Types and treatment of abdominal hernias

A hernia of the abdominal wall (abdominal) is a congenital or acquired disorder in which a part of the organ exits through the muscle layer under the skin. Outwardly, a rounded formation is visible, which can be from a few centimeters in diameter to a meter or more. The factors for the appearance of a hernia of the anterior abdominal wall in children and adults are past injuries, chronic diseases of the gastrointestinal tract and respiratory system, as well as increased stress.

Athletes often face this problem. A hernia in women often appears during the period of gestation, which is caused by both increased pressure and sprain. Hernia in men is associated mainly with hard work and congenital anomalies. In children, abdominal hernia is a consequence of the underdevelopment of individual systems and the influence of factors that appeared after birth: frequent screaming, crying.

Less common is an internal hernia in the abdominal cavity, which does not appear outwardly. In this case, the organs go into the chest, provoking only mild symptoms.

Types of abdominal hernias

The muscles of the abdominal cavity are connected by a white line, a membrane that weakens under the influence of certain factors, which causes diastasis, and through the hole formed, the nerve and vascular plexuses first exit, then this area becomes a hernial ring. More often it occurs near the navel, in the lower abdomen and along the midline.

What are the hernias of the abdominal cavity according to the anatomical location:

• epigastric;
• umbilical;
• femoral;
• inguinal;
• white line.

Rare forms will be formations of the pelvis, diaphragmatic, Spigelian line and xiphoid process.

According to the degree of formation, the types of hernias are divided into initial, canal and complete. Depending on the origin, there are congenital and acquired. The latter can be traumatic and postoperative.

The most common forms of pathology are formations in the navel and groin. This arrangement allows you to accurately determine the disease at the initial stage, and immediately begin treatment. Less often, in surgery, an internal hernia of the abdominal cavity is diagnosed, the signs of which are visible only when radiography with contrast is performed.

Symptoms of the disease

An uncomplicated abdominal hernia of the anterior abdominal wall without obstruction or gangrene has typical symptoms in every patient. It is diagnosed by a doctor during examination, an ultrasound may be additionally prescribed. A wandering hernia in the abdominal cavity is more dangerous, it shows mild symptoms, but strangulation can occur at any time.

How to determine a hernia of the abdomen by external manifestations and sensations:

• mild soreness in the area of ​​​​education;
• irradiation of pain in the perineum, lower back, spermatic cord, labia;
• increased discomfort during muscle tension;
• bulging hernia during coughing (cough shock symptom);
• reduction or complete reduction of the hernia in the supine position;
• constipation, rumbling in the abdomen, accumulation of gases, less often nausea and vomiting;
• with an internal hernia, heartburn, hiccups, pain behind the sternum are disturbing.

Signs of an internal abdominal hernia:

• dysfunction of an organ that has entered the bag;
• pasty consistency of the wall;
• enlargement of the inguinal canal;
• urinary retention, no stool.

With a sliding protrusion, the hernial sac contains the structures lying next to the peritoneum, and the visceral membrane becomes part of it. This increases the risk of injury to the bowel or bladder during surgery. Mortality due to organ damage reaches 8%, and peritonitis, which occurs in the early period after surgical treatment, becomes the cause of death more often.

Clinical manifestations largely depend on the age and sex of the patient, systemic diseases, reducibility or irreducibility, and the size of the hernial sac also matter.

Causes

Distinguish producing and predisposing factors for the onset of the disease. In the first case, conditions are formed for the development of the disease, weakness of the abdominal wall appears. Producing factors directly affect the output of organs through weakened muscles under the skin.

Predisposing factors:

• anomalies of intrauterine development;
• loss of elasticity due to aging;
• expansion of the openings of the inguinal canal, umbilical and femoral rings;
• postoperative wound or traumatic injury to the abdomen.

Producing reasons:                 

• heavy physical activity;
• persistent cough;
• overeating, frequent bloating;
• period of pregnancy;
• obesity;
• accumulation of fluid in the abdominal cavity;
• overweight and hypodynamia;
• difficult urination.

Postoperative hernias occur in the area of ​​the surgical scar, they are associated with suppuration of the wound, a sharp return to the load, non-compliance with the preparation and technique of the operation.

Hernia Research

It is possible to diagnose a formation in the abdominal cavity by visual inspection and palpation of the protrusion area. The doctor checks for the presence of a cough shock, interrogates the patient about the first manifestations and disturbing symptoms. Ultrasound is performed to confirm the diagnosis and select the surgical technique for hernias of the abdominal wall. Complications are also diagnosed by ultrasound.

Comprehensive diagnosis before hernia repair includes the following studies:

• Ultrasound of the abdominal cavity and small pelvis;
• Ultrasound of the hernial sac;
• herniography - X-ray with the use of a contrast agent;
• general and biochemical blood test;
• analysis of urine and feces;
• echocardiography and others according to indications.

With a strangulated hernia, the patient needs immediate examination by a surgeon. To diagnose intestinal obstruction, a CT scan or plain radiography is performed.

