After the hernia is formed, some parts of the organs inside the abdominal cavity fall outside the abdominal cavity, causing a decrease in abdominal pressure. After the body gets used to the low pressure, once the organs return to the abdominal cavity, they may cause internal organ dysfunction. Can you explain the reason for this? The appearance of visceral function after hernia repair is similar to the relationship between a person and housing. If the abdominal cavity is compared to a house and the internal organs are compared to a person living in a room, then the formation of a hernia is like an unauthorized building built outside the main structure. The hernia repair is like removing the illegal structure and allowing the person living in the illegal structure to move back into the main structure. In this way, the housing conditions of the main structure, which had seemed to be relaxed, are suddenly constrained by people moving back in. The old residents living in the main structure will naturally be uncomfortable. This discomfort after hernia repair is caused by a sudden increase in intra-abdominal pressure from low to high, which is clinically manifested as follows: compression of the inferior vena cava, which affects the blood supply to the heart; compression of the lungs by the top-height diaphragm, which affects the lung function; and compression of the renal veins, which affects the kidney function. If the intra-abdominal pressure changes too much, it can lead to inter-abdominal compartment syndrome, which can be life-threatening in severe cases. This condition is usually seen in patients with giant extra-abdominal hernias. Some patients have the attitude of “putting off inguinal hernias as long as they can” and do not treat them actively and promptly, resulting in massive visceral protrusion and formation of giant ventral hernia, which is an important cause of visceral dysfunction and even induced inter-abdominal compartment syndrome. The hernia will gradually increase in size over time, as the defect in the abdominal wall becomes larger and the protrusion of the viscera becomes larger, even forming a so-called “second abdominal cavity”. When hernia repair is performed in this case, the patient is prone to severe postoperative symptoms. The severity of symptoms is also generally related to the patient’s age, the size of the abdominal wall defect, the amount of visceral protrusion, and the underlying medical condition. Generally, elderly patients with more visceral protrusions, poor cardiopulmonary metabolic function and other underlying diseases have a strong symptomatic response. Before surgery, patients need to be trained to tolerate high abdominal pressure; during surgery, a “roof-like” abdominal cavity needs to be tension-free reconstructed using repair materials so that the pressure in the abdominal cavity does not rise too quickly; after surgery, a lap band is placed around the abdomen for 2 to 3 months to allow the body to gradually tolerate the increase in abdominal pressure. The increase in abdominal pressure. In clinical practice, there are many patients who are initially reluctant to operate when they are eligible for surgery, but when they want to operate again 5 to 10 years later due to the inconvenience caused by a huge hernia, they are unable to do so. The reason for this is that after 5 to 10 years, the patient’s physical condition becomes worse and it is difficult to tolerate surgical treatment. If surgery is not possible, the patient will need to wear a lap band around the waist to protect the hernia, but this can be extremely inconvenient for life. Why is smoking associated with the formation of a hernia? There is a medical consensus that smoking causes emphysema because the nicotine in tobacco causes an imbalance in the protease-anti-protease balance of the body through an inflammatory response that activates the protease system and thus destroys pulmonary elastic fibers. At the same time, the dysregulation of the protease-anti-protease balance caused by nicotine can also break down collagen tissue in other locations, leading to a number of problems, including the dissolution of collagen tissue in the abdominal wall and the inhibition of its repair, making it thinner and easier to break down. Clinical statistics also show that smokers who have smoked for many years have a higher incidence of hernias than nonsmokers or those who have smoked for a shorter period of time. At the time of consultation, smoking history has become one of the two most important items, along with family history, before diagnosing a hernia. Therefore, the first thing to do for a smoker diagnosed with a hernia is to quit smoking. Hernias can also occur in active young men, is this related to physical activity? Hernia is associated with excessive intensity physical activity, especially weight-bearing and breath-holding physical activity. Among sports, weight-lifters and soccer players are hernia-prone. The long-term overload and breath-holding training of weight-lifters is a direct cause of hernia. Soccer players, especially some high-level professional athletes, often have to make some irregular movements of their legs with fast frequency and large amplitude, which puts great pressure on the muscles in the groin and the abdominal wall, which also leads to the greater prevalence of inguinal hernia among soccer players. International stars such as C. Ronaldo, Vanni and Scholes have all suffered from inguinal hernia. Construction workers, porters and other heavy laborers are also occupational groups with a high incidence of hernias. The adoption of appropriate physical exercise can play a role in strengthening the abdominal wall muscles and can also reduce the probability of hernia. The reason for the high incidence of hernia in