Types of operations for inguinal hernia in men and rehabilitation after hernia repair
An inguinal hernia in men is a disease characterized by prolapse of the abdominal organs into the inguinal canal. Such a hernia is a congenital defect, but there are also acquired variants. Most often, parts of the greater or lesser omentum, elements of the intestine or testicles fall into the hernial sac. An increase in intra-abdominal pressure is the main link in the pathogenesis of the disease.
Inguinal hernia in men develops due to such factors:
- excessive physical tension on the abdominal muscles;
- diseases of the gastrointestinal tract, accompanied by prolonged constipation and bloating;
- chronic cough;
- injuries of the anterior abdominal wall;
- transferred operations on the abdomen;
- congenital weakness of the muscular and ligamentous apparatus.
The most common symptoms:
- stomach ache;
- the presence of a tumor-like protrusion in the groin area;
- periodic nausea;
- discomfort during urination and defecation.
Also in the clinical picture, there is sometimes an increase in body temperature, vomiting, headache and rapid exhaustion.
Preparing for the operation
Before proceeding with surgical treatment, the patient must prepare and undergo several mandatory procedures - the surgical tactics, the choice of anesthetic and medications depend on this.
Mandatory procedures include:
- general and biochemical blood test;
- electrocardiogram, ultrasound diagnostics;
- consultation with a surgeon.
During the preoperative period, the patient is advised to stop drinking alcohol and smoking. Also, before the intervention, the doctor will prescribe a diet, and the nurse will make a cleansing enema.
Treatment of the disease
Traditionally, there are two branches of treatment: surgery and conservative therapy. However, surgery to remove an inguinal hernia in men is the only way to definitively treat the disease. A conservative therapy option will not get rid of the cause, but only temporarily deprives the problem of symptoms, when the operation of an inguinal hernia is the cause and signs of the disease.
Removal of an inguinal hernia in men is carried out by several methods:
This is the most effective inguinal hernia surgery. With the help of special devices, surgeons penetrate the patient's body, subsequently removing the hernia. To do this, experts use a set of tools: a video camera, an illuminating light bulb and manipulators.
During the operation, the doctor makes incisions (up to two centimeters) in the area of the hernia and inserts an instrument there. In total, the doctor makes three such incisions and introduces three tubes there, each of which has its own functional purpose.
The first tube, the trocar, is inserted into an incision near the navel, through which the laparoscope is launched. This device has its own tiny camera and a small backlight. The laparoscope transmits video to monitors that surgeons are guided by. The other two tubes are needed for the actual removal of the hernial sac, release and reduction of organs. For comfortable work, they clamp and secure fabrics.
At the end of the operation, a special implant is applied, which is fixed with a sect. Such manipulations are needed to strengthen the anterior abdominal wall, which will prevent relapse.
The lengthy operation reaches one hour. After the procedure, the patient undergoes a short recovery and is discharged from the hospital a few days later.
The pain syndrome disappears after the third day.
The operation is effective because:
- the likelihood of relapse is reduced to a minimum;
- tissue regeneration occurs quickly: instead of long incisions, small roundish scars remain on the skin;
- short rehabilitation course;
- minimal risk of complications.
How much does the operation cost? The price varies depending on the clinic and the personal skill of the surgeon. On average, the cost reaches 45-50 thousand rubles.
Surgery for inguinal hernia in men according to the Liechtenstein method.
A distinctive feature of this method is simplicity and speed. The procedure is performed under spinal anesthesia. During the operation in the groin area, the doctor makes an incision 6 centimeters long. Then the subcutaneous tissue and adjacent layers are dissected. After the surgeons have operated on the outer ball, they gain access to the hernia. Depending on the type of pathology, the hernial sac is immediately reduced into the abdominal cavity, or it is bandaged and dissected. After manipulating the hernia, the doctor puts a polypropylene mesh, which is reinforced with threads.
After the intervention, the built-in mesh grows into the surrounding tissues and is evenly distributed. Complete germination of synthetic material to organic tissues occurs on average in 4 weeks. Three weeks later, the patient can fully resume his former life: work, play sports, relax, travel.
From the advantages:
- after surgery, there is a low percentage of relapses and complications (up to 2%);
- short recovery period;
- fast and easy technique.
Hernioplasty method Bassini.
