One of the main operations in a surgical hospital is the removal of a hernia of the abdomen. It is carried out both urgently and in a planned manner.
The procedure for abdominal hernia removal depends on the duration of the disease. From the presence of infringement and how timely the patient sought medical help.
The operation is a protrusion of the abdominal organs through holes that do not exist normally. For example, in the umbilical region of the white line of the abdomen.
Types and causes of occurrence
- tendency to constipation,
- children or old age
- violation of the anatomical integrity of the anterior abdominal wall, due to previously transferred operations,
- heavy physical labor
- male gender,
- tendency to increased body weight,
- severe cough or scream
- repeated complex natural births,
Hernias of the white line of the abdomen are congenital and acquired. They rarely reach a diameter of more than 10 cm. More often they are located above the navel and are rarely infringed.
The clinical picture is manifested by pain in the organ that falls into the hernial sac. It can be an omentum, loops of the small intestine, bladder.
In case of getting into the hernial gate of the intestinal loops, unpleasant sensations arise. This may be a burning sensation in the loops of the intestine in the upper abdomen. In childhood, white line hernias practically do not occur.
1. Purulent-surgical infections of the skin and soft tissues.
- Boil - inflammation of the hair follicle,
- Carbuncle - purulent inflammation of the hair follicles,
- Panaritium - purulent inflammation of the skin, soft tissues, tendons and bones of the fingers,
- Festering atheromas,
- Infected open wound,
- The inflammatory process of the fingers and periungual bed,
- Bursitis - inflammation of the joint bags,
Inguinal hernia refers to a hernia of the abdominal wall, but is visualized in the inguinal region.
There are a number of characteristic features that determine an inguinal hernia:
protrusion of individual parts of the internal organs, or any internal organ entirely through the inguinal canal under the skin.
On both sides of the inguinal region, the inguinal canal passes, which is visualized as the space between the wide muscles of the abdomen. In women and men through the inguinal canal pass: in women - a round ligament of the uterus, in men - the spermatic cord with nerves.
Disease - inguinal hernia is found in both men and the fair sex. However, due to the anatomical structural features in men, it is observed much more often than in women of the opposite sex.
There are a number of reasons that contribute to the development of inguinal hernia:
Allocate congenital and acquired causes.
- Age (due to muscle weakness)
- Gender (male predisposition)
- Genetic features of the body structure
- Rapid weight loss (for example, when losing weight)
- Regular birth in women
- Atrophy of the nerves that provide innervation of the abdominal wall
- Difficulty urinating
- Frequent constipation
- Difficult birth
- Heavy physical exertion
- Persistent cough
There are a number of symptoms that indicate the development or presence of inguinal hernia:
- Groin discomfort when walking
- Disorder of urination and even digestion
- Swelling in the inguinal zone
- In men, there is a stretching of the skin on the scrotum and its increase, a state of deviation of the penis to the side opposite to finding a hernia is possible.
The only radical and effective method of treating inguinal hernia to date is the rapid elimination of hernia formation. It allows you to completely eliminate the hernia and eliminate possible consequences.
The operation consists in removing the hernial sac itself and subsequent strengthening of the weakened area of the abdominal region with its own tissues, or, if it is impossible to use its own tissues, with a polypropylene mesh transplant.
Qualified surgeons treat an inguinal hernia under local or general anesthesia. The decision is made by the surgeon according to individual indications. With general anesthesia, consultation with an anesthetist is mandatory.
After the operation, the patient can continue to lead a normal life without any anxiety or discomfort with an inguinal hernia.
An umbilical hernia is visually manifested by protruding the navel outward or in part, which does not always look aesthetically pleasing.
A common cause of umbilical hernia is a protrusion of the internal organs (possibly part of the intestine) into the navel, due to the weakness of the abdominal fascia. In 70% of cases it is a hereditary disease.
Umbilical hernia is treated by surgery, during which the umbilical hernia is removed. Photos before and after the operation, you can see on the site. In addition to eliminating the umbilical hernia itself, the aesthetic perception of the navel is significantly improved.
Inguinal hernia repair
Inguinal hernias are much more common than others: they account for 73.4% of all hernias.
The purpose of an operation for inguinal hernias is to eliminate the hernial sac and close the hernia gate.
Over 100 different methods have been proposed for closing hernia gates, of which only a few have found application in surgical practice (methods of Girard, S.I. Spasokukotsky, A.V. Martynov, Bassini, M.A. Kimbarovsky, etc.).
Surgery for oblique inguinal hernias
As a rule, operations for inguinal hernias are performed under local anesthesia. General anesthesia is used only in children and very nervous patients.
