What is an inguinal hernia?
A hernia is a protrusion of tissue or an organ of the body from a weak area. An abdominal organ that protrudes in the groin through a defect in the abdominal wall is called an inguinal hernia. These include hiatal and direct hernias. The former is a protrusion from the internal ring of the inguinal canal, which passes through the inguinal canal and may fall into the scrotum in male patients and to the inguinal region in females, accounting for about 95% of all patients with inguinal hernias. The latter, on the other hand, is mostly seen in the elderly and protrudes directly from the inguinal triangle (Hay’s triangle) without passing through the internal ring and without falling into the scrotum.
What are the causes of inguinal hernia?
1. The anatomical structure of the inguinal region is distributed in such a way that its tensile strength is weaker than that of the rest of the abdominal wall.
2, Embryonic developmental factors: incomplete descent of the testes and/or incomplete closure or atresia of the sphincter can lead to congenital hiatal hernia or syringomyelia.
3. As the patient ages, further atrophy of the abdominal wall muscles or the presence of other pathological factors causing increased intra-abdominal pressure such as: chronic cough, difficulty in urination, chronic constipation, ascites, etc., inguinal hernia is likely to occur.
Pathogenesis of inguinal hernia
In the early embryonic stage, the testis is located in the retroperitoneum next to the 2nd to 3rd lumbar vertebrae, and then it gradually descends, forming a sphincter in the descending peritoneum, which atrophies and atresizes on its own shortly after birth, leaving a fibrous cord behind. If it is not atretic, a congenital hiatal hernia can be formed. Sometimes, the unclosed sphincter is just a very small duct, which does not appear clinically as a hernia, but only as a syringomyelia. The right testis descends slightly later than the left and the sphincter atresizes later; therefore, right inguinal hernias are more common.
Acquired hiatal hernias are more frequent than congenital ones, and their pathogenesis is completely different. The inguinal canal area is a weak area of the abdominal wall, and poorly developed or weak abdominal muscles can induce acquired hiatal hernias.
Do women get hernias?
Hernia can occur in women as well. Both unilateral and bilateral. Hernia in women is more common in young girls, where it prolapses when standing or exercising and disappears when lying down or with pressure. Adults with hernia in women have similar symptoms to those in young children. Their treatment is the same as in males.
Inguinal hernias occur in the majority of males. The ratio of male to female prevalence is 15:1.
Does a pediatric hernia heal on its own?
Most pediatric hernias do not heal on their own, but only a very small number of children aged 3-6 months with very mild hernia symptoms and a small amount of hernia volume may heal on their own. After the age of 6 months, pediatric hernias generally require surgical treatment.
An incarcerated hernia often occurs when the child has a sudden increase in intra-abdominal pressure such as crying or defecation. It is characterized by a sudden increase in the size of the hernia mass and is associated with significant pain. The mass cannot be retracted by lying down or pushing it by hand. The mass is tense and hard, and there is significant tenderness. If the embedded content is intestinal collaterals, it may be associated with abdominal cramps, nausea, vomiting, constipation, abdominal distention and other signs of mechanical intestinal obstruction. Once the hernia is embedded, it has less chance of self-retraction and will eventually become a strangulated hernia if left untreated.
Treatment of inguinal hernia
Traditional hernia surgery is categorized as high ligation, hernia repair and hernioplasty.
Since inguinal hernias in children are mostly due to congenital non-closure of the peritoneal sheath, there is no weakness of the inguinal canal, and the inguinal canal is short, usually only high ligation of the hernia sac to close the inner ring can achieve the purpose of cure.
Traditional transinguinal herniorrhaphy with high ligation of the hernia sac is recognized as the basic treatment for pediatric inguinal hernia.
The procedure involves opening the inguinal canal and disrupting the anatomy of the inguinal canal.
This surgical approach has an incidence of about 10% scrotal hematoma and about 0.5-1% of male children are injured intraoperatively to the vas deferens or epididymis, and children may develop postoperative complications such as testicular atrophy.
Laparoscopic hernia surgery directly observes the hernia contents without dissecting the inguinal canal and separating the spermatic cord, without stripping the spermatic cord tissue, thus avoiding the above-mentioned complications of traditional surgery, and without sutures in the incision.
It is also possible to detect the contralateral occult hernia intraoperatively and perform bilateral surgery at one time. Current statistics show that about 30-40% of children have a combination of bilateral hernias.
The incision left in the umbilicus after surgery
Features of laparoscopic surgery
The surgical method is to place the laparoscope in the umbilicus through two holes plus a small poke hole, i.e. one incision on the left and one on the right side of the umbilicus. It is called transumbilical double-port laparoscopic high ligation of the hernia sac because the double incisions along the left and right side of the umbilical chakra are concealed in the folds of the navel, giving full play to the aesthetic advantages of the miniature laparoscope incision.
Advantages of laparoscopic surgery
Minimally invasive
Laparoscopic hernia surgery avoids the complications of traditional hernia surgery, such as vas deferens injury, bladder injury, intestinal injury, scrotal hematoma, and testicular displacement. It does not cause testicular atrophy or vas deferens damage.
Aesthetics
The wound on both sides of the umbilical chakra is extremely inconspicuous, and the integrity of the abdominal wall is not damaged, so the clinical cosmetic effect is excellent.
What should I pay attention to after the hernia is healed?
Strenuous activities such as lifting heavy things, carrying heavy objects, coughing and sneezing should be avoided as much as possible after the hernia is healed. Young children should try to prevent or reduce crying.