Complications of inguinal hernias clinic diagnostics treatment. Inguinal hernia

The protrusion of all the organs that make up the abdominal cavity beyond the anatomical location through the inguinal canal is called an inguinal hernia in medicine. An inguinal hernia in men manifests itself as a tumor-like bulge in the groin, pain, and discomfort when walking.

In surgical gastroenterology, inguinal hernia occurs 75% more often than other types of abdominal hernia. Men suffer from the disease much more often than women (ratio 7:1). This is explained by the difference in the anatomy of the female inguinal canal and the male one. The male inguinal canal consists of the inguinal ligament located inferiorly, the transverse and internal oblique muscles located superiorly, and internal connective tissues. The male canal is shorter, wider and reinforced by muscle tissue and tendon.

A hernia can form in childhood. The peak of the disease in men is 40-45 years. According to statistics: in children, a congenital inguinal hernia was detected in 90% of cases; in middle age - acquired oblique hernia, in old age - direct and oblique inguinal hernias.

Causes of inguinal hernia in men

Due to the structure of the canal, hernias in men are much more common. Inside the inguinal canal there is a spermatic cord, through which the testicles from the abdominal cavity are lowered into the scrotum from early childhood. Therefore, the entrance to the canal is widened and the canal process does not overgrow. With the further growth of the child and in the presence of a provoking factor, the abdominal organs move into free space.

In older men, the canal remains a weak spot for the same reasons. The congenital risk factor is joined by an acquired one, in which the muscles of the abdominal wall weaken, forming a protruding hernia.

An inguinal hernia can be congenital or acquired. Congenital is formed when the testicle descends from the abdominal cavity into the scrotum in boys. Acquired appears when the muscle and tendon layer of the abdominal wall of the inguinal canal is weak.

Predisposing factors for the development of the disease: destruction of connective tissue (age-related), defective muscles provoked by systemic and frequent diseases, increased intra-abdominal pressure - with chronic cough, constipation, heavy lifting, obesity, etc. These factors gradually lead to a defect - the formation of a hernial orifice in the groin canal and further to the formation of pathology in a man.

Sometimes pathology can develop after surgery performed in the abdominal cavity: resection of the duodenum, gastric resection, gall removal, hysterectomy, removal of appendicitis, adnexectomy, etc.

Classification of inguinal hernias

Anatomical features distinguish the following types of hernias: oblique, combined and direct. Oblique can be either congenital or acquired. In this case, all the elements that make up the hernial contents exit through the inguinal ring into the canal and are located along it among the structures of the spermatic cord.

Congenital - develops if the abdominal process in childhood, located in the groin canal, does not heal and its cavity freely communicates with the abdominal cavity.

Acquired - appears in adults and is divided into the following types:

• Direct and internal - the stroke is short, not connected with the male reproductive system, always an acquired form. It has a characteristic protrusion of the peritoneum through the inguinal space, bypassing the spermatic cord, into the inguinal canal.
• Oblique or external - the hernial sac is connected to the spermatic cord, to the membrane of the testicle, which leads to complications of the male genital organs.

Inguinal oblique hernias are divided into several types:

• Beginning - the hernial sac can be palpated only at the entrance to the groin canal; this type cannot be identified independently.
• Canal - in which the bottom of the hernial sac is located at the level of the external opening of the canal and the sac located in the inguinal canal does not affect the abdominal wall and is detected when it is under strong tension.
• Funicular - the bottom of the sac is located in the canal at different levels of the spermatic cord and the hernial sac descends along the spermatic cord towards the scrotum.
• Inguinal-scrotal hernia is one of the most severe types of indirect hernia, but it occurs quite often. The hernial sac with its contents (intestinal loops, internal organs and peritoneum) descends into the scrotum area and increases its size several times.

The following types of hernias also occur:

• Combined - complex formations that consist of several sacs, and the hernial sacs do not communicate with each other and exit through different hernial openings. A combined hernia may consist of several direct inguinal or oblique hernias, or a combination of them,
• Irreversible - the adhesion of the hernial sac and hernial contents makes it impossible for it to disappear and eliminate on its own,
• Sliding inguinal – formation of a hernial sac by the parietal peritoneum and its visceral layer,
• Recurrent – ​​appears again after surgery. There are repeatedly recurrent hernias, provoked by the wrong choice of hernioplasty method, as well as a technical error in the operation,
• Reducible,
• Uncomplicated inguinal
• Complicated pathology.

Symptoms of an inguinal hernia in a man

At an early stage, the disease can go undetected for a long time due to the absence of symptoms. Only after heavy exertion, severe coughing, and abdominal tension do patients begin to notice a protrusion. An inguinal hernia can develop suddenly, gradually and acutely.

An inguinal hernia in men is caused by the following symptoms:

• Tumor-like protrusion in the groin - the swelling has different sizes, increasing with physical exertion, severe coughing and decreasing, also disappearing in a lying position. Tumor-like formations cause constant or periodic dull pain of varying intensity and are localized in the groin and lower abdomen, also radiating to the lumbosacral region.

A large inguinal hernia creates inconvenience during physical activity and walking. When the cecum enters the hernial sac, intestinal pain and constipation appear.

Sliding hernias in the bladder provoke physical disorders: pain in the urethra, frequent urination, urinary retention (in elderly patients), pain above the pubis. In acute appendicitis - inflammation of the appendix, which is a hernial content, pain in the abdomen, nausea, vomiting, fever and tachycardia.

• Enlargement of the side of the scrotum - with a scrotal inguinal hernia, the corresponding side increases.
• Incarcerated hernia – compression of the hernial contents at the inguinal gate develops incarceration. In this case, nausea, vomiting, increasing groin pain appear, gases do not pass and the hernia acquires a tense, irreducible state.
• The strangulated form causes certain complications: coprostasis, inflammation of a section of the intestine, necrosis of a section or other element of the contents of the hernia, ischemic orchitis.
• Painful pulling sensation in the groin.
• Discomfort while walking - increases with increasing load.
• Diarrhea, constipation, false urge - if there is an intestinal disorder.
• Impaired urination - occurs rarely, in case of entry through the inguinal ring into the hernial sac of the bladder.