An incision of the skin, subcutaneous tissue and superficial fascia 8 to 12 cm long is made 2 cm above the inguinal ligament. Bleeding vessels are clamped and bandaged.
The aponeurosis of the external oblique muscle of the abdomen is carefully peeled from the subcutaneous fat and dissected through a grooved probe. The resulting aponeurosis flaps are captured by clamps, stretched to the sides and separated with a tuffer from the underlying tissues: the internal flap is from m. obliquus internus abdominis, and the outer - from the spermatic cord, highlighting the groin of the inguinal ligament. Fascia cremasterica, m. Is carefully dissected along the spermatic cord. cremaster, transverse fascia and bare hernia sac, as well as elements of the spermatic cord. The hernial sac is carefully separated from the surrounding tissues with a finger wrapped in a gauze napkin or tupfer, from the bottom to the neck, until it is completely released. It should be remembered that rough manipulations with the spermatic cord can cause damage to its elements, which leads to swelling of the testicle, in the tissues adjacent to the outer surface of the hernial sac, the ileo-inguinal nerve is located, which must be moved outward to avoid damage. The isolated hernial sac at the bottom is captured with two forceps and carefully, avoiding damage to the contents, open.
Fig. 19. Prompt access to the hernial sac with inguinal hernia.
In the presence of adhesions between the wall of the bag and the hernial contents (omentum, gut), they are disconnected, and the contents are inspected and inserted into the abdominal cavity. After that, the wall of the bag is cut along the length to the neck. The neck of the hernial sac is stitched as proximal as possible under visual control, and the ends of the threads are tied first on one side and then on the other side. When stitching the neck and tying ligatures, the hernial sac should be tightened well so as not to trap the wall of the intestinal loop or omentum. The peripheral part of the hernial sac distal to the superimposed ligature is cut off. After making sure that there is no bleeding from the stump of the hernial sac, the ends of the threads are cut off, and several nodal catgut sutures are placed on the dissected fascia cremasterica. This ends the first stage of the hernia repair operation (Fig. 20).
Then proceed to the plastic inguinal canal. In this case, the methods of Girard, Spasokukotsky, Martynov, Kimbarovsky, Bobrov are most often used.
Fig. 20. Stages of hernia repair with inguinal hernia. a - dissection of the hernial portal, b - isolation of the hernial sac, c - opening of the hernial sac, d - revision of the contents of the hernial sac, d - immersion of the contents into the abdominal cavity with suturing of the neck, e - cutting off of the hernial sac.
Girard's Way (Girard). Girard's method is to strengthen the anterior wall of the inguinal canal over the spermatic cord.
After processing and cutting off the hernial sac, the aponeurosis flaps of the external oblique muscle of the abdomen are pulled to the sides and the edge of the internal oblique and transverse muscles are sutured with interrupted sutures to the inguinal ligament over the spermatic cord. In this case, it is necessary to avoid trapping the ileo-inguinal nerve into the ligature, since its infringement leads to the development of painful and prolonged pains radiating to the groin. First, the edge of the internal oblique and transverse muscles of the abdomen is sutured with silk thread, and then the inguinal ligament. To prevent damage to the peritoneum and abdominal organs at the time of suturing the muscles, a finger or spatula is placed under them. In order to avoid damage to the femoral vessels, the inguinal ligament should not be pierced too deeply, for this it is better to use needles of small diameter. A total of 5 to 7 stitches are applied, which are then tied alternately. After that, the entire aponeurosis flap is sewn to the edge of the inguinal ligament along the entire length of the incision with interrupted sutures. The first suture is applied in the area of the pubic tubercle, tying it, you should make sure that the spermatic cord is not infringed. The outer flap of the aponeurosis is laid on top of the inner (like the floors of the coat) and hemmed by a number of interrupted sutures to the last. The newly formed outer ring of the inguinal canal should pass the end of the index finger.
Fig. 21. Plastic surgery of the anterior wall of the inguinal canal according to Girard. a - hemming of the edges of the internal oblique and transverse muscles of the abdomen to the inguinal ligament, b - hemming of the upper flap of the aponeurosis of the external oblique muscles of the abdomen to the inguinal ligament, c - duplication of the aponeurosis, d - diagram.
As a result of the plastic surgery of the inguinal canal, a rather strong muscle-aponeurotic layer is created, consisting of the internal oblique, transverse abdominal muscles and a duplicate of the aponeurosis of the external oblique muscle, which prevents the protrusion of the insides and the repeated formation of a hernia.
