Inguinal Hernia: Causes, Symptoms, Treatment

The protrusion into the intermuscular tissue or under the skin of the parietal peritoneal sheet along with the viscera through the defect of the muscular layer of the abdominal wall is called a hernia. Hernial protrusion, as a rule, constantly increases in size. The most formidable and often occurring complication is the infringement of the hernia, which occurs as a result of a pressure jump inside the peritoneum, a sharp contraction of the muscles that surround the protrusion, and also with a large accumulation of stool and gases.

There are several types of hernias, which are usually divided in the place of their localization. Hernias are inguinal, umbilical, hernia of the white abdominal line, femoral, postoperative (ventral) and diaphragmatic. Inguinal hernia is located directly in the inguinal canal, femoral - along the large vessels of the inner side of the thigh. The umbilical hernia passes through the outlet of the vessels and the umbilical ring. The diaphragmatic hernia passes through the aperture opening, and the abdominal hernia passes through the muscle layers of the abdomen.

The main cause of the hernia is low elasticity of the walls of the abdominal cavity, leading to the appearance of a defect. The risk factors that can be triggered by inguinal hernia include conditions that increase the pressure inside the peritoneum, as well as the load on the abdominal wall. These include: obesity, chronic cough, the need to press on defecation or urination, lifting weights, pregnancy, frequent intensive sneezing, weakened from the birth of the abdominal wall. Inguinal hernia is much less common in women than in men, inguinal hernia protrusions account for 80-90% of all cases of hernia formation.

The main signs of inguinal hernia are protrusion in the area of the appearance of the hernia, especially at the time of physical effort, with the vertical position of the body, and also the clear designation of the hernial gates during palpation. Patients are concerned about pain in the area of a hernia and abdomen, discomfort during walking, and dyspepsia.

Diagnosis of inguinal hernias reduces to examination of the patient in an upright position, to form an idea of the asymmetry of inguinal areas. If there are protrusions of the abdominal wall, the size and shape of the hernia, as well as its consistency, is determined.

To prevent the development of complications, a bandage for inguinal hernia is used to prevent relapses in the postoperative period, as well as to provide local compression of the hernial protrusion site.

At present, the following methods are used to treat inguinal hernias : surgery, Bassini plastic, PHS plastic, endoscopic hernioplasty, plug and patch technique.

The operation involves traditional access to the abdominal cavity and plastic by a two-dimensional Teflon mesh or polypropylene implant in the back wall of the inguinal canal.

Bassini plastic is plastic with its own tissues. Its essence is reduced to three positions: the movement of the spermatic cord, the creation of the inguinal canal, the closure and fascia of the muscles of the hernia gates.

Plastic with the use of PHS - the use of a complex three-dimensional prosthesis, consisting of a connector, suprafascial flap and subfascial flap.

Endoscopic hernioplasty consists in the formation, with the help of a special instrumental and hardware complex, of the posterior wall of the inguinal canal through laparoscopic access.

When using the "plug and patch" technique. "Cork and patch" is the usual access to the inguinal canal, as a rule, the opening of the hernial sac is not performed. The inguinal hernia is immersed inwards with a "cork" obturator from a polypropylene mesh in the form of a shuttlecock. Its upper part obturator is directed towards the hernial sac, and its base is fixed to the surrounding tissues with several sutures. In this case, the back wall of the channel is strengthened by a "patch" in the form of a grid.

The choice of technique depends on the type and size of the hernia, as well as on the age and health of the patient.