Provoking factors

Factors contributing to the appearance of anterior abdominal hernia:

• Heavy physical activity - sports, professional,
• Diseases that provoke increased pressure in the abdominal area - bronchial asthma, cirrhosis of the liver, chronic lung disease, acute bronchitis, diseases of the gastrointestinal tract and pneumonia,
• Alcoholism,
• Smoking – causing an unproductive and prolonged cough,
• Obesity increases the load on the anterior wall of the peritoneum and prevents the hernia from appearing for a long time.

Diagnosis of the disease

At the first suspicion, a man must consult a surgeon who will conduct the following diagnostics of the patient:

• Study of patient complaints,
• Examination of the groin area,
• Palpation of the area - to assess the size and shape of the protrusion both in a vertical and horizontal position and the reducibility of the hernia,
• Ultrasound of the abdominal cavity - allows you to examine the contents of the sac, the structure that forms its contents,
• Ultrasound of the scrotum - with a muscular hernia, it becomes large and resembles testicular hydrocele; the examination is used to effectively differentiate the two diseases,
• Irrigoscopy,
• Cystography,
• Cystoscopy,
• Ultrasound of the bladder,
• Blood and urine tests are prescribed immediately before surgery to determine the functions of organs and systems and identify relative contraindications.

Surgery

Treatment of the disease includes surgical removal and strengthening of abdominal wall defects. It is possible to close the hernial defect and restore the integrity of the wall using local tissues - aponeurosis (hernioplasty is performed using one’s own tissues) and synthetic prostheses (hernioplasty involves the installation of a mesh prosthesis).

In modern medicine, surgeons use a plastic method using a mesh graft - the hernial orifice is strengthened from the inside with a polypropylene mesh, which subsequently serves as a frame for the germination of connective tissues. The mesh prevents the exit of internal organs. The tension method reduces the risk of disease relapse; treatment is also carried out laparoscopically.

Strangulated and large protrusions recur in 50% of cases. The strangulated species is operated on urgently, causing multiple complications of the genitourinary and gastrointestinal systems. A long period makes the patient incapacitated; prolonged infringement sometimes leads to death.

Only a surgeon can decide how to treat the pathology, based on the individual characteristics of the patient and his condition. The surgeon also determines the duration of treatment.

In medicine, the gold standard for surgical treatment of inguinal hernia is hernioplasty according to Liechtenstein. The operation is used for all types of protrusion. During the operation, plastic surgery of the inguinal canal is performed, strengthening it with a special mesh made of polymer material, which prevents the development of relapses.

Some cases involve the use of other modifications of plastic surgery:

• Hornioplasty according to Girard-Spasokukotsky - used for oblique types of pathology of small sizes, especially in young patients,
• Bassini or Kukudzhanov method - for direct, recurrent pathologies, large indirect hernias,
• In case of a strangulated hernia, if the operation was carried out in a timely manner and the strangulated organ was not removed, the operation is practically no different from hernioplasty using the Kukudzhanov method.

Previously, the only method of getting rid of the pathology was tension repair - the hernial orifice was tightened with tissue of the abdominal wall. But modern technologies and innovative acquisitions have made it possible to use effective and painless methods, which include:

Tension-free plastic surgery using the Lichtenstein method– after local anesthesia, the surgeon makes an incision in the groin area and sections of the spermatic cord. The hernia is excised or simply reduced. Next, the hernial orifice is repaired; in its place, the doctor places a polymer mesh with a hole for the spermatic cord and sews the mesh to the surrounding tissue. Since the material used is synthetic, it is not rejected by the body. Gradually, the mesh becomes overgrown with human tissue and will act as a supporting material. A few hours after the operation, the patient can leave the hospital. The disadvantage of this technique is the small scar at the incision site.

Laparoscopic surgery– after general anesthesia, three punctures are made in the anterior abdominal wall. Instruments penetrate through them and carbon dioxide is pumped into the abdominal cavity. Gas and maximum wall tension force the hernial sac back into the cavity. Using the inserted instruments, the surgeon places a patch in the form of a mesh on the inside of the hernial orifice and sutures the error. If the hernia is of an impressive size, the technique is ineffective. The laparoscopic method is more expensive than standard surgery.

Endoscopic surgery– considered safer and more effective. Local anesthesia is used. No scars remain on the body, internal tissue damage is minimal, the operation is performed in the preperitoneal space, and the patch is applied not from the inside of the abdominal cavity, but between the layers of its wall. This method does not require suturing the wall, because it is held in place by pressure inside the cavity.

Postoperative complications

Frequent complications after surgery are:

• Hematomas - to avoid them, ice is applied after surgery,
• Seams coming apart
• Infection of the wound and its suppuration - to avoid the inflammatory process, a course of antibiotics is prescribed,
• Hydrocele of the testicles - when the membrane of the testicle is damaged, the size of the scrotum increases on one side or both. The pathology is treated surgically,
• Damage to the spermatic cord occurs due to the negligence of the surgeon and is associated with the individual structure of the groin canal. The cord is located next to the hernial sac and its damage is fraught with male infertility,
• Damage to the hip joint - occurs due to rough sutures,
• Relapse - if the regimen is not followed, a secondary appearance of protrusion occurs,
• Damage to a blood vessel provokes testicular atrophy.

Any operation, even an easy and safe one, can cause complications. Sometimes they appear due to the fault of the patient who violates the restrictions of the rehabilitation period, sometimes due to the fault of the doctor. Complications can also arise due to the individual characteristics of the patient’s body.