After plasty of the inguinal canal, several catgut sutures are placed on the subcutaneous tissue (if it is well developed). The skin is sutured with a number of interrupted sutures.
The disadvantage of this method is the possible erosion of the inguinal ligament and the insufficient strength of the first row of sutures, as well as the lack of a durable scar due to stitching of dissimilar tissues.
Method C.I. Spasokukotsky lies in the fact that the internal flap of the aponeurosis of the external oblique muscle of the abdomen together with the edges of the internal oblique and transverse muscles of the abdomen are sutured to the inguinal ligament with one row of nodal sutures. Then the outer flap of the aponeurosis is sutured over the inside.
Fig. 22. Plastic surgery of the anterior wall of the inguinal canal according to the method of Spasokukotsky.
The disadvantage of this method is the possibility of interposition of muscle tissue and its infringement between aponeurosis and inguinal ligament, which worsens the healing process.
The way of Kimbarovsky. After processing and cutting off the hernial sac, the internal flap of the dissected aponeurosis and the underlying muscles are stitched from the outside to the inside, retreating 1 cm from the edge of the incision. The needle is carried out a second time only through the edge of the internal flap of the aponeurosis, going from the inside out, then the edge of the inguinal ligament is sutured with the same thread. Having applied 4 to 5 of these sutures, they are tied in turn, and the edge of the internal aponeurosis flap is tucked under the edge of the muscles and brought into close contact with the inguinal ligament. On top of the internal flap, the external aponeurosis flap is sutured.
Method A.V. Martynova. Based on the fact that a strong fusion occurs between homogeneous tissues, A.V. Martynov suggested using only the aponeurosis of the external oblique muscle of the abdomen to strengthen the anterior wall of the inguinal canal.
Its method is reduced to the formation of a duplicate of the leaves of the dissected aponeurosis: the internal flap of the aponeurosis is sutured to the inguinal ligament, then the external flap is laid on top of the internal one and sutured to the last.
Fig. 23. Plastic surgery of the anterior wall of the inguinal canal. a - according to Kimbarovsky, b - according to Martynov.
Depending on the period of occurrence, congenital and acquired inguinal hernias are distinguished. Congenital hernias occur when the testicle is lowered from the abdominal cavity into the scrotum. Normally, at the end of this process, the gonadal sheet of the peritoneum should overgrow, which will cover the inguinal canal. If this does not happen, a defect is formed through which internal organs can be lobbied. Acquired hernias are formed during life due to thinning or weakening of the muscle-aponeurotic apparatus under the influence of provoking factors.
The second classification is based on the anatomical features of the hernia. Here are distinguished:
- Oblique hernias - the inner inguinal ring serves as the entrance gate. In this case, the hernial sac is located next to the spermatic cord.
- Direct hernias - the hernial gate is the medial fossa located opposite the external inguinal ring. Neither the inguinal canal nor the spermatic cord are affected.
- Combined hernia. This is a complex formation, which includes both oblique and direct hernias, while they do not communicate with each other.
The examination for umbilical education is carried out by the surgeon in two stages. First, the hernial sac is examined, its size, the possibility of repositioning. With large sizes of formation, the contours of the intestinal loops, intestinal motility are noticeable.
For a detailed study, hardware diagnostic procedures are performed:
- Ultrasound - allows you to determine the size of the hernia gate, to study the contents of the protrusion and the state of the aponeurosis,
- gastroscopy, radiography of the stomach, examination of the small intestine using barium - to assess bowel obstruction, the possible presence of adhesions.
The results of objective diagnostics are used as the basis for the exclusion of a restrained condition, which is similar in manifestations to an irreversible hernia. In addition, to determine whether there is a need for umbilical hernia surgery, differentiation is performed with the following pathologies:
- hernia of the white line of the abdomen - protrusion of the peritoneum through a weak section of tendon fibers along the vertical axis, which divides the anterior abdominal wall into two symmetrical parts,
- metastases - secondary tumors of stomach cancer,
- extragenital endometriosis - the growth of endometrial cells in the navel, is found in the fairer sex.
After receiving the results of each examination, the doctor makes a decision on the method of treatment.
If it is possible to treat non-surgical, conservative therapy is carried out on an outpatient basis. Otherwise, the patient is prescribed a planned or emergency removal of the umbilical hernia.
Operation - hernioplasty can be performed in the following ways:
- suturing of the defect in the white line with purse-string, U-shaped, nodal and other types of seams,
- own tissue plastic
- laparoscopic surgery.
