The recurrence rate after inguinal hernia surgery is about 4% to 10%. The most likely recurrence time is within 6-12 months after surgery. Recurrence after inguinal hernia is 4 times higher than that after hiatal hernia, and the recurrence rate is even higher after recurrent hernia repair. With such repetition, how exactly should recurrence be prevented after hernia surgery?
Postoperative precautions.
1. Compress the wound with a salt bag after surgery to prevent bleeding edema, and intravenous antibiotics need to be applied for 4 to 5 days after surgery.
2. Patients with inguinal hernia should lie flat in bed after surgery, and if they want to adopt a semi-sitting position, they should bend their knees to avoid increasing abdominal pressure.
3.Help elderly patients to move their lower limbs moderately (massage, contraction of muscles, moderate walking, etc.) to prevent venous thrombosis of the lower limbs.
4.On the day after surgery, you can get out of bed, when you get out of bed, first move the healthy side of the body to the bedside, lie down to the healthy side, support the body with the healthy side of the arm to do up, when you want to lie down, first sit on the bedside, support the body with the healthy side of the arm, lie down slowly by the healthy side
5.After going home, change the medication for 3 days and remove the stitches for 7 days (for patients who apply absorbable thread for intradermal suture, no need to remove the stitches).
6.After surgery, develop a regular life, eat more fresh fruits and vegetarian dishes, prevent constipation, coughing and crying, and avoid strenuous activities such as jumping, hopping, stretching, pulling and weight-bearing for 3 months after surgery, which may increase abdominal pressure and lead to hernia recurrence.
Causes of hernia recurrence.
1.Mistake in suturing the transversus abdominis fascia or transverse abdominis tendon membrane arch
The inguinal oblique muscle is mistakenly sutured to the inguinal ligament, failing to suture the transversus abdominis fascia or the transversus abdominis tendon arch and not using the firmest structure of these inguinal defect areas as a repair.
2. Errors in hernia sac removal during hernia surgery
Negligence in the proper management of the hernia sac, such as failure to make a true high ligature, is likely to result in hernia recurrence. However, failure to remove the hiatal hernia sac has also been reported as a cause of recurrence.
3. Legacy internal ring too large
If the internal ring is not reduced to the extent that the space outside the spermatic cord is less than 2 to 3
The risk of recurrence after surgery is increased if the internal ring is not reduced to the extent that the space outside the spermatic cord is less than 2-3 mm. If the levator muscle and adipose tissue on the spermatic cord are not removed, it is impossible to reconstruct the internal ring to the appropriate width by the transverse abdominal fascia and the tenosynovial arch.
4. Defects in the pubic tuberosity area
A common cause of recurrence of hiatal hernia is a defect in the innermost part of the rectus hernia triangle adjacent to the pubic tuberosity. Failure to suture to the pubic tuberosity including suturing the pubic symphysis in, or too much suture tension, may be the cause of such defects.
Preventive measures for hernia recurrence.
1. Avoid early excessive weight bearing
Patients with inguinal hernia surgery are usually discharged from the hospital one week after surgery, but this does not mean that the wound tissue has healed, let alone that the wound has a certain level of resistance to tension. Excessive weight bearing before complete healing of the tissue may tear the tissues that are not yet tightly bound due to a sharp increase in abdominal pressure; the poor blood supply and lack of elasticity of these tissues, together with the high suture tension during defect surgery, affect healing. Increases the possibility of hernia recurrence.
2.Strengthen abdominal muscle exercise
First, strengthen the whole body sports, such as jogging, qigong, taijiquan and medical gymnastics and other fitness activities, the second is to carry out abdominal muscle exercise. The method is to do knee extension and leg lift activities or pedal bicycle action with both feet in the air alternately after lying down, or to do sit-ups with both hands crossed over the head or without holding the edge of the bed.
3.Rational adjustment of diet
The purpose of reasonable adjustment of diet is to make the nutritional structure reasonable to meet the needs of the human body for complete postoperative wound healing and long-term collagen metabolic balance. Obese people have more fat in the peritoneum, and the structure of the transverse abdominal fascia and peritoneum in the inner ring area is more lax; plus the excess fat may hinder the blood supply to the muscle and infiltrate the muscle, increasing the possibility of hernia formation.
4.No smoking
Smoking can cause an increase in proteolytic enzymes in the blood circulation and a decrease in proteolytic enzyme-inhibiting substances, which in turn can damage the collagen and elastic scleroplasm of the body and weaken the fascial layer of the transversus abdominis muscle key membrane, an important tissue for repair. The prohibition of smoking is of great significance to the prevention of inguinal hernia and the reduction of postoperative recurrence.
5, prevention and control of chronic diseases that increase abdominal pressure
Chronic diseases causing increased abdominal pressure and chronic cough, chronic constipation, urinary difficulties and cirrhotic ascites should be treated not only in the perioperative period of hernia surgery, but also in the long-term postoperative rehabilitation life, and should be actively prevented and treated for their causes.