Types and treatment of oblique inguinal hernia

An oblique inguinal hernia is a congenital or acquired pathology, which is characterized by pathological migration of the abdominal organs to the inguinal region. An oblique inguinal hernia is considered one of the most common surgical pathologies. The frequency of occurrence is approximately up to 80% of all hernias.

Inguinal hernia is more common in men than in women.

Thus, statistics state that inguinal hernia in women is recorded 5 times less often than in men. In general, inguinal hernias belong to the class of external abdominal hernias.

Mechanisms of inguinal hernia formation

At the root of the formation of inguinal hernias are the wrong mechanisms for lowering the testicles in a boy and the ovaries in girls. It is known that the movement of the testicles is strictly determined by physiological laws. In the first trimester of intrauterine development, the internal genital organs of the boy are located in the peritoneal cavity. To the testicles themselves, a long cord is attached from below, located in the scrotum, and from above - the vaginal process of the peritoneum.

Only after three months of development, the boy's testicles begin to gradually descend. Closer to the fifth month, the internal genital organs are already located in the lumen of the inguinal canal, by the eighth they gradually pass it, falling lower and lower, and only by the end of the 9th month the testicles completely reach the bottom of the scrotum. As a rule, this happens closer to the boy's birthday.

If by the time of birth all the processes were successful, the inguinal canal overgrows, if not, the same vaginal process goes down, closer to the scrotum, and thereby pulls on the internal organs of the abdomen or parts thereof. In addition, due to non-hollow fusion of the canal, a funicocele may occur in the area of ​​the spermatic cord - a volumetric neoplasm that contains serous fluid.

Inguinal hernia in women has a similar nature, however, instead of the testicles in the pathological chain, the ovaries are involved, which also pull the vaginal process of the peritoneum with internal organs.

Congenital hernia of the inguinal region

It should be noted that the congenital form occurs only in boys. With this form of the disease, the peritoneal vaginal process plays the role of a hernial sac, where the internal organs of the small pelvis or abdomen are contained.

Often, the congenital variant is combined with other pathologies of the genital organs: dropsy of the testicles or funicocele.

The main provoking factor is the rapid increase in intra-abdominal pressure, due to which the internal organs are simply pushed out under the influence of force. Since the inguinal ring is anatomically considered a weak point, it is through it that organs are pushed out. Often, intestinal loops, a large and small omentum, less often the stomach and parts of the genitourinary system get into the bag.

Acquired inguinal hernia

This form is the result of the influence of several internal or external factors at once. Sometimes the acquired variant of inguinal hernia develops against the background of a complete and successful fusion of the groin canal. But there are a number of prerequisites that provoke a painful condition.

Among them are:

1. Early pregnancy of the mother , when the mother's body is not able to supply a number of necessary resources to the child.
2. Prematurity of the child . Prematurity in general is the cause of many diseases of the baby. In an immature organism, many systems and protective processes (connective tissues, muscle corset, nervous regulation) are not yet developed, so the child's body has to "grow" being already born.
3. genetic predisposition. Sometimes heredity plays a key role. If the parents had a hernia, then it can be assumed that their child will also have it.
4. Congenital features of the muscles , namely the weakness of the muscular system.
5. Excessive body weight, which contributes to an increase in intra-abdominal pressure due to the fouling of the omentum with adipose tissue.
6. Sudden and severe weight loss . Not only excess fat plays a pathological role. The rapid loss of adipose tissue leads to the formation of hollow "reservations" inside the abdomen, where some layers of the abdominal wall can be displaced.
7. Postponed injuries in the abdomen (blows, falls, wounds).
8. Pregnancy is a common cause of inguinal hernia in women. The development of the fetus in the abdomen is the strongest factor in increasing intra-abdominal pressure.
9. A sedentary lifestyle, in which most muscles lose their tone over time, and no longer perform the function of a pressure regulator properly.
10. Strong physical exertion on the human body. This is especially true for those people whose life in any form is connected with power loads. So, athletes, builders or loaders most often suffer.
11. A number of background diseases, where the main symptoms are: coughing, sneezing, increased gas formation, constipation are key provocateurs of high pressure in the abdominal cavity.

Types of hernia in the groin

There are many varieties of this local ailment, but two are most often distinguished: oblique and direct inguinal hernia.

Direct inguinal hernia. This variant is less common than an oblique inguinal hernia. Direct inguinal hernia is exclusively acquired. With this variant, the gate arises directly in the middle region of the inguinal canal. With a direct inguinal hernia, the size of the protrusion is directly proportional to the diameter of the hernial opening.