2Conservative treatment of inguinal hernia

The only method of conservative treatment recognized by doctors is wearing a bandage, which reduces the load on the groin muscles and alleviates the patient’s condition. In certain cases, a special bandage not only does not give positive results, but also aggravates the situation, leading to complications.

The use of a bandage is allowed only with a reducible type or with contraindications to surgical intervention:

• For elderly patients,
• For problems with blood clotting - anemia and leukemia,
• For heart diseases - acute stage of heart attack, stroke, heart failure, hypertension,
• Pulmonary diseases - pulmonary ephymesis, severe bronchial asthma,
• Exacerbation of chronic pyelonephritis, with acute hepatitis and liver cirrhosis,
• Diabetes mellitus - surgical hospitals allow patients with a sugar level of 9-10 mmol/l to undergo surgery,
• Immunodeficiency,
• Infectious process of the acute phase.

Visceral therapy is the mechanical reduction of the sac into the cavity, after which the patient experiences relief. But such therapy is not a panacea for pathology and only an experienced manualist can perform these actions. It is not recommended to straighten the protrusion yourself. This leads to serious consequences.

Medications

Medicines used for inguinal hernias:

• Antacids - Maalox and Phosphalugel, Almagel - prevent damage to the mucous membrane of the digestive system,
• Antispasmodics – Papaverine and No-Shpa – eliminate discomfort and increased peristalsis.

For hernias of the anterior abdominal wall, anti-inflammatory drugs are not used, since they also eliminate pain. When taking these drugs, there is a risk of missing the pathology, which is fraught with mortal danger.

Treatment of the disease without surgery

Treatment of the disease without surgery is impossible, given the pathogenesis. The bandage also does not cure, but helps to retain the protrusion in the abdominal cavity. According to doctors, physical exercise is also not able to cure the disease. But experts still advise using exercises to increase the muscle strength of the abdominal wall, but only in a sitting position or lying on your back:

• A load weighing from one to two kilograms is placed on the abdominal wall and breathing is performed with the stomach,
• With a horizontal body position - lift the legs in a straight position at an angle of 30 degrees,
• In a horizontal position, lift the shoulder girdle and shoulder blades, with your hands behind your head,
• In a horizontal position with your knees bent, you need to squeeze the ball placed between your legs.

ethnoscience

The traditional medicine health resort offers patients to get rid of their illness with cold. Patients are allowed to apply a cold compress to the protrusion site, wipe the protrusion with ice, or swallow ice cubes for pain relief. Doctors deny such therapy, because cooling leads to muscle contraction and pinching of the hernia.

Popular lotions, compresses and ointments:

• Place two teaspoons of oak bark in half a liter of boiling water and boil for 15-20 minutes. Cool the broth and use for compresses. Keep the compress for three hours.
• Sauerkraut juice – used for compresses.
• Apple cider vinegar - 500 gr. Dilute four tablespoons of apple cider vinegar with water and use for lotions.
• Golden mustache, onions, plantain leaves are passed through a meat grinder, pork fat is added to the chopped greens. The resulting ointment is applied to the site of the protrusion.

If you have an inguinal hernia, you should not self-medicate. Only timely and qualified help is the best way to get rid of this disease.

To speed up rehabilitation, it is advisable to maintain your diet and consume liquid, pureed food in small portions during the first days. After four to five days, you need to gradually switch to a normal diet: eat foods containing fiber and proteins. The diet should include:

• Boiled, but not fatty meat (chicken or beef),
• Vegetables – steamed or raw,
• Cottage cheese,
• Berries, fruits,
• Porridge – buckwheat, millet, pearl barley and oatmeal,
• Fish, seafood,
• Dried fruits, nuts.

Disease prevention

To prevent the disease, it is necessary to avoid excessive physical activity and lift heavy objects. You should promptly take care of the stable function of the gastrointestinal tract, since constipation is a provocateur of an inguinal hernia. It is also recommended to lose excess weight and exercise, strengthen the abdominal wall with exercises and not neglect therapeutic exercises.

It is important to follow a proper diet, eat little and not drink alcoholic beverages. You should reduce your intake of fatty and spicy foods, flour and confectionery products, and consume more meat, fish and vegetables.

Inguinal hernia (hernia inguinalia) is a pathological condition in which the pelvic and abdominal organs are displaced under the skin of the anterior abdominal wall through one of the “weak spots” of the abdominal wall - the inguinal canal.

The groin area is the most common location of hernias, accounting for 70-90% of all ventral hernias. The incidence of inguinal hernia in men is 5-6 times higher than in women, which is due to the anatomy of the inguinal canal.

The inguinal canal is a space in the form of a slit, bounded in front and above by the abdominal muscles, behind by the transverse fascia and below by the inguinal ligament. In men, the inguinal canal is shorter and wider, where the spermatic cord (vas deferens, vascular bundle) is located. In women, the round ligament of the uterus is located in the inguinal canal; the inguinal canal is longer and narrower than in men.

Inguinal hernias are most often localized on the right, and can also be bilateral. The contents of an inguinal hernia, as a rule, are a strand of the omentum or a loop of the small intestine, less often - the pelvic organs in women (ovary, fallopian tube), the wall of the hernial sac is formed by a sheet of peritoneum.

Classification of inguinal hernia:

• Oblique hernia- the hernial contents exit through the spermatic cord, which consists of the vas deferens, blood and lymphatic vessels and is surrounded by a common membrane. The contents of the hernia are located inside the spermatic cord. The gateway of an indirect hernia is the internal inguinal ring. An oblique hernia can be congenital or acquired. Indirect hernias are divided into inguinal (within the inguinal canal) and inguinal-scrotal (hernia extending beyond the inguinal canal and descending into the scrotum in men and into the labia majora in women).
• Direct hernia- internal organs move into the inguinal canal, bypassing the spermatic cord. It can only be acquired. A direct inguinal hernia differs from an oblique one in the location of the hernial sac. It is located under the skin outside the spermatic cord.
• Combined inguinal hernia- the patient has several separate hernial sacs on one side that do not communicate with each other. In the case of a combined hernia, direct and oblique hernias can be combined.