During the operation, a standard set of actions is performed: an incision is made, the subcutaneous fat layer is dissected, muscles and other soft tissues are fixed. Having gained access, the surgeon removes the hernia sack, dissects it, highlights the organs and removes excess tissue. After working with the hernial sac, the doctor proceeds to its plastic surgery. At the end of the procedure, the specialist applies interrupted sutures and strengthens the edges of the wound.
Positive aspects of hernia repair using the Bassini method:
- sufficient strengthening of the weak points of the inguinal canal;
- low risk of recurrence and complications.
- there is a risk of damage to neighboring organs, such as the bladder;
- long-term rehabilitation.
In this operation, the emphasis is on the bilateral movement of the spermatic cord. During the intervention, the doctor "creates" a new inguinal canal and a corresponding hole, the old canal disappears. This method is most often applied to the elderly, in whom the soft tissues of the anterior abdominal wall are weak and decrepit.
Of the shortcomings, a relatively high percentage of relapses (up to 7%) should be noted.
Stretch hernia removal methods for plastic surgery using patients' own tissues. For the full closure of the hernia gate, surgeons use the patient's tissues during the intervention. Tension methods as a method of treatment have become obsolete - it has been replaced by modern non-tension plastic methods using synthetic implants.
Stretch methods mainly have disadvantages: a high probability of relapse, the risk of complications, there is pain and a long rehabilitation course.
On average, two hours is how long the operation takes.
Any intervention can have complications. Their appearance depends on several factors, such as the skill of the surgeon, the individual characteristics of the patient's body structure, the choice of medications and their tolerance.
Common complications include:
- damage to the spermatic cord, which may be caused by the inexperience of the operating doctor;
- damage to the integrity of the spermatic nerve, which will lead to a violation of the innervation of the organ;
- injury to part of the intestine, which is observed with improper hernia repair. Often, such a violation occurs when the caecum or sigmoid colon enters the hernial sac;
- hip joint injury. The defect occurs when the surgeon operates on the inguinal ligament, applying strong sutures to it;
- circulatory disorders of the lower extremities, which is more common in older people;
- testicular pathology: dropsy, varicocele.
All these are local complications, but there are also general ones:
- during the operation, the wound may become infected, then additional treatment will be required;
- allergic reactions to the anesthetic;
- in the postoperative period, suppuration of the sutures may occur, which is eliminated by subsequent dressings.
The length of stay in the hospital depends on the type of operation, the choice of anesthesia and the severity of the patient's condition. The scale of anesthesia is the main factor determining how long the patient will stay in the hospital: recovery after local anesthesia takes no more than half a day, after anesthesia - several days.
For stable patients, the average length of stay in the hospital is a few days. During this period, the patient is obliged to follow a diet, stay in bed and not expose his body to physical exertion.
In the first few days, the patient will be under the supervision of a doctor. The doctor will study his condition, monitor nutrition and give appropriate instructions. In addition, in the period after the operation, the patient will take medication: painkillers, anti-inflammatory, restorative.
The recovery period also depends on the method of surgical treatment. In the following days, you must follow all the principles of the diet and the rehabilitation course.
Speaking about the diet, it is necessary to exclude such foods that can cause increased gas formation: legumes, cabbage, pasta and flour products. It is recommended to focus on: boiled dishes, stewed vegetables, fresh fruits, lean meat, fish.
During the first month, a strong load on the body is excluded. It is important to avoid going to the gym, sharp turns and jumps, but simple gymnastic exercises in the form of morning exercises are allowed.
It is recommended to wear a medical bandage. This device helps to reduce intra-abdominal pressure, which is especially necessary for overweight people. The size of the bandage and the duration of its wearing is determined by the doctor according to the parameters of the body and the condition of the patient.
After the operation, physiotherapy is indicated - a set of methods for influencing the body with water, heat and electric current. Physiotherapy procedures accelerate tissue regeneration, speed up metabolism. It also includes massage and self-massage sessions. They are useful for restoring blood flow to muscles that have lost their tone after the intervention.
The main goal of exercise therapy is to restore lost muscle tone, strengthen the ligaments and corset, and teach the patient to monitor their health and hygiene. As a rule, physical education begins two weeks after the operation.
First, light and simple exercises are prescribed that do not require significant physical training. After adapting the body, the patient performs exercises on the muscles of the groin, abdomen, thereby strengthening local weaknesses.
Gymnastic complexes must be performed daily and systematically - this is the only way to achieve full success in the treatment of hernia.