Often, not only the organs of the digestive tract, but also parts of the genitourinary system flow into the cavity of the bag.

Oblique inguinal hernia. This form is characterized by the fact that the hernial sac passes through the entire inguinal canal. Often the bag of contents reaches the bottom of the scrotum. Unlike the previous period, in this case, two types of oblique inguinal hernia are distinguished: congenital and acquired. In the first case, the vaginal process of the peritoneum does not overgrow, the canal does not close. In the hernial sac, the testicles or individual intestinal loops are most often located. As a rule, this form of protrusion is mainly for children, but it also occurs in adults, but much less frequently.

This hernia goes through several stages of development:

1. Initial.
2. Channel.
3. Rope.
4. Scrotal.

Each of these stages reflects the pathological process of descending the hernial sac through the inguinal canal, at the end of which the sac reaches the bottom of the scrotum.

So, the main differences between oblique and direct hernia are the specifics of migration and the location of the bag, congenital and acquired.

Also, hernias are distinguished by their location:

• bilateral process - the presence of a protrusion on both sides of the inguinal region;
• left-sided process (due to the anatomical features of the abdominal cavity);
• right-sided process - most often formed due to an imbalance between pressure from the muscles and internal organs.

Symptoms

The disease has a pronounced clinical picture:

1. A tumor-like formation appears in the groin area . At first, it does not cause discomfort, but as it grows, the pathological bulge declares itself with pain. Over time, the degree of pain syndrome becomes more and more expressive, increases with bending, turning the torso. The wearer also experiences discomfort when walking and sleeping. Visually, the hernia increases with coughing or constipation.
2. Depending on the involvement of certain organs, constipation, pain in various areas of the abdomen can be observed . Difficulty urinating appears, the act of defecation may be accompanied by pain.
3. In women during the menstrual cycle, the severity of pain is usually stronger, sometimes they appear a few days before the first blood appears.

The painful course of the disease can be complicated by infringement. This term means a sharp and sudden pinching of the organs that are in the hernial sac, followed by serious violations of their function.

According to statistics, patients come to the first examination with a doctor already with signs of this complication.

There are two main types of infringement: fecal and elastic. They say about the fecal variant when the intestinal lumen is full of feces. With this form of development, there is a gross violation of local blood circulation and subsequent necrosis of nearby tissues.

Elastic infringement is usually formed against the background of a strong increase in intra-abdominal pressure. Often this phenomenon contributes to chronic coughing or lifting heavy weights. This variant of the complication implies the exit of a large volume of organs into the hernial sac, which are pinched from behind by a ring.

Consequently, the infringed structures can no longer go back. The organs are trapped and undergo serious changes: ischemia (impaired local blood flow and oxygen starvation) and tissue necrosis are observed in the affected area.

In the clinical picture of a gross complication, there are four main signs:

1. Severe and sharp pain that is not relieved by painkillers . As a rule, pain sensations extend to the entire abdomen. Often the strongest pain syndrome leads to shock or collapse in the patient.
2. The inability to repair a hernia is partly an indirect sign, but it is always taken into account.
3. The beginning of inflammatory processes : the body temperature rises, the patient complains of heaviness in the body, exhaustion, he experiences a headache. There is also severe nausea, vomiting, thirst and unpleasant dryness in the mouth.
4. Negative cough symptom.

Treatment

Full treatment is possible only with the help of surgery. The operation allows not only to eliminate the clinical picture, but also to eliminate a number of causes contributing to the development of the disease. The efficiency of this method reaches 95% -100%. Modern surgical techniques allow performing intervention with minimal trauma and low probability of various complications.

The most common treatment option is endoscopic access - laparoscopy.

It is shown in almost all conditions except:

• old age;
• severe comorbidities;
• pregnancy;
• pronounced forms of exhaustion of the body.

So, the essence of laparoscopy is that the surgeon makes three small punctures into the affected area, into which tubes are then inserted, on which cameras and flashlights are installed. The main task is the complete removal of the hernial sac, excess tissues and the reduction of the released organs. Direct inguinal hernia is also subject to the same treatment.

In the postoperative period, the patient is advised to strictly adhere to a diet and perform prescribed physical exercises.

Therapeutic exercise helps to strengthen the muscles of the abdomen and groin. Further constant training increases the endurance of the body.

After treatment, a person is recommended to lead an active lifestyle, eat right and rationally, regulate and dose physical labor, prevent exacerbation of chronic diseases and carefully monitor weight.