middle-aged and elderly people is related to the thinning and rupture of part of the collagen tissue of the abdominal wall due to the disorder of collagen metabolism, but also to the weakening of the abdominal muscle groups in middle-aged and elderly people. However, to my knowledge, there is no medical report on what type of exercise is beneficial for strengthening the abdominal wall muscles to reduce the incidence of hernias. Therefore, it can only be recommended that weight-bearing and breath-holding activities should be reduced in the regular life of people who are prone to hernia. Is sclerotherapy for hernias effective? Sclerotherapy of hernia means injecting sclerosing agent into the defective part of the hernia ring to make the sclerotic substance adhere to the surrounding tissues in order to fill the hole. However, this has been proven to be a treatment that treats the symptoms but not the root cause, and has greater health risks. Because the abdominal wall defect that causes a hernia is a piece of surface, not a point, and the injection of sclerosing agent is only to fill a point, so that is why the recurrence rate of hernia is high after treatment by sclerosing agent. Since it is a blind injection, if it is not injected accurately in the defect area, it is very easy to damage other parts and cause intestinal adhesions resulting in intestinal obstruction, which can even be fatal. In addition, for patients who receive sclerotherapy and have recurrence, their surgical wounds will be enlarged and bleeding will increase due to serious adhesions during surgery, and their management will be much more difficult than normal surgery. Therefore, the Hernia and Abdominal Wall Surgery Group of the Chinese Society of Surgery specifically states that the only way to cure a hernia radically is surgery. Why do hernias occur in women too, and more often in femoral and umbilical hernias? Although men are the majority of hernia cases, hernias are not exclusive to men. Pregnant and postpartum women, middle-aged and elderly obese women are also the most common group of hernias. Of course, the prevalence of hernias in women is different from that in men: inguinal hernias are more frequent in men, while femoral and umbilical hernias are more frequent in women. Anatomically, the pelvis of women is wider than that of men, and the tendons and ligaments are weaker. This makes the superior femoral canal wide and lax, and pregnancy leads to increased abdominal pressure, which can easily lead to femoral hernia. Umbilical hernias, on the other hand, are more common in middle-aged and elderly obese women, as aging of the body causes relaxation of the navel scar, resulting in the protrusion of internal organs from the navel, often forming a bulbous sized lump in the navel. Is it possible to perform a tension-free patch hernia repair in young, infertile men? The inguinal hernia occurs at the site of the anterior peritoneal region, which also happens to be where the vas deferens is located. As a result, studies in Europe and the United States have reported that sperm viability is lower in men with patches than in men without patches. In addition, painful ejaculation has been observed in men with patch implants in Europe and the United States. The reason for this is that the polypropylene patch is in direct contact with the vas deferens and causes scarring and distortion. Furthermore, it is well established that inflammatory reactions caused by polypropylene materials can reduce sperm viability. In general, conventional medical opinion usually recommends that infertile men with inguinal hernias undergo either a tension-free repair after childbirth or a tensioned suture for infertile men. However, young men are usually more active, resulting in tension sutures that are more likely to disintegrate. With advances in clinical surgical techniques and materials, it is no longer difficult to perform tension-free hernia repair with implanted patches in infertile young men with the guarantee that their fertility will not be affected. The key to keeping the polypropylene patch from affecting sperm viability is to keep the vas deferens from being exposed under the patch. Consider adding a spermatic cord pad to the patch to separate it from the vas deferens to avoid adhesions. A 50% absorbable lightweight patch with a large mesh may also be considered to reduce the impact of foreign body reaction on the spermatic cord. The mesh size of the large mesh is usually in the range of 5 mm, and the mesh of a typical mesh is only 600 to 800 microns. The mesh filaments of the patch are usually where the human tissue grows to attach. It is like: the mesh filaments are the steel reinforcement and the human tissue is the cement. The cement can only be poured over the rebar to build a solid building structure. The smaller the mesh, the greater the density of the “reinforced cement”, and the more rigid the protective screen formed by the fusion with the abdominal wall will be like a concrete slab, which will make the patient feel the abdomen stiff and have a distinct feeling of abnormality. Conversely, if the mesh is larger, the less dense the “reinforced concrete” is, and the fatty tissue between the mesh can be filled, similar to foam, so that the screen formed later will be flexible and the patient will feel much less abnormal. Therefore, today’s selection of patches is based on the aim that they can tolerate more pressure in the abdominal cavity than the maximum pressure in the abdominal wall. For infertile men, the less dense “steel and concrete” not only brings comfort of movement, but also, with less polypropylene material, the impact on sperm viability is lower. As to how the procedure is to be performed, it requires more thought and discretion on the part of the surgeon.