There are also clinical classifications of inguinal hernia that take into account the degree of stretching of the internal inguinal ring and the severity of damage to the posterior wall of the inguinal canal, and also include recurrent hernias. These classifications were created for the optimal choice of surgical treatment method.

According to ICD-10, inguinal hernia is classified in the K40 heading, which includes six subheadings.

Symptoms of inguinal hernia

The main signs of an inguinal hernia are the appearance of a painless protrusion in the groin area, which increases after physical exertion and decreases or disappears with rest.

The formation has a soft-elastic consistency, round (inguinal hernia) or oval (inguinal-scrotal hernia) shape. In the case of an inguinoscrotal hernia, its contents descend into the scrotum, leading to its asymmetry; In women, an inguinal hernia of significant size moves to the labia majora.

In a horizontal position, the hernia is easily reduced into the abdominal cavity, with a positive symptom of a “cough shock” and rumbling of the hernial contents upon palpation.

Diagnosis of an inguinal hernia does not present significant difficulties. To establish a diagnosis, a thorough questioning and examination of the patient is sufficient.

How to determine what is the contents of the hernial sac? To clarify the nature of the hernial contents, additional diagnostic methods are used:

1. Ultrasound of the scrotum;
2. Ultrasound of the pelvic organs in women;
3. herniography;
4. in some cases - cystoscopy;
5. cystography;
6. irrigoscopy.

A hernia in the groin itself is not a life-threatening condition, but there is always a risk of complications. The most common complication of an inguinal hernia is strangulation.

Symptoms of a strangulated inguinal hernia are a sudden onset of constant pain and loss of the ability to reduce into the abdominal cavity. When a loop of intestine is strangulated, a clinical picture of small intestinal obstruction develops (severe paroxysmal pain, vomiting, flatulence); when the omentum is pinched, the clinical picture is less pronounced (constant pain of moderate intensity, infrequent vomiting, which is of a reflex nature).

In women, when the ovary is strangulated, general symptoms (vomiting, weakness) may not be observed, which complicates diagnosis. With prolonged infringement and development of necrosis, the intensity of pain decreases.

Causes of inguinal hernia

The cause of a congenital inguinal hernia is non-fusion of the processus vaginalis of the peritoneum and expansion of the internal inguinal ring. A distinctive feature of such a hernia in boys is that the testicle is also located in the hernial sac.

Inguinal hernia in adults in most cases is acquired. The cause of an inguinal hernia is anatomical weakness of the tendon-muscular layers of the abdominal wall.

The most common predisposing factors are age-related changes in connective tissue or its changes due to systemic diseases, on the one hand, and factors leading to an increase in intra-abdominal pressure, on the other. Such factors are regular heavy lifting, pregnancy, obesity, constipation, conditions accompanied by chronic cough, primarily smoking.

Treatment of inguinal hernia

Is it possible to cure an inguinal hernia without surgery? No, the only way to get rid of an inguinal hernia is surgical treatment aimed at restoring the integrity and strengthening the abdominal wall.

In case of strangulation of an inguinal hernia, emergency surgical treatment is performed.

Treatment methods for inguinal hernia

In principle, there are the following methods for treating an inguinal hernia: tension repair of the inguinal canal using the patient’s own tissues and non-tension repair using synthetic materials.

Tension plastic

Tension plastic (Tension, Tissue-based) is divided into posterior and anterior plastic. The most widespread and recognized as the “gold standard” is plastic surgery of the posterior wall of the inguinal canal according to Shouldice (E. Shouldice). Bassini, Halsted, and Cooper operations are also often performed. In Russia, plastic surgery is most often performed according to Postemsky. Anterior repairs have been used to a limited extent for indirect inguinal hernias. Currently, they are practically not used, since they are extremely unreliable and give a high percentage of recurrent hernias.

The main disadvantages of tension methods:

1. a large percentage of recurrent hernias;
2. severe pain in the postoperative period;
3. long period of hospitalization;
4. significant duration of the period of incapacity and rehabilitation period. In the last twenty years, tension operations have been performed less and less frequently.

Tension-free plastic

Tension-free plastic surgery includes two main methods: the Lichtenstein operation (strengthening the hernia orifice with a polymer mesh) and obstructive hernioplasty (an obstructive mesh is installed in the inguinal canal, which is designed to completely prevent the penetration of the peritoneum there and the recurrence of the hernia). After installing the mesh, layer-by-layer suturing of the surgical wound is performed.

There is also an endoscopic technique, when the operation is performed without a large incision, under the control of an endoscope using special manipulators.

The main advantages of tension-free plastic surgery are the complete elimination of relapses, minor pain after surgery and a short period of hospitalization and complete sports and occupational rehabilitation.

Operations are performed under various types of anesthesia, including regional and local.

The disadvantages of endoscopic plastic surgery are the impossibility of performing it under local anesthesia, which limits the use of this method in patients at high anesthesia risk, as well as the high cost of endoscopic equipment.

Prevention of inguinal hernia

Prevention of inguinal hernia is aimed at strengthening the muscular corset and eliminating or weakening factors that cause an increase in intra-abdominal pressure. Prevention measures include physical education and sports, a balanced diet that avoids constipation, rational organization of work related to heavy lifting, and quitting smoking. It is recommended to wear a brace during pregnancy.

What to do after surgery? During the rehabilitation period, it is recommended to perform a set of special gentle exercises aimed at strengthening the muscles of the anterior abdominal wall and thereby preventing the occurrence of recurrent hernias.

Lifting heavy objects should be avoided for some time after surgery; the duration of the restriction depends on the nature of the surgery.

After the operation, the attending physician will give comprehensive recommendations, compliance with which will allow you to fully recover and continue to lead your usual lifestyle.

