Inguinal hernia: symptoms, photo, surgery, treatment, causes

Inguinal hernia is a pathological process, the main characteristic of which is the exit of internal organs or tissues from the abdominal cavity( from the place of its normal topographical location) through natural openings( in this case through the inguinal canal) into the subcutaneous fat of the anterior abdominal wall.

As organs capable of forming pathological protrusions in the inguinal region, there are: loops of the small intestine, large omentum, ovaries, bladder.

Inguinal hernia is more common in males than in females. The ratio of inguinal hernia in men and women is 6: 1.It can appear at any age.

Classification

Depending on the time of occurrence, the immediate site of the protrusion, and the presence or absence of complications, inguinal hernias are divided into several types.

By the time of occurrence, the following are distinguished:

1. 1) Congenital( indirect) - appear immediately after birth, or the child is already born with it;
   
2. 2) Purchased( indirect) - arise in the process of life.

Depending on the site of the exit of the hernial protrusion, inguinal hernia is divided into:

1. 1) Skew - can be both congenital and acquired. With this type of pathological process, the internal organs exit through the inner inguinal ring directly through the external inguinal canal;
   
2. 2) Direct - just purchased. In view of the fact that the hernial protrusion leaves through the inner inguinal cavity, which is located near the bladder, the wall of the bladder itself can also be in the hernial sac( in case of its involvement, it is a sliding inguinal hernia);
   
3. 3) Combined - the presence on one side of two or more hernial sacs, not connected with each other. There is a combination of oblique and direct hernias.

By the presence of infringement:

• strangulated;
  
• uncomplicated infringement.

Causes of inguinal hernia

The reasons for the development of congenital and acquired inguinal hernias are somewhat different. Thus, congenital hernias are most often the result of the non-invasion of the vaginal leaf of the peritoneum.

In this case, during the physiological omission of the ovaries and testicles in the small pelvis and, respectively, the scrotum, the pathological exit of the organs occurs beyond the anatomical boundaries of the abdominal cavity. In addition, the cause may be the underdevelopment of the abdominal wall or its muscular layer.

Acquired hernias appear in the event that there is a defect in the abdominal muscles and the ligaments in this area. The inferiority or defect in the muscular layer of the anterior abdominal wall can be caused by: systemic diseases, destruction or reverse development of connective tissue( age parameter), previous operations( among them: cholecystectomy - removal of the gallbladder, resection of the stomach and / or duodenum, hysterectomy( removaluterus with or without appendages), adnexectomy( removal of one or both ovaries).

In addition to the immediate cause of the disease, there are, so-called, provokingThese factors include those that increase intra-abdominal pressure, thereby provoking the exit of the organs through a defect( a "weak" place in the abdominal wall.)

These include:

• chronic cough;
  
• frequent sneezing;
  
• frequent constipation;
  
• pregnancy,
  
• obesity,
  
• excessive heavy weight lifting

Symptoms of inguinal hernia

The main and primary clinical sign of inguinal hernia is the appearance of palpable visible protrusion in the scrotum( in men) or in the groin. The protrusion appears suddenly.


As for the time of its onset, the herniation may appear a fewdays, weeks and even months after exposure to a provoking factor( concerns acquired inguinal hernias).


For a long time, the pathological process can take place without any special features and absolutely do not disturb the patient. However, as the education grows, additional symptoms may appear, among which special attention should be paid to:

• tenderness in the area of ​​hernial protrusion;
  
• swelling in the location of the hernia;
  
• feeling of ripple or gravity;
  
• feeling of discomfort when walking and other physical activity( as the hernia grows and discomfort increases);
  
• if the wall of the bladder has fallen into the hernial bag, then various kinds of dysuric disorders appear: soreness above the bosom( in the suprapubic region), frequent urination, urinary retention;
  
• with a large hernia size and compression of the nerve endings of the lumbosacral plexus of the spine, pains appear in the lumbar region and sacrum;
  
• constipation.

Virtually all of the inguinal hernia symptoms disappear or become less noticeable for the patient when he is lying down. In addition, clinical signs may disappear after repositioning of the hernia.


