A protrusion into the intermuscular tissue or under the skin of the parietal sheet of the peritoneum together with the insides through a defect in the muscle layer of the abdominal wall is called a hernia. The hernial protrusion, as a rule, is constantly increasing in size. The most formidable and frequently encountered complication is hernia pinching, which occurs as a result of a jump in pressure inside the peritoneum, a sharp contraction of the muscles that surround the protrusion, as well as with a large accumulation of feces and gases.
There are several types of hernias, which are usually divided according to their location. Hernias are umbilical, umbilical, hernia of the white line of the abdomen, femoral, postoperative (ventral) and diaphragmatic. Inguinal hernia is located directly in the inguinal canal, femoral hernia along the large vessels of the inner side of the thigh. An umbilical hernia passes through the exit site of the vessels and the umbilical ring. Diaphragmatic hernia passes through the opening of the diaphragm, and abdominal through the muscle layers of the abdomen.
The main reason for the occurrence of hernias is considered to be the low elasticity of the walls of the abdominal cavity, leading to the appearance of a defect. Risk factors that can cause an inguinal hernia include conditions that increase pressure inside the peritoneum, as well as the load on the abdominal wall. These include obesity, a chronic cough, the need to push during bowel movements or urination, weight lifting, pregnancy, frequent intense sneezing, and the abdominal wall weakened from birth. Inguinal hernia is much less common in women than in men, inguinal hernial protrusions account for 80-90% of all cases of hernia formation.
The main signs of an inguinal hernia are a protrusion in the area of occurrence of a hernia, especially at the time of physical effort, with the body standing upright, as well as a clear indication of the hernial gate during palpation. Patients are concerned about pain in the hernia and abdomen, inconvenience when walking, and dyspeptic symptoms.
Diagnosis of inguinal hernias is reduced to examining the patient in an upright position, to form an idea of the asymmetry of the inguinal regions. If there are protrusions of the abdominal wall, the size and shape of the hernia, as well as its consistency, are determined.
To prevent the development of complications, in order to avoid relapse in the postoperative period, as well as to provide local compression of the site of hernial protrusion, an inguinal hernia bandage is used.
Currently, the following methods are used for the treatment of inguinal hernias : surgery, Bassini plastic surgery, PHS plastic surgery, endoscopic hernioplasty, plug and patch technique.
The operation involves traditional access to the abdominal cavity and plastic with a two-dimensional Teflon mesh or polypropylene implant of the posterior wall of the inguinal canal.
Bassini plastic is plastic with its own tissues. Its essence boils down to three points: the movement of the spermatic cord, the creation of the inguinal canal, the closure and fascia by the muscles of the hernia gate.
Plastic surgery using PHS - the use of a complex three-dimensional prosthesis consisting of a connector, a supra-fascial flap and a sub-fascial flap.
Endoscopic hernioplasty consists in the formation of the posterior wall of the inguinal canal with the help of a special instrumental and hardware complex using laparoscopic access.
When using the "plug and patch" technique ie "cork and patch" provides normal access to the inguinal canal, as a rule, the opening of the hernial sac is not performed. An inguinal hernia is immersed inside with a “cork” obturator from a polypropylene mesh in the shape of a shuttlecock. With its tip, the obturator is directed towards the hernial sac, and with 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.