Inguinal hernia and military service

According to Article 60 of the Schedule of Diseases (PP of the Russian Federation of February 25, 2003 “On approval of the regulations on military medical examination”), after successful surgical treatment of a hernia, the conscript is recognized as fit for military service. Expansion of the inguinal rings without hernial protrusion during physical activity also does not interfere with military service.

Recurrent hernias, large hernias, irreducible hernias, hernias requiring the wearing of a bandage, hernias that appear in an upright position of the body with minor physical exertion, coughing, prone to strangulation, as well as refusal of surgical treatment and contraindications for its implementation serve as a reason for limiting eligibility for surgery. military service. The fitness category is determined individually, taking into account the exact diagnosis, as well as depending on the type of military service.

Video: Inguinal hernia

Strangulated inguinal hernia (ICD - 10 K40.3 - K 45.8) is a common complication, occurring in 10-20% of all cases of the disease. In this case, compression of the abdominal organs or peritoneum occurs in the hernial orifice, in the inguinal canal. This is the anatomical space in which...

Direct inguinal hernia (hernia inguinalis interna) is a protrusion of the abdominal organs or peritoneum into the existing pathological space. Due to the weakness of the muscles and ligaments, the internal organs do not protrude into the inguinal canal, but directly next to it. A direct hernia is exclusively acquired. Provoking...

Right-sided inguinal hernia (lat. hernia inguinalis dextra) is the most common type of hernia of the anterior abdominal wall. Intestinal loops, part of the omentum or peritoneum, under the influence of increased intra-abdominal pressure, extend beyond their boundaries into the available space in the inguinal canal, where ...

An inguinal hernia is a pathology in which protrusion of the internal organs of the abdominal cavity, peritoneum or subcutaneous fat into the existing space occurs due to increased intra-abdominal pressure (during physical exertion, prolonged coughing, etc.), existing muscle weakness or congenital changes in childhood. ...

An inguinal hernia (hernia inguinalis) is a protrusion of the abdominal organs beyond its boundaries due to an increase in the size of the inguinal canal. In men, blood vessels and the spermatic cord are located here. This pathology occurs in representatives of the stronger sex 4-5 times more often, this is due...

An abdominal hernia is a violation of the muscular network and a pathological protrusion of the peritoneum with internal organs.
Umbilical, diaphragmatic and inguinal lesions are distinguished according to the type of formation, and according to the type of acquisition they are divided into congenital, acquired and postoperative.

Based on the contents of the hernial sac, single-chamber and multi-chamber hernias are distinguished.

Stomach

Hernias are classified by location, muscle group, nature of damage, multiplicity of damage, and recurrence.

• Sredinnaya M.
• Lateral L.
• Combined ML.

According to clinical signs, they are classified as reducible, irreducible, partially reducible, strangulated, perforated, complicated, with acute or chronic intestinal obstruction.

The width of the hernial orifice is determined by the letters:

• W1 – up to 5 cm.
• W2 – up to 10 cm.
• W3 – up to 15 cm.
• W4 – more than 15 cm.

The relapse rate is written using the letter R followed by a number indicating the relapse rate.

Diagnosis of abdominal hernia and classification of damage is determined using ultrasound.

Congenital, acquired and postoperative

Hernias occur due to defects in the abdominal muscle tissue. Through the internal organs, the peritoneum shifts and forms a bulge. Organs and parts of the intestine may become exposed or pinched between muscles.

The typology and classification of pathologies contributes to the systematization of medical records, the accuracy of medical diagnosis and the prescription of correct treatment.

The cause of the appearance may be the development of the fetus in the womb, injury, damage to the muscle corset, or muscle tear as a result of excessive physical exertion. Most often, problems appear when lifting weights suddenly.

Postoperative or ventral occur after surgery and cuts in muscle tissue. To avoid the danger of hernias, modern medicine offers minimally invasive surgical methods without extensive incisions of muscle tissue.

After classical operations, when the laparoscopic method cannot be used, it is recommended to follow the prescribed regimen and wear a retaining bandage until the tissue has completely healed. Such operations also include caesarean section and surgical assistance during childbirth.

Note!

The cesarean section procedure involves cutting the abdominal muscles. The actual surgery is performed. After a cesarean section, you must also follow the same regimen and avoid lifting any heavy objects. Wear a post-operative bandage. Hire an au pair and baby care assistant for the duration of your rehabilitation. If the regimen is violated, a postoperative hernia after cesarean section is quite likely.

Video

Definition, causes and diagnosis of hernia.

Features of ventral or postoperative

Symptoms of a postoperative hernia include protrusion of the scar, accompanied by discomfort, pain when moving or straining. The cause is improper tissue fusion after surgery.
Classification of ventral hernias is carried out according to the size of the formations and the degree of tissue damage.

The following types of ventral or incisional hernias are distinguished:

1. Small. Protrusion occurs only during intense physical exertion or muscle tension.
2. Average. They occupy a noticeable area of ​​the peritoneal wall.
3. Extensive. Extensive pathologies include those that occupy the entire area of ​​the anterior abdominal wall.
4. Gigantic. It spreads to more than one area of ​​the abdominal wall.

Postoperative hernias are treated with a repeat operation with surgical removal of the defect.

Such pathologies are quite easily treated by reduction and fixation with timely, ultra-fast diagnosis. If you start the development of a postoperative hernia, it can become recurrent and this is due to the peculiarities of tissue healing after surgery. In a short time, the muscle fibers can grow together correctly. Then, if fusion does not occur, connective fibrous tissue grows, which does not have the same elasticity and ability to contract as muscle tissue.

Classification of inguinal

Inguinal hernias are classified as external. Due to certain physiological characteristics, inguinal hernia is more common in male children. In inguinal bulge, the inguinal canal can be affected. Serious disorders in the genitourinary area often occur. Diagnosis requires a comprehensive examination and clarification of the condition of internal organs. Modern types of classification contribute to the most accurate diagnosis based on basic characteristics.