Disturbing symptoms are also considered the presence of an admixture of blood in the stool, the inability to correct the hernia. Such signs require urgent skilled medical intervention.

See also: inguinal hernia in men.

Complications of

In the absence of timely necessary treatment or in the case of late diagnosis of the disease, inguinal hernia can be complicated. The most common complications of a hernia include the following:

• infringement( compression of the hernial sac by the hernial ring) - can lead to necrosis( death) of the part of the intestine;
  
• attachment of secondary infection;
  
• transition of the inflammatory process to the testis( orchitis);
  
• coprostasis;
  
• intestinal obstruction;
  
• peritonitis;
  
• formation of uncontrolled hernial formation.

Diagnosis of inguinal hernia

Diagnosing inguinal hernia is easy enough. It is possible to suspect it by assessing the patient's complaints about the appearance of protrusion in the inguinal region. When examining and palpating this area is a rounded form, more often painless with no changes in the skin over it.

The hernia is characterized by the symptom of a "cough thrust", which consists in palpation of the deep inguinal ring during the coughing of the patient( at this moment hernial protrusion as it moves towards the fingers of the palpating one).

When auscultation of the hernial sac, one can hear a rumbling characteristic of the intestine. And with percussion, you can find a tympanic sound, indicating the presence of intestinal loops in the hernial sac. To confirm the diagnosis of inguinal hernia will help the method of ultrasound diagnosis.

Treatment of inguinal hernia

The only effective method of treatment of inguinal hernia is surgical intervention.

is necessary.
Currently, 5 main types of surgical intervention are used to treat inguinal hernia:

1. 1) Operation by the Liechtenstein method .The essence is to strengthen the back wall of the inguinal canal with a specialized mesh. Strengthening is done behind the spermatic cord. This technique has its undeniable advantages among other methods of treatment and is "classical".The main advantages of the Liechtenstein operation include: an extremely low percentage of relapse( nearing zero), a short rehabilitation period, a minimal risk of traumatic urinary tract injury, as well as a minimal possibility of development of postoperative complications from the cardiovascular and respiratory systems, mild pain syndrome,under local anesthesia;
   
2. 2) Operation Trabukko .It is one of the modifications of Liechtenstein's method. Most often, it uses a single-component flat prosthesis, which is not fixed by the sutures( there is no need for stitching due to the high stiffness of the mesh material);
   
3. 3) Endoscopic hernioplasty .This technique is performed under the mandatory control of specialized endoscopic equipment. The reinforcing mesh can be established by abdominal preperitoneal or extraperitoneal methods. In the first case, the mesh is located between the muscular aponeurotic layer and directly the peritoneum. In the second case, the intervention is made without penetrating the abdominal cavity: the mesh is placed between the peritoneum and other layers of the anterior abdominal wall. The main advantages of such an intervention are: the ability to simultaneously assess the situation from two sides, the low percentage of possible relapse, the weakness of the pain syndrome, the minimum size of surgical incisions( punctures) and postoperative scars, rapid rehabilitation, the ability to perform physical exertion after a short time after the operation;
   
4. 4) Obturation hernioplasty .A special feature of this type of treatment is the obstruction of the hernial gates with a mesh prosthesis. Sewing with the reinforcement of the inguinal canal is not applied. This operation, as well as the previous one, allows you to monitor the progress of the manipulations from both sides. In addition, it has a short postoperative period, the possibility of performing physical exercises several days after the medical intervention, a low incidence of relapse, a minimal pain syndrome;
   
5. 5) Application of UHS, PHS systems. Obturation of the hernial gates is performed using implants made of semi-resorbable or polypropylene materials. For the purpose of obturation, a monoblock implant is used. It has 2 parts: one of them is attached to the preperitoneal space, and the second is somewhat lateral( between the layers of the anterior abdominal wall).

Prevention of disease

Preventive measures aimed at preventing the occurrence of congenital inguinal hernia are not present.

Regarding the acquired hernias, their occurrence can be avoided by controlling body weight, refraining from lifting heavy objects, observing all recommendations in the postoperative period, timely treatment of diseases leading to weakness of the muscular layer of the anterior abdominal wall.

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