Surgical treatment of hernias
Hernia removal is one of the ways to treat pathology along with conservative therapy. Surgery is used in two cases: when medical treatment does not work, and when a hernia can only be cured with an operation, for example, in case of infringement. It is important to know that a hernia can be completely cured only with the help of surgery. Thus, the intervention eliminates both the cause and the effect of the disease.
Hernia surgery happens:
- minimally invasivewhen serious intervention in the patient's body is not required;
- invasive - a series of operations that require deep intervention in the patient's organ.
Indications and contraindications for surgery
There are relative and absolute indications for surgery. The first ones arise if the procedure is necessary for the patient, its implementation is justified, and it gives a lasting and quick effect. Relative indications include more or less stable, uncomplicated hernias.
Absolute - these are the signs in the presence of which the operation is necessarily performed:
- infringement of any organ;
- hernia recurrence;
- postoperative protrusions;
- lack of effect from conservative treatment;
- severe organ dysfunction.
Contraindications are a number of signs that determine whether the operation can be performed or not:
- exacerbation of existing diseases of the heart, lungs, kidneys;
- deep old age;
- severe forms of diabetes;
- heart, lung or liver failure;
- comatose states.
Ways to remove a hernia
There are many types of hernia surgery, each with its own advantages and disadvantages. In addition, there is no single correct and ideal operation: a certain method will be good for a hernia of the spine, but bad for a hernia of the abdomen.
For the treatment of a hernia surgically on the spinal column, the following interventions are used:
Discectomy and laminectomy.
The procedure involves the removal of part or all of a vertebra. It is performed under local anesthesia.
- focusing on the midline of the back, the surgeon makes a small incision in the skin where the hernia itself is located;
- with the help of tools, the superficial and deep muscles of the back are moved away, which exposes the vertebrae;
- to gain access to problem areas of the vertebra, a specialist often removes part of it;
- after obtaining full access to the affected area, the doctor removes part of the connective tissue and the hernia itself.
The patient is discharged from the hospital after an average of two weeks. Discectomy has its drawbacks: the patient recovers for a long time, undergoes a long rehabilitation, there is a high probability of developing inflammatory processes. However, such an operation is cheap, and after it, the risk of recurrence is extremely small (up to 3% on average).
The patient is not allowed to physical labor for a year, to non-physical labor - up to a month.
Microsurgical removal of the intervertebral disc.
This procedure is popular in the developed clinics of the world and is considered the "gold standard" in the field of intervertebral disc surgery.
Microsurgery is performed under anesthesia and using an operating microscope.
- the surgeon makes an incision in the area of the hernia, after which he pushes back the local muscles;
- for a complete study of the contents, the doctor removes part of the yellow ligament;
- having gained access, the main task for the surgeon is to remove part or the whole intervertebral disc, after which the wound is sutured and sutures are applied.
Advantages: local nerve structures are almost never damaged, quick recovery, discharge from the hospital on the third day, effective pain relief. The patient will be able to return to his previous way of life in a month, at the same time he is allowed to engage in physical labor. Disadvantages: the operation is expensive, on average its cost is 70 thousand rubles, the risk of recurrence reaches 15 percent.
This disc surgery is a minimally invasive procedure and is performed under local anesthesia. The essence of the operation is to reduce pressure on the nerve roots. In real time, several thin and small needles are inserted under the X-ray machine. With the help of these needles, the doctor acts on the hernia with laser and plasma radiation, which destroys the disc tissue.
Advantages: low probability of complications and consequences, fast rehabilitation, the patient returns to his former life within a few hours after the operation. Large hernias are the only disadvantage of nucleoplasty, since it can remove a protrusion of no more than seven millimeters.
Removal of a hernia with a laser - vaporization.
The procedure is a process of irradiating a damaged disc with a special laser. The destruction of the affected tissues is carried out by evaporation. This method reduces the pressure on the nerve fibers.
Vaporization is carried out for people from 20 to 60 years old. Weaknesses of the operation: carrying out is possible only in the first stages of the development of the disease, it is not carried out on hernias of more than six millimeters.
Advantages: the intervention has a therapeutic and preventive effect, fast execution (up to 30 minutes), the patient is discharged after two hours. 5. Disc reconstruction - also laser removal of a hernia. The operation is carried out in non-destructive mode. During the intervention, irradiation of the damaged disc is used. Thus, heating the disc to high temperatures stimulates the regeneration of cartilage tissue and the restoration of the disc.
After the operation, six months later, the restored connective fibers fill the intervertebral space, which contributes to the disappearance of pain in the back. The disadvantages include the high cost of the operation. The benefits are the same as with vaporization.
Destruction of pain receptors.
The essence of the operation is the destruction and subsequent shutdown of pain receptors in the intervertebral region. It is most effective for facet syndrome. The procedure is compact: local anesthesia, duration - up to 30 minutes, after an hour the patient is released.