The operation is best done as planned without waiting for complications. For which you will have to perform emergency surgery. It is best to carry out the operation in specialized hernia removal clinics.
Preparation for surgery includes the following tests:
- clinical blood count, urinalysis,
- blood chemistry,
- coagulogram - analysis of blood coagulability and duration of bleeding,
- determination of blood type and Rh factor,
- blood for Wasserman reaction, HIV, hepatitis,
- chest x-ray,
- ultrasound dopplerography of the vessels of the lower extremities,
- in the presence of diabetes, consultation with an endocrinologist is indicated,
If the patient has a peptic ulcer of the stomach or duodenum, then FGDS is necessary.
How is the operation - removal of a hernia of the abdomen?
If the contents of the hernial sac is preperitoneal fat, then the operation involves the application of U-shaped sutures. First you need to make sure that only abdominal fat is inside the hernial portal and there are no intestinal loops.
With large protrusions, a hernia of the white line of the abdomen is removed. The operation is performed laparoscopically and includes the installation of the mesh in the area of divergence of the leaves of the aponeurosis.
A mesh is implanted when there is not enough local tissue for plastic surgery. Also, if the connective tissue is very soft, loose, there is a risk of hernia recurrence.
The benefits of using the mesh during surgery are:
- Relapse of hernias is practically excluded.
- The postoperative period is easier, less pain in the postoperative wound, because there is less tension of local tissues in the area of surgical intervention.
- The opportunity to activate the patient earlier, restoring the quality of life.
- This method significantly reduces the duration of surgery.
- A significantly smaller amount of suture material is used during the operation, and, therefore, the risk of ligature fistulas is reduced.
- The mesh quickly grows with fibrous tissue and capillaries, is not torn away, it does not need to be removed in the future.
With a divergence of the rectus abdominis muscles on the side of the white line, laparoscopy is used. It allows you to make surgery less traumatic and the postoperative period smoother.
Removing a hernia of the abdomen using a laparoscopic technique allows you to:
- perform this operation in elderly patients
- or patients suffering from severe concomitant somatic pathology.
Laparoscopy is desirable when there is a suspicion that the contents of the hernial sac are filled with loops of the intestine and the hernia should be revised from the side of the abdominal cavity.
The peculiarities of surgical treatment of postoperative hernias is the need to allocate a hernial sac from adhesions formed since the previous operation.
In this situation, laparoscopy also gives a good effect, because it can significantly reduce the risk of developing intraoperative complications. The more accurately the operation is performed, less tissue trauma, bleeding. The lower the risk of suppuration and the occurrence of hernia recurrence.
In the postoperative period, early activation in the bandage is necessary. This is necessary to prevent the development of such a dangerous type of complications as hypostatic pneumonia.
Features of the postoperative period depend on at what stage of the disease the operation was performed. Whether the infringement of intestinal loops was preceded by surgical intervention, as well as what are the accompanying somatic diseases.
Wearing a bandage is strictly required.
In the uncomplicated course of the postoperative period, the hospital stay is 1 day after the operation.
The purpose of the use of postoperative bandage is:
- pain reduction,
- reduction in the likelihood of developing recurrent hernias after surgery,
- the bandage protects against infections, skin irritation, promotes the fastest recovery of motor activity.
After the restoration of intestinal motility, the diet gradually expands, food is allowed. Nutritional features include eating healthy foods. Food rich in fiber, with the goal of preventing constipation, diseases of other organs of the gastrointestinal tract.
Rehabilitation after hernia removal is easier if surgery was performed laparoscopically. With this technique, there are no large traumatic incisions and pain after surgery is less pronounced.
The rehabilitation process includes control over the following main parameters:
- Change in temperature 2 times a day in the morning and evening.
- Dressings before removal of sutures and control of a postoperative wound. Sutures are removed 7-10 days after surgery.
- Refusal to drive a car in the next 2 days after surgery, because the anesthetics used to anesthetize reduce attention and the ability to drive a vehicle.
- If a person is engaged in mental work, then returning to work is possible a few days after the operation.
- During physical work, rehabilitation will be needed for several weeks after the operation, which will include exercise therapy, massage.
In the postoperative period, the following complications may develop:
In the case of a timely operation, fulfillment of doctor's prescriptions, adherence to diet and physical activity, the likelihood of developing complications will be minimal.
If complaints of discomfort and discomfort appear in the midline of the abdomen, it is necessary:
- see a doctor
- take blood tests
- perform an ultrasound of the abdominal cavity.
Timely diagnosis and treatment will allow you to perform the operation on time, to exclude the possibility of complications and relapses.