Standard classifications of inguinal hernias have a common system. Classification according to Solinger or Robins includes a special distinction between oblique, straight and femoral pathologies. Classifications are based on determining the degree of tissue damage.

There are 5 main options for characterizing the development of an indirect inguinal hernia:

1. Initial – no damage to the back wall.
2. Canal with the formation of an enlarged hernial ring.
3. Directly inguinal – the sac descends.
4. Inguinoscrotal - the hernial sac descends into the scrotum.
5. Straightened.

The greatest danger is peritoneal necrosis and purulent inflammation. The presence of a hernia significantly reduces a person’s performance and activity. And in men it reduces sexual activity. Most often, an inguinal hernia, as a developmental pathology, is detected in infancy and is successfully treated without leaving a trace. If a hernia is detected in the early stages of the disease and timely therapeutic treatment is prescribed, the likelihood of relapses and the need for surgical intervention is reduced.

The presence of a hernial sac is not decisive in the diagnosis of an inguinal hernia. In some cases, the sac is hidden by a hernial ring. A qualified medical examination is required for correct diagnosis. Early diagnosis and prediction of the possibility of pathology in infancy contributes to successful treatment.

Currently, an expanded Niehus classification has been adopted, which includes a more precise determination of the location and damage to tissues.

Classification according to Nyhus (L.M.Nyhus)

This classification of inguinal hernias was approved in 1993. A special feature of the Niehus classification system is the inclusion of recurrent ones and the possibility of separately indicating local aggravating factors. Combined and associated hernias are also included in a separate group. A more accurate classification system allows you to determine the optimal method of treatment and hernioplasty.

Typical classification

1 type. Oblique inguinal without enlargement of the inguinal ring. The hernial sac remains in the inguinal canal. The first type is most common in infants and young adults.

2 type includes oblique with a displaced and expanded inguinal ring, protrusion of the wall of the inguinal canal. A characteristic feature of type 2 can be considered the absence of descent of the hernia extension into the scrotum. When classifying, expansion of the deep ring up to 2 cm is allowed.

3 the type has several subtypes and is characterized by a general weakening of the inguinal fundus with or without prolapse:

• 3A – Any straight groins without correlation in size.
• 3B – Oblique with an extended hernial ring. This type is characterized by the descent of the hernial sac into the scrotum. Type 3B also includes the so-called “pantaloons”.
• 3C – Any femoral.

4 type combines recurrent inguinal hernias and includes 4 main types:

• 4A – Direct inguinal.
• 4B – Oblique inguinal with recurrence.
• 4C - Femoral.
• 4D - Combined recurrent.

Femoral hernias are further classified by type of development:

• typical, with standard development;
• lacunar;
• pre- or retrovascular;
• lateral.

Navel

An umbilical hernia is characterized by protrusion of the umbilical ring. Based on the type of origin, umbilical pathologies are divided into congenital and acquired.

Umbilical bumps in babies are a fairly common occurrence. Treatment is prescribed therapeutically, with reduction of the hernial ring. Surgical treatment is prescribed for serious pathologies and a large area of ​​damage.

• Congenital umbilicals are divided into embryonic and germinal - according to the type of formation.
• Acquired umbilicals are divided into straight and oblique according to the type of muscle damage and recommended treatment.
• Direct umbilicals are characterized by the formation of a protrusion directly through the navel area.
• Oblique umbilicals form a protrusion under or above the umbilical ring. Possible extrusion into the subcutaneous tissue.

Classification of diaphragmatic hernias

Diaphragmatic are characterized by displacement of the abdominal organs towards the diaphragm.
According to the type of origin, diaphragmatic ones are divided into traumatic and non-traumatic.

Non-traumatic include congenital diaphragmatic hernia, false and true.
False ones are characterized by underdevelopment of the diaphragm with non-closure of the communication between the thoracic and abdominal sections and squeezing out organs from one part to another.

True diaphragmatic ones are formed in weakened or atypical areas.
An additional difference between false ones is the absence of a full hernial ring, which reduces the likelihood of strangulation.

Classification by type and early diagnosis allows you to determine treatment with maximum accuracy in accordance with professional medical reference books. Separating relapses into a separate category allows us to carefully consider this type of hernial formation and prescribe special treatment. Accurate classification speeds up the diagnostic process and increases the accuracy of medical prescriptions.

(Total 440, today 1)

Most domestic surgeons use the traditional classification of inguinal hernias in our country.

• 1. By origin:
  • congenital;
  • acquired.
• 2. According to the mechanism of formation:

■ straight;

■ supravesical.

3. By degree of development:

■ initial;

■ channel;

■ full;

■ large;

■ very large.

4. According to the clinical course:

■ uncomplicated (reducible);

■ complicated (strangulated, inflamed, irreducible, with traumatic injury).

It is important in clinical practice to divide hernias into oblique and direct. An indirect inguinal hernia, depending on its origin, may

Figure 2.17. Oblique inguinal-scrotal hernia (diagram):

1 – spermatic cord (funiculus spermaticus); 2 – hernial contents (intestinal loop); 3 – hernial sac (opened) as part of the membranes of the spermatic cord

be congenital or acquired, direct - only acquired.

The occurrence of congenital inguinal hernias is closely related to the embryogenesis of the lower abdominal wall and the descent of the testicles into the scrotum. It is known that the inguinal canal begins to form in the 7th month of intrauterine life. During the VIII and IX months, the testicle descends from the internal ring through the inguinal canal into the scrotum. Together with the testicle and spermatic cord, the parietal peritoneum protrudes, which has the shape of a tube and is called the vaginal process, at the bottom of which the testicle is located. By the beginning of labor, the appendix is ​​overgrown. If this does not happen, a communication remains between the abdominal cavity and the testicle, which is a prerequisite for the formation of congenital inguinal hernias. A hernia can occur immediately after the birth of a child, at the first tension of the abdomen (screaming, crying), or manifest itself in childhood or adulthood (with a narrow process). A mandatory sign of a congenital inguinal hernia is the location of the testicle and abdominal organs together in the hernial sac.