Endoscopic hernia removal.
Endoscopy refers to minimally invasive removal methods. During the procedure, electro-optical instruments are used, which are inserted into the vertebrae using a miniature needle. After inserting the endoscope, the surgeon removes part of the damaged disc, releasing the nerve fiber from compression and lowering the pressure. As a result of the intervention, the inflammatory fluid is removed from the disc, the pressure on the vertebra is reduced and its structure is restored.
The advantages include: minimal intervention, no scarring after surgery, quick recovery (in a day the patient is discharged from the hospital).
The patient is allowed to start mental work after a week, to physical work after a month. A person can do simple gymnastics and light physical education after 14 days.
Operations for abdominal hernias
Abdominal hernia surgery is performed in several ways.
Hernioplasty according to Liechtenstein.
This type of hernia treatment is non-stretch. The intervention is performed under spinal anesthesia. At the location of the hernia on the skin, an incision is made with a length of no more than 5 centimeters. Next, the surgeon cuts through the tissues until he gets access to the bulge, after which he removes the hernia. After that, the specialist sutures the tissue. During the procedure, a medical material is used - a surgical mesh for a hernia.
The mesh during hernia surgery plays the role of a connector of the two edges of the wound. Advantages: low probability of complications, no pain, relatively short rehabilitation period, variability of anesthesia (in case of allergies, the doctor selects an individual method of anesthesia). Disadvantages: there is a risk of damage to nerve fibers and ligaments, a scar remains at the incision site, the likelihood of developing infectious inflammation. How much does it cost to remove a hernia in this way? Such a hernia repair has an average price tag of 20 thousand rubles.
Alloplasty of a hernia.
This method is applied to postoperative hernias. During the operation, the doctor creates access to the hernia by cutting the skin in a transverse section. Then the surgeon opens the hernial sac, examines the contents and separates it from the surrounding tissues. Cutting off the organ from the walls of the sac takes a whole stage, since sometimes whole casts are formed in the hernial sac from the surrounding tissues and organs. At the end of the intervention, the surgeon performs alloplasty with a mesh material.
Hernia repair by the Bassini method.
Most often, the Bassini method is used for inguinal oblique and direct hernias. The surgical process is performed under local anesthesia. During the operation, the surgeon performs standard actions: cuts the skin, gains access to the protrusion, sets it, removes excess tissue and sutures the wound.
Mayo hernia removal.
The Mayo method is considered a stretch operation. Often it is used in the treatment of hernias of the white line of the abdomen and hernias of the navel. During the intervention, the specialist gradually dissects tissue balls and opens the hernia sac. After that, the surgeon adjusts the organs to their normal location and sews up the external incision. Advantages of tension and non-tension operations: does not cause gross injuries to the body.
Disadvantages: there is a possibility of relapses, long rehabilitation, after the operation the patient experiences pain in the wound area.
Basically, laparoscopic operations for hernias are used for inguinal protrusions. The hernia is removed by inserting a laparoscope into the abdominal cavity, which has a small video camera and a lighting device. The camera transmits the image to the monitor, on which the doctor examines the internal environment. The other two tubes are removed.
The intervention is performed under anesthesia. How long does a hernia surgery take? The laparoscopic method requires no more than one hour. The patient is discharged the next day. A person returns to the previous way of life after a few weeks.
Advantages of the laparoscopic method: the absence of massive scars at the puncture site, the patient does not complain of pain after the operation, fast rehabilitation, low probability of recurrence and complications. From 15 to 50 thousand rubles - that's how much laparoscopic surgery costs.
Complications after surgery
Any intervention is stress and tension for the body: even the simplest operation can cause consequences.
The following types of postoperative complications are distinguished:
- damage to organs that appears when working with a section of the hernial sac. The surgeon may accidentally touch the surrounding tissues, thereby violating the tissue integrity of the organ;
- thrombosis of the veins of the lower extremities. Most often this phenomenon occurs in older people;
- the formation of blood clots under the skin - hematomas;
- recurrence - the recurrence of a hernia due to poor suturing of the edges of the wound;
- damage during the operation of nerve fibers;
- infection in the wound;
- exacerbation of osteochondrosis, if any;
- inflammatory processes at the site of surgical intervention;
- paralysis or paresis of the limbs, which is caused by damage to the spinal cord after the removal of the intervertebral disc.
The development of complications depends on several factors: the competence of the surgeon, the resistance of the patient's body, compliance with medical instructions and diet.
A surgical operation brings a full-fledged result when the patient diligently undergoes a course of rehabilitation. In the course of recovery, the doctor prescribes a complex of gymnastic exercises, physiotherapeutic procedures to the patient, and diet is also important for full rehabilitation. On average, the recovery of the patient lasts up to three weeks. The timing directly depends on the type of operation that was carried out.