You can see some more details about this operation from the transfer of Elena Malysheva.
Causes of inguinal hernia in men
In adult men, the formation of inguinal hernias is facilitated by the anatomical features of the inguinal canal - it is wider, shorter, and not so well strengthened by muscles and tendons as in women. However, anatomical features alone are not enough, still provoking factors are needed:
- Age-related changes that lead to a weakening of muscle tone and connective tissue structures.
- Systemic diseases leading to impaired muscle function.
- Frequent increase in intra-abdominal pressure. This condition is characteristic of constipation, chronic cough, obesity, etc.
Preparation for surgery and preoperative diet
The success of the surgical treatment and the duration of the rehabilitation period depend on the quality of measures taken before the removal of the hernial defect. The preparatory phase begins with the moment the decision to conduct the operation.
The list of preoperative measures includes:
- Training a patient in breathing exercises to prevent complications from the lungs. It is important to show the patient how to breathe deeply and evenly during a hernia defect resection. “Rehearsal” is carried out in a hospital on the operating table, from which patients have confidence before the operation.
- In people with large protrusions, after surgery, they can change intra-abdominal pressure, which will negatively affect heart function and breathing. To prevent secondary pathologies, the patient is periodically placed on a functional bed with a raised leg end. The hernial sac is set and an object is placed on top that will hold the contents inside the abdominal cavity.
- With a tendency to constipation, laxatives, cleansing enemas are prescribed.
- Postoperative bandage is acquired in advance, which protects the suture from overstretching for the duration of its healing.
- To patients of advanced age there should be a special relation. As practice shows, they better tolerate surgical treatment if preparatory procedures are carried out in a hospital in 10-12 days.
Before surgery to remove umbilical hernias in adults, a lightweight diet is recommended. Fatty and fried foods, smoked meats, sausages, chocolate, pastries should be excluded from the daily diet. Dietary food includes low-fat dairy products, fresh vegetables and fruits, buckwheat, rice, and oatmeal cereals.
On the eve of surgery, the patient last eats in the evening, in the morning eating is prohibited. Before going to bed, preparation of the surgical field is underway: shaving the abdomen. Patients of advanced age are given banks for the prevention of pneumonia. Before going to bed, give a light sleeping pill.
Necessary analyzes and studies
Upon admission to the hospital, the patient is assigned to repeat laboratory and hardware studies. The list of control tests before umbilical hernia surgery includes:
- blood pressure measurement
- X-ray examination of the lungs
- blood and urine tests,
- Ultrasound of the abdomen.
Women will additionally need a consultation with a gynecologist. In the process of preparation, the presence of allergic reactions to drugs is revealed. For several days, stop taking anticoagulants, which thin the blood, worsening the quality of coagulation.
Together with the anesthesiologist, the question of choosing the type of anesthesia, which depends on the size of the hernia cone, concomitant diseases and the age of the patient, is being decided.
Umbilical hernia surgery
Excision of the umbilical defect is a responsible manipulation, the result of which is affected by the method of surgical intervention, as well as the skill and experience of the surgeon. The high-quality implementation of all stages of surgical treatment depends on the absence of repeated hernias and intestinal disturbances.
If an umbilical hernia in adults is diagnosed, the operation consists of three main periods:
- phased dissection of the anterior abdominal wall,
- atraumatic extraction of the hernial sac, dressing of its mouth,
- closing of hernial gates with maximum preservation of the anatomical structure.
For the proper formation of the suture, a careful layered connection of all structures is important: muscle tissue, aponeurosis, skin layers. Minimally invasive techniques are less traumatic, but such methods will not always be used correctly.
A hernia repair performed through a small incision in the abdomen is called hernioplasty. In practical surgery, there are two varieties of an open method for hernia resection:
- stretch, when suturing of the hernia gate is due to its own tissues,
- unstretched - an endoprosthesis is used to strengthen a weak spot.
In the course of lengthy studies, it was noted that umbilical hernia resection in women - an operation that takes place without the use of a mesh implant, often leads to secondary pathologies. Plastic surgery, during which the mesh is introduced, is the most modern and popular method of hernia repair in modern medicine.
The defect is removed through an incision near the navel, after which a mesh transplant is sutured to the site of the hernial portal. A flap made of a special material that has high biocompatibility with abdominal tissues is reliably connected by sutured surgical sutures. The endoprosthesis overlaps the weakened area and overlaps healthy tissue by 2 cm from all sides.
The nets take root well and germinate with connective tissue, strengthening the abdominal wall. In most cases, this technique is indicated for adults and children after 5 years. The absolute indication is the recurrent formation and the large size of the hernia gate. Using a mesh prosthesis effectively replaces the defect and reduces the risk of re-protrusion to 1%.
