recurrence of inguinal hernia

In some patients inguinal hernias appear repeatedly.Relapses occur in 5-10% of cases.

The causes of the new hernia can be:

  • operation errors and incorrectly selected type of plastic;
  • non-compliance with recommendations in the postoperative period: intense physical overload, weight lifting, etc.;
  • severe cough;
  • diseases accompanied by constipation;
  • suppuration in the area of ​​the postoperative suture;

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

Preventive measures for the prevention of the development and progression of inguinal hernias

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

  • lead an active lifestyle with normal physical activity;
  • to eat foods with sufficient fiber content;
  • during hard work and training related to lifting weights to wear a bandage;
  • treat chronic diseases accompanied by a severe cough;
  • monitor your weight, avoid obesity;

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

Stepanenko Vladimir Alexandrovich, Surgeon


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