The process of testicular descent can be influenced by the following factors (V.V. Grubnik, 2001):

• 1. Distortion of genetic information.
• 2. Teratogenic effects (physical, chemical, biological).
• 3. Deficiency of differentiating hormones of the mother and thyroid hormones, which regulate the process of testicular migration.

The consequence of these factors is a lag in the development of mesenchymal structures of the groin area (muscles, aponeuroses, ligaments), a delay in the descent of the testicle or its deviation from the normal path, as well as varying degrees of disturbance in the processes of obliteration of the processus vaginalis of the peritoneum. In the case when the processus vaginalis remains completely unfused, its cavity communicates freely with the abdominal cavity. In the absence of obliteration of the middle part of the peritoneal process, hydrocele of the spermatic cord may occur during life, and hydrocele of the testicle may occur in the lower third.

Acquired indirect inguinal hernias form during a person’s life. In this case, the peritoneum protrudes into the deep (inner) ring of the inguinal canal, into which the abdominal organs emerge and a hernia is formed. The hernial sac and the organs in it pass through the entire inguinal canal and exit through its outer ring in the groin area. Since the hernia follows the course of the inguinal canal, it is called an oblique inguinal hernia (Fig. 2.17).

Depending on the degree of development of hernias, O.P. Krymov identified the following types of oblique inguinal hernias:

■ initial;

■ channel;

■ cordial;

■ inguinal-scrotal;

■ large hernia (hernia magna);

■ very large hernia (hernia permagna).

Depending on the location of the hernial sac, hernias are distinguished:

• 1. Hernia inguinalis preperitonealis – in which the hernial sac is located between the peritoneum and the transverse fascia.
• 2. Hernia inguinalis intersticialis – when the hernial sac is located between the muscle layers.
• 3. Hernia inguinalis superficialis– the hernial sac is located in the subcutaneous tissue above the aponeurosis.
• 4. Hernia inguinalis encystica (Cooper)– Cooper’s hernia, which is characterized by the presence of two hernial sacs nested inside each other; is extremely rare.

In direct inguinal hernias, the hernial sac exits through the internal deep ring of the inguinal canal and is located outside the spermatic cord. Such hernias have a spherical shape, do not descend into the scrotum, appear when the elasticity of the tissues of the anterior abdominal wall decreases, and are often bilateral.

According to modern views, in the surgical treatment of inguinal hernias, it is pathogenetically justified to strengthen the posterior wall of the inguinal canal in both direct and oblique hernias. In this regard, a classification of hernias was created that takes into account the severity of damage to the posterior wall of the inguinal canal, which helps to objectively evaluate various methods of inguinal canal plastic surgery, which is extremely important for choosing the most universal method. Most of all, the classification proposed by L Nyhus in 1993 meets these requirements, which, according to a survey conducted in 2003, is used by the majority of herniologists in Europe and America.

Classification of inguinal hernias according to Lloyd M. Nyhus:

Type I – indirect hernias with an internal inguinal ring of normal size. Usually occurs in children and young adults. The posterior wall of the inguinal canal in the projection of the medial inguinal fossa is intact, the hernial sac is located inside the inguinal canal (Fig. 2.18).

Type II – oblique hernias with an expanded and displaced internal inguinal ring without protrusion of the posterior wall of the inguinal canal. The hernial sac can occupy the entire inguinal canal, but does not descend into the scrotum (Fig. 2.19).

Type III – divided into 3 groups (Fig. 2.20):

III A – all direct hernias (large and small);

III B – oblique hernia with a large, expanded internal inguinal ring; the hernial sac is often located in the scrotum. This group also includes typical pantaloon (a combination of oblique and direct hernia) and sliding hernias;

III C – femoral hernia.

Type IV – all recurrent hernias:

IV A – straight;

IV B – oblique;

IV C – femoral;

IV D – combination of recurrent hernias.

This classification is the international standard for comparing the results of open and laparoscopic hernioplasty of inguinal hernias.

In 1998, R. Stoppa added to this classification aggravating factors of a local (sliding hernia, multiplicity, large hernia, technical difficulties, risk of infection) and general (obesity, collagen deficiency, age, diseases of the respiratory system, dysuria, constipation) nature, which are the basis for transferring each type of hernia to the next (for example: hernias with an aggravating factor from type I go into type II).

Rice. 2.18. Classification no Lloyd M. Nyhus:

Type I ( A ): 1 – a. et v. epigastrica

Rice. 2.19. Classification according to Lloyd M. Nyhus:

Type II (B): 2 – a. et v. testicularis; 3 – a. et v. ilica externa; 4 – ramus genitalis nervi genitofemoralis

Rice. 2.20. Classification no Lloyd M. Nyhus:

Tun III (B): 4 – ramus genitalis nervi genitofemoralis; 5 – ductus deferens

A clear division into categories is a necessary condition for an objective comparative assessment of methods of treating hernias and the frequency of their recurrence. In addition, the widespread use of the L. Nyhus classification makes it possible to more accurately determine the indications for the use of prosthetic methods of hernioplasty.

Ball-shaped bacteria are called cocci. Normally, single cocci are found in smears. With a decrease in immunity, the amount of coccobacillary flora in smears increases. Cocci are divided into gr (positive) and gr- (negative). Let's look at their differences.

In microbiology, for a detailed description of bacteria, in addition to indicating their shapes, sizes and other characteristics, there is also the “Gram stain” method. The smears are exposed to a special staining agent.