Surgical treatment using a laparoscope is considered a highly effective surgical method for hernia removal. A medical device with a microscopic camera is inserted into the abdominal cavity through a micro section (1.5 -2 cm). To access the operative field, three punctures are made. The other two are trocars and miniature instruments.
Laparoscopy is performed according to strict indications under general anesthesia. The duration of the operation is about an hour.
During the manipulation, a review of the internal organs is displayed on the monitor, which provides good control over the course of surgical operations. After dissection of the peritoneum and excision of the hernial formation, the mesh is fixed. The transplant should be well-spaced and firmly attached to its own tissues.
Due to the fact that the anterior abdominal wall is not damaged, the load on the mesh insert extends evenly. Recovery time is reduced, and the seam is fused in 2-3 weeks. A day after surgery, the patient may be discharged. Further monitoring is done on an outpatient basis.
Hernioplasty using Sapezhko, Lexer or Mayo methods
In adults and children, umbilical hernias are often operated on by known methods that differ in the technique for closing a hernial defect. Each of them is named after the doctor who first proposed this option for hernia repair.
Sapezhko conducted the first operation at the beginning of the last century, but his technique is still used by modern practitioners. Through a vertical incision, the hernial sac is cut off from the tissues of the peritoneum and aponeurosis by 15 cm from all sides. The umbilical ring is cut along the white line in the upper and lower directions. The hernial formation is processed, after which one edge is sutured to the wall of the tendon sheath of the rectus abdominis muscle in the back. The other part - to the front half, as a result of which the artificial “smelling” of one part onto another is simulated.
Using the Mayo method, two semicircular dissections are made transverse to the axis around the hernial seal. The formed part is gradually separated around the hernia gate. A ring in the navel is dissected and a protrusion is secreted. After studying for necrotic masses, the contents of the bag are returned to the abdominal cavity. The mouth of the formation is bandaged and resected together with the skin. After that, all tissues are sutured in layers, parts of the aponeurosis are captured taking into account the layering of one part on another, reinforcing with seams with the letter “P”.
The Lexer method is prescribed for excision of a hernia through a single incision made in the form of a semicircle under an umbilical formation. The skin layer along with subcutaneous fat is pushed back, after which the education is separated. After reduction of the peritoneum, a resection is performed. A feature of this technique is that the navel can be removed during the operation.
Olshausen's intraperitoneal method
This method removes hernias that form during fetal development. Infants diagnosed with fetal hernia are operated on in the first day after birth. In order to urgently carry out surgical treatment, the written consent of the parents is required.
With the intraperitoneal method, the formation is cut and its contents are studied. If the peritoneum or bowel loops are subject to reduction, they are installed in the abdominal cavity. When the liver is wedged into the umbilical ring, the tissues are additionally dissected to return the organ “to its place”. After that, the pathological tissues are excised, and the front wall of the abdomen is sutured in stages.
For surgical treatment of small hernias, provided there are no signs of obesity, laser beam removal is used.The operation lasts about an hour, performed under local and epidural anesthesia. Through a small puncture, a quartz fiber is introduced into the abdominal cavity, which actively evaporates the water without affecting the bones and muscles.
When gaining access to pathological protrusion, the surgeon performs a dissection with a surgical laser. According to the traditional scheme, viable tissues return to the abdominal cavity, and the pathological formation is excised. To strengthen the weakened umbilical ring, a mesh endoprosthesis is sewn, which over time provides reliable protection against the reappearance of hernias.
How long does the operation
Correction of protrusion of the navel area takes from half an hour to two hours. The duration depends on the chosen method of removal, the size of the hernial portal, the degree of development of the disease. The shorter the time period, the lower the likelihood of complications after prolonged anesthesia.
When an umbilical hernia is impaired in adults, the operation does not matter how long it lasts.
In an emergency, a team of surgeons makes an instant decision, more often in favor of open excision of the affected area. In such a situation, the life of the patient depends on coherence and accuracy of actions.
Rehabilitation after surgery
The speedy return of the patient to everyday life is the main goal of the recovery period, which can take from 4 to 6 weeks. Long-term recovery, lasting several months, is observed in complicated cases, as well as in individuals with a low level of metabolic processes that affect tissue regeneration.
Rehabilitation can be divided into:
- early - carried out in the postoperative period,
- late - which consists in the implementation of the doctor's recommendations after hospitalization.
