Inguinal hernia
An inguinal hernia is a pathological process during which the internal organs of the abdominal cavity protrude together with the surrounding peritoneal (lining the abdominal cavity) sheet into the inguinal canal. In turn, the inguinal canal is a cavity located in the thickness of the broad abdominal muscles. In this cavity, elements of the spermatic cord are located in men, and in women - the round ligament of the uterus. Radical treatment of inguinal hernia is surgery. Men are most susceptible to the disease, accounting for about 97% of all cases of pathologies.
Classification and causes of the disease
In clinical practice, there are
- oblique forms, in which the hernia sac passes through the thickness of the inguinal canal together with the structures of the spermatic cord in men or the round ligament of the uterus in women. This type of hernia is almost always unilateral. It appears in childhood and young adulthood and can have a specific character. Incurable cases gradually progress, the hernia sac descends into the scrotum. In this case, an inguinal-scrotal hernia is formed;
- straight forms - the formed hernia sac goes inward from the spermatic cord. These hernias, as a rule, are formed in the elderly, more often determined on both sides. They do not descend into the scrotum.
Most often, the pathology is formed
- as a result of hereditary, sexual and age-related predisposition. If there is this disease in the family, then the probability of inguinal hernia in male infants increases several times. Older people also have a similar risk of developing the pathology, because age-related changes lead to a decrease in the tonic tension of the abdominal wall muscles;
- in obese or overly asthenic patients;
- women who have given birth to many children;
- in people who subject themselves to heavy physical activity. Treatment of inguinal hernia without surgery in this case is ineffective and has only a temporary effect;
- in case of diseases with constant constipation and severe cough.
Main symptoms and complications of inguinal hernia in children and adults
Patients' complaints depend on which organs are trapped in the hernia sac, its size, and the complications present. The degree of these complaints determines the need for inguinal hernia surgery in a child or an adult.
During the examination and questioning of the patient, attention is paid to
- spherical protrusion in the groin area, especially noticeable during physical activity, coughing
- unpleasant sensations in the inguinal area, pain of varying intensity;
- rapid, two-step urination is a sign of the presence of bladder contents in the hernia.
A hernia can be repaired on its own. Most often this happens if the patient is lying on the back. If this does not happen, we can talk about an incompressible hernia. An inguinal-scrotal hernia in children requires differentiation from inguinal ectopia of the testicle (cryptorchidism).
Delayed treatment can lead to
- inguinal hernia strangulation (impingement);
- formation of intestinal obstruction;
- development of inflammation in the peritoneal lining, peritonitis, bleeding;
- spread of inflammation to the testicle;
- incurable hernia.
Treatment of inguinal hernia in men, women and children
You can completely forget about hernias only after surgical repair of the defect. But in some cases, you can do without a scalpel.
Conservative therapy provides a good effect for weakened and seriously ill children. Treatment of inguinal hernia in children without surgery can be carried out with the help of a special children's bandage, which has different sizes and configurations depending on the side of the hernia. The bandage does not cure the disease, but it can prevent complications.
Conservative treatment of inguinal hernia in men and women is used during the progression of the disease and the development of complications. In addition to wearing a bandage, the therapeutic complex includes special gymnastics aimed at strengthening the muscles of the abdominal wall. Swimming is also very useful. All patients should follow a diet that prevents the development of constipation, as well as use folk remedies (compresses of cabbage juice, steamed wormwood, cornflower flowers, etc.) The compress is applied on top of the hernia. Ointments made at home on the basis of pork fat, vinegar, eggs are also used.
Surgical treatment
A large number of surgical techniques have been developed to eliminate this pathology.
The most acceptable method of surgery for inguinal hernia in women is the Bassini method, which is based on fastening the walls of the internal oblique and transverse muscles, which are sutured to the inguinal ligament. This manipulation in men is performed under the spermatic cord.
In some cases, namely, if there is a high inguinal gap that causes excessive muscle tension, a weakening incision of the anterior wall of the rectus muscle is performed (McVeigh modification). The method is most widely used in the treatment of oblique inguinal hernia.
One of the main requirements for preparing a child for surgical treatment is the absence of inflammatory diseases for 2 weeks before surgery. Surgery to remove inguinal hernia in children can be performed with a classic incision or with the use of laparoscopy.
Surgical variants of hernioplasty are often used - installation of a special mesh in the problem area that strengthens the abdominal wall. In some cases, the outlet of hernial contents to the inguinal canal is blocked with a special mesh prosthesis or polymer implants that have good survival rate.
The prognosis of treatment is positive, depending on a skillfully selected and performed surgical technique, as well as on the patient's compliance with the regimen, diet, and physical activity within reasonable limits.
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