Microorganisms that remain colored after washing the smear are called gram-positive (gr), while those that become discolored during washing are called gram-negative (gr-). The most common gram-positive microorganisms include, for example, staphylococci, streptococci, enterococci, and lactobacilli. Proteus, gonococci and Escherichia coli are gram-negative.

In what cases is a smear analysis for flora carried out?

This study is always performed when a woman complains of any symptoms associated with gynecological diseases (pain in the lower abdomen, itching and discomfort in the vagina, changes in the nature of discharge).

Women have a question: how long does it take to analyze a smear for flora? It will be ready within 1 day.

The analysis result is valid for 10 days.

What does a smear reveal for flora and cytology? Its main purpose is to detect pathological changes in tissues, which can later transform into a cancerous tumor. If a cytology smear from the cervix is ​​taken regularly, then negative indicators can be identified at an early stage - for example, an inflammatory disease, which can be cured in a short time with appropriate therapy and prevent further complications.

What does a cytology smear show? The results of the study can be both positive and negative.

Positive can be "bad", "abnormal", "atypical" or mean "dysplasia". It is clear that a bad cytology smear is not the norm, that is, there are inflammatory changes in the mucosa, atypical pathological cells are detected in the smear, which should not be there.

A negative smear is considered normal. This means that the cervix is ​​healthy, the cellular structure of the epithelium is not changed, and the microflora does not contain pathogenic microbes. When to take a smear for cytology, the gynecologist decides. Experts advise conducting research at least twice a year.

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As a rule, a smear on the flora is taken during any initial visit of a woman to a gynecologist.

Also, indications for taking a smear and its subsequent microscopy are:

1. 1 Scheduled preventive examinations and medical examinations.
2. 2 Pathological leucorrhoea (vaginal, cervical, urethral discharge), unpleasant odor, profuse nature, discoloration.
3. 3 Pre-conception preparation as part of planning natural and IVF-induced pregnancy.
4. 4 Screening during pregnancy.
5. 5 Unpleasant, painful sensations in the lower abdomen, which the woman does not associate with the menstrual cycle.
6. 6 Painful urination, dysuria, including symptoms of urethritis, cystitis. Urological pathology in women, as a rule, requires consultation and examination by a gynecologist.
7. 7 Completion of the course of antibiotics in order to determine the nature of the flora and the possibilities of its restoration.

Pap smear during pregnancy

A smear for cytology during pregnancy is taken at least 3 times - this can be done either in the gynecologist’s office or in a private laboratory - for example, in Invitro using liquid cytology. The study is important for monitoring the vaginal microflora of the expectant mother.

The result of a smear on flora above type 2 purity during pregnancy means an inflammatory process in the woman’s genital tract. In this case, the expectant mother may complain of itching and burning in the external genital area, as well as a change in the smell and color of vaginal discharge.

The body of pregnant women begins to produce a lot of progesterone, which is why the number of lactobacilli increases several times. This is necessary to protect the developing fetus from pathogens. Therefore, it is advisable to undergo an analysis of the degree of vaginal cleanliness at the stage of pregnancy planning.

In pregnant women, flora smears are taken repeatedly. The first time a woman registers, then at 30 and 38 weeks. In this way, vaginal microflora is monitored throughout the entire period of pregnancy.

Complications after taking a smear

The smear collection procedure itself is practically painless for a woman. Most often, discomfort occurs when a doctor installs a gynecological speculum. After a smear for cytology, a woman may experience slight discharge mixed with blood from the genital tract, but the bleeding lasts for no more than two days, and the condition goes away on its own without external intervention.

If after the procedure there is severe pain in the lower abdomen, fever and chills, you should consult a doctor. Grossly incorrect sampling of epithelium in the deep layers of the cervical canal with simultaneous violation of antiseptic rules can cause tissue infection.

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A cytology smear is a simple, fast and cheap way to find out about a woman’s intimate health. Due to the absence of side effects, painlessness and speed of obtaining results, cytology smears have been introduced into gynecological practice everywhere.

Indications and contraindications

When to do a smear for cytology:

• with diagnosed infertility;
• at planning pregnancy;
• when menstrual irregularities, for example, an atrophic type of cytology smear will indicate hormonal changes in the body against the background of menopause;
• if used oral contraception;
• with genital herpes;
• for obesity;
• if human papillomavirus is detected in the body;
• if a woman is promiscuous;
• in preparation for installation of the IUD.

This research is not always possible.

A smear for cytology is not taken:

• during menstruation, because red blood cells may be erroneously detected in a cytology smear;
• with acute inflammatory process in the genital area;
• with heavy vaginal discharge and severe itching.

Pregnancy cannot be a contraindication to the procedure. There is no point in taking this test for women who are not sexually active (virgins). The same applies to women who have undergone surgery to remove the uterus - a hysterectomy.

Interpretation of smear results for flora in women

In gynecology, one of the most informative diagnostic methods is a smear test for flora. Material for analysis is taken from the mucous membrane of three areas: urethra, vagina, cervix.

Such diagnostics give doctors the opportunity to determine the quantitative and qualitative composition of the microflora of the genitourinary tract, the presence of an inflammatory process and the presence of atypical cells. With the help of a smear on the flora in women, the causative agents of various sexually transmitted infectious diseases can be easily identified.

What do the results of the smear analysis indicate? The presence of certain components in a smear makes it possible to suggest a certain disease, choose further diagnostic methods and prescribe the correct treatment.

If the content of leukocytes and epithelium is high, there is reason to suspect an inflammatory process (acute or chronic). In healthy women, mucus is present only in the vagina. Its detection in the urethra is a sign of inflammation in the urinary system.

If the smear contains cocci, small rods and “key” cells, the gynecologist diagnoses bacterial vaginosis.

When gonococcus is detected, a diagnosis of gonorrhea is made. If gardnerella and trichomonas are detected, then the patient has gardnerellosis and trichomoniasis. A large number of Candida fungi indicates a deterioration in the degree of purity and dysbiosis.