Throughout the recovery period, the patient needs to wear a postoperative bandage, which should be bought in advance. The size is selected according to the girth of the abdomen with the adjusted hernia. Constant wearing of the protective device prevents excessive load on the anterior abdominal wall, promotes the speedy healing of the suture, and prevents the risk of developing a repeated hernia.
Postoperative Recovery Period
In the postoperative period, the operated person remains under the supervision of a doctor. The first hours the patient is not allowed to get out of bed to exclude any load on the abdomen. When a pain symptom occurs, the doctor prescribes painkillers. Antibacterial therapy is performed to prevent wound infection.
With the abdominal hernia technique, the patient remains horizontal for the first two days, after which the patient is allowed to rise. In the first week, it is important to conduct regular dressings of the postoperative wound, monitor the condition of the suture. For 14 days, any physical activity is prohibited. Performing light exercises to strengthen the abdominal muscles begins from the third week after the operation.
Proper nutrition plays an important role in the success of the rehabilitation process. To start the digestive system, it is recommended to start with liquid food. Subsequently, lean meat, fish, is steamed. Gradually cereals, fresh vegetables and fruits are introduced into the diet.
Physical activity and sports after surgery
When the postoperative scar is fully formed, the patient is recommended the first classes of physiotherapy exercises. Light strengthening movements accelerate healing and shorten the recovery period. The treatment complex includes exercises to strengthen the muscles of the abdomen, back and hips, and it’s strictly forbidden to “pump the press”.
For each patient, the exercises are selected by the attending physician based on the functionality and age of the patient. The first classes are conducted under the guidance of an instructor in exercise therapy, who teaches the implementation technique, and also monitors the correct dosing of the load.
Sessions are held regularly for 15-20 minutes, putting on an abdominal bandage before class.
Subsequently, the patient should not get involved in sports that are associated with weight lifting. Daily physical activity should not be intense. Useful walks in the fresh air, Nordic walking, light jogging. If necessary to perform inclined movements, it is advisable to wear a bandage. You can also use a corset for the lumbosacral, which will help to protect not only the stomach, but also the back from excessive load.
What patients need to know and do after surgery
Proper behavior during the recovery period contributes to a quick recovery. The patient is forbidden to lift weights, to experience intense physical exertion. Proper nutrition and drinking regimen will prevent constipation, which can contribute to relapse.
Positive adult umbilical hernia surgery, which is positive, is accompanied by a sparing regimen regarding daily stresses. Any sharp tension, including coughing, can lead to a violation of the integrity or weakening of the seam. Therefore, strengthening immunity is also among the measures aimed at the speedy recovery of the body.
The cost of surgical treatment of umbilical hernia depends on the method of removal, the method of anesthesia, the complexity of the clinical case, as well as the time spent in the clinic. The price of the operation also depends on the level of the medical institution where the treatment is carried out.
How much is hernia repair:
- open method - from 18,000 rubles,
- laparoscopic method - from 55,000 rubles,
- according to the Sapezhko method - from 25,000 rubles,
- intraperitoneal method - from 70,000 rubles.
The rehabilitation period is usually not included in the cost of surgical treatment, so the final amount is added after discussing the full list of medical services that will be required to restore the patient’s health.
For more information, we recommend that you study pricing on the website of the Center for Laparoscopic Surgery. N.I. Pirogova
In most cases, a hernia surgery is well tolerated. With all the recommendations, the patient quickly recovers and returns to work and normal life. The prognosis is favorable if therapeutic measures are taken immediately after the discovery of the problem. If the hernia is not treated, it gradually becomes irreparable and may be affected.
Patient reviews after surgery
Svetlana, Moscow, 32 years old
An umbilical hernia was given to me for a long time, even before pregnancy. Doctors suggested an operation to remove the bump. Friends advised me not to rush, and I refused treatment. When I was 32 weeks pregnant, there was a sharp pain in the navel. After the examination, the surgeon said that I had a hernia and that the operation would have to be done urgently. They removed it under local anesthesia for half an hour, all the time I was very afraid for the baby. The day after the operation, they were not allowed to go home, they said that I better stay under the supervision of specialists. I am very glad that everything ended well and is grateful to everyone who saved the life of me and my child!
Irina Andreevna, Krasnodar, 54 years old
Having discovered a protrusion on the navel, she suspected a hernia in her. I read reviews on the Internet that many people live with such a problem for a long time without surgery. But I signed up for a consultation with the doctor. At the reception, the doctor confirmed my assumptions and convinced me that it is vital to undergo examination and treat hernia. You can not wait until serious complications come. The operation was successful, I easily got out of anesthesia. On the third day I was allowed to stand, and the doctor said that if there were no contraindications, he would soon let me go home. After the operation, 2 years have passed, and I forgot that I generally had a hernia. Thanks to the doctor!