Principles of treatment

The only way to eliminate abdominal hernias is surgery. Hernia repair is planned. When an infringement occurs, the patient is immediately hospitalized in the surgical department, where he is preparing for an urgent operation.

All types of hernia repair are divided into two types: plastic with own tissues and suturing of the hernial sac with an artificial implant.

A hernia of the anterior abdominal wall without obstruction or gangrene is the case when a planned operation with fixation of tissues with a mesh will be prescribed. If there is a suspicion of a complicated disease, an emergency intervention is performed to resect the damaged areas of the internal organs to preserve their function.

The operation has relative contraindications:

• chronic diseases in the acute stage;
• purulent dermatological pathologies;
• elderly age;
• period of pregnancy;
• weakened body, severe exhaustion;
• diseases of the cardiovascular system in the stage of decompensation.

Operation steps

Preparation is necessary before removing a large hernia. In the process of moving organs, intra-abdominal pressure can rise sharply. This phenomenon will cause circulatory and respiratory disorders. For prevention, bandaging is performed or a bandage is fixed, which will contribute to a gradual increase in pressure.

Standard hernioplasty is performed as follows:

1. Access is created - the tissues are dissected in layers over the formation.
2. The hernial sac stands out.
3. The organs move into the abdominal cavity.
4. The hernial sac is tied up, then excised.
5. The tissues are sutured with the installation of a mesh implant.

There are other methods of hernia repair:

• according to Mayo - the navel is removed along with the hernial sac by a horizontal incision, then the tissues are superimposed and sutured;
• according to Lexer - it is carried out with a hernia in children, the tissues after removal of the hernia are pulled together, sutured with purse-string sutures;
• according to Sapezhko - access is created through a longitudinal incision, after excision of the hernia, the muscles are superimposed on each other and sutured;
• according to Napalkov - is carried out for obesity, the abdominal wall is additionally strengthened, aponeuroses are connected above the white line, which reduces the volume of the abdomen.

The laparoscopic technique is also used, and it has the following advantages:

• low tissue trauma;
• fast recovery;
• the ability to return to physical work in 1-2 weeks;
• painless during the recovery period;
• absence of scars and scars;
• low risk of complications during and after surgery.

Consequences

Possible complications before surgical treatment:

1. Infringement is the most dangerous consequence before and after hernia repair surgery. There are several types, among which elastic is more often diagnosed. It is a compression of organs against the background of a sharp increase in intra-abdominal pressure and compression of the hernial orifice. It is manifested by severe pain, the death of part of the intestine begins, intestinal obstruction, intoxication, and dehydration of the body are observed. Infringement can be sudden, when the disease was not previously diagnosed.
2. Irreducibility - the condition often precedes infringement, fusion of the walls of the bag with the contents occurs, the protrusion ceases to move freely, only one part is reduced when pressed. Most often, this condition affects the umbilical and femoral formations. There is the formation of several adhesions at the same time, which threatens further intestinal obstruction.
3. Caprostasis is a condition in which feces are retained in the large intestine, which is the contents of the hernial sac. More often occurs in elderly patients, which is aggravated by a contraindication to the operation. In men, caprostasis occurs mainly in the inguinal formation, in women - in the umbilical.

After surgery, the patient may experience a recurrence of the disease, a relapse.

Ventral hernia also requires surgical treatment. Relapse can happen several times, and everyone will have to resort to surgery. After hernia repair, there is a risk of urinary retention, infection of the wound with the spread of inflammation to neighboring organs and nearby tissues.

Rehabilitation after hernia repair

An important condition for the prevention of complications and stable rehabilitation after hernia repair is the rejection of physical work for the time set by the doctor. It can be a week or even several months, depending on the severity of the condition. After the operation, the patient is discharged from the hospital for 3-7 days. The doctor prescribes pain medication and recommends a diet.

Bandaging should be done several times a week, sometimes less often, depending on the condition of the wound. This can be done on your own at home or by visiting a doctor.

Be sure to follow a sparing diet to eliminate the occurrence of constipation and bloating. The first days after the operation, you should eat light soups and cereals, lean white meat, boiled vegetables, seafood. It is better to refuse fried foods and spices.

Relapse after hernia repair is possible for the following reasons:

• old age, physiological weakness of muscles and ligaments;
• high loads leading to increased intra-abdominal pressure;
• suppuration of the postoperative wound;
• large defect in the abdominal wall.

When the operation was performed for a strangulated hernia with the removal of a part of the necrotic organ, this will become a factor in digestive disorders in the future. In this regard, surgeons do not delay the appointment of herniotomy, carrying out a planned operation with a lower risk of complications in the early and late periods of rehabilitation.

The first 2 months after hernia repair, it is not allowed to lift more than 3 kg, make sudden movements and overwork. It is important to use a postoperative bandage regularly and monitor the condition of the wound to prevent inflammation and suppuration.

After 3-4 months, you can return to your usual routine, do physical education, sign up for a gym to strengthen the muscles of the anterior abdominal wall. It should be understood that a recurrence of a hernia can happen at any time, a repeated protrusion will have the same symptoms, and then you should immediately contact a surgeon.