The main complaint with inguinal hernia is a tumor formation in the inguinal fold, which increases with straining and disappears (or at least decreases) when lying down. Periodically in this place there are aching dull pains of varying degrees of intensity, which can give to the sacrum.
How to prepare for removal of an inguinal hernia
To prepare for inguinal hernia repair, it is necessary to undergo a standard examination, which is performed with all surgical interventions. These include:
- General clinical tests - blood, urine, biochemistry.
- Blood test for infections - syphilis, HIV, hepatitis B and C.
- Coagulogram - an analysis that reflects the functioning of the blood-coagulation system.
- Determination of blood type and Rh factor.
- Blood pressure measurement.
- Chest x-ray (not older than a year).
In addition, as part of a preoperative examination, irrigoscopy, a gynecologist's examination, cystoscopy, and computed tomography can be prescribed according to indications. As a rule, such an extensive diagnosis is required for large hernias involving the pelvic internal organs in the process.
Preparation just before surgery
In patients with large hernias, displacement of internal organs is often observed. With their reduction, the level of intra-abdominal pressure changes, which can affect the activity of the cardiovascular and respiratory systems. In order to prepare the patient in advance for such changes, it is recommended to make a hernia reduction (if possible) with a compression bandage applied for several hours. This will allow him to adapt to changing conditions.
On the eve of the operation, it is necessary to shave the hair in the groin and on the pubis. Bowel cleansing is also performed. On the day of surgery, you can not drink and eat food.
Indications and contraindications for surgery
An indication for the planned removal of inguinal hernias is an uncomplicated disease. When choosing a surgical technique, the condition of the patient, his age and history are taken into account. Risks are necessarily assessed.
They can refuse a planned operation in the following cases:
- Giant inguinal hernias in patients older than 70 years with decompensated disorders of the cardiovascular system.
- Cirrhosis of the liver, complicated by ascites, enlarged spleen, dilated veins of the esophagus.
- Uncompensated diabetes.
- Inguinal hernias that occurred after palliative surgery, for example, in the treatment of malignant neoplasms.
Emergency operations are performed when there is a threat to the patient's life. For example, with infringement of a hernia or the occurrence of intestinal obstruction against its background. As such, there are no contraindications, even with a serious condition of the patient or his very respectable age, when the risk of complications is quite high.
Information on the types of hernia removal operations and their features
All methods of hernia removal available today involve the following steps:
- Incision at the site of protrusion of the hernial sac.
- The direction of the internal organs into the abdominal cavity.
- Plastic hernia gates.
The last point is key, since it is he who must prevent the recurrence of the disease. All types of hernia repair are divided into two large groups:
Stretch hernioplasty - the hernia gate is sutured with its own tissues. At the same time, the inguinal canal narrows to normal sizes - 0.6-0.8 cm. The disadvantage of this operation is the high risk of relapse, long pain in the postoperative period, and quite a long rehabilitation. In this regard, in economically developed countries this method is practically not used, with the exception of the treatment of children under 16 years of age.
Tension-free hernioplasty - artificial implants are used to strengthen the hernia gate (as a rule, they have the form of a mesh made of inert synthetic materials). The implant not only assumes the load that occurs with increasing pressure, but also strengthens the tissues, preventing them from stretching and the reverse formation of hernial protrusion. The use of implants allows you to save the anatomy of the inguinal canal and to avoid tissue tension. This will provide an easier recovery period.
Laparoscopic surgery is a relatively new minimally invasive method for removing an inguinal hernia. All manipulations are made through several small punctures. This minimizes tissue damage. Accordingly, the patient experiences less pain and discomfort in the postoperative period. Disability is restored literally within a couple of days. During this intervention, a special technique is used: a laparoscope, which provides an overview of the surgical field, and trocars with miniature instruments, with which they eliminate hernial protrusion, establish and fix a mesh implant.
Features of the surgical period will vary for each type of hernioplasty. The longest and most painful stage of recovery after removal by the tension method. The period of disability in this case can reach several weeks. Laparoscopic surgery is most easily tolerated because it involves minimal interference with the tissues. Recovery after it occurs within a few days.
No matter how the operation is performed, at first it is necessary to refrain from physical exertion, especially those that lead to increased pressure in the abdominal cavity. Nutrition is also recommended to avoid constipation. You can return to work and resume physical activity only after consulting a doctor.