Definition: Hernia – a part of the body’s tissue or organ that leaves its original site and enters another part through a gap, defect or weakness in the body. It occurs mostly in the abdomen and is more common in the groin area. It is commonly known as “small intestine gas”. Hou Dongsheng, Department of Minimally Invasive General Surgery, The First Hospital of Guangzhou Medical University
Etiology: I. Decreased strength of the abdominal wall: 1. congenital: non-closure of the peritoneal sphincter, elevated lower edge of the internal oblique abdominal muscle, etc. 2. acquired: a) poor healing of the surgical incision or drainage port b) trauma, inflammation, infection, etc.
2. Increased intra-abdominal pressure: chronic cough, chronic constipation, urinary difficulties, late pregnancy, ascites lifting, frequent crying of infants and intra-abdominal tumors, etc.
Symptoms: 1. Repeatable swelling in the inguinal region (gradually increasing in size during standing activities and disappearing during bed rest), sometimes falling into the scrotum, generally without special discomfort, some patients can cause abdominal discomfort due to intestinal tube falling into the hernia sac.
Occasionally, there is localized distension and involvement pain, and with the development of the disease, the mass may gradually increase in size, affecting the life. In case of herniation, the hernia mass suddenly increases in size and cannot be retracted, with obvious pain and tenderness. If there is also an obstruction of blood supply, clinical symptoms of strangulated hernia may occur.
Types.
Recurrent hernia: It means that the hernia contents can be easily and completely retracted into the abdominal cavity. The hernia can be returned to the abdominal cavity when the intra-abdominal pressure rises suddenly, and can be returned to the abdominal cavity by lying down naturally or by pushing gently.
Refractory hernia: The hernia contents cannot be completely retracted into the abdominal cavity but do not cause serious clinical symptoms.
Intrusive hernia: When the hernia ring is small and the abdominal pressure suddenly increases, the hernia contents forcibly expand the neck of the sac and enter the sac.
Strangulated hernia: If an incarcerated hernia cannot be released in time, resulting in impaired blood circulation or even necrosis of the incarcerated hernia contents, it is called strangulated hernia.
Diagnosis: Hernia should be seen in general surgery, and the diagnosis can be confirmed based on clinical symptoms and physical examination by physicians, with ultrasound examination if necessary.
Treatment.
I. Surgical treatment.
The most effective treatment for inguinal hernia is surgical repair. Surgical methods can be divided into the following three types.
1. traditional hernia repair: high ligation of the hernia sac + repair (strengthening the anterior wall of the inguinal canal, strengthening the posterior wall of the inguinal canal), hernioplasty; this procedure has been clinically proven to be effective and reliable; however, the surgery is more traumatic and mostly requires changing the normal anatomical relationships.
2. Tension-free hernia repair: artificial mesh hernia repair, this procedure is now widely used clinically. It is less traumatic, tension-free, does not need to change the normal anatomical relationship, and can repair hiatal hernia and straight hernia triangle at one time.
Laparoscopic inguinal hernia repair (LRIH): (recommended) has obvious minimally invasive advantages: less trauma, less pain, faster recovery, and the patient quickly returns to normal life and work. It can achieve both high ligation of the hernia sac and strengthening of the posterior wall of the inguinal canal, avoiding damage to the physiological anatomy of the inguinal canal area, achieving tension-free repair, short operative time, small incision, small scar, and significantly less postoperative pain than open surgery. With the development and maturation of minimally invasive laparoscopic techniques, laparoscopic inguinal hernia repair is now refined into transabdominal extraperitoneal inguinal hernia repair (TAPP) and complete extraperitoneal inguinal hernia repair (TEP). Our hospital has been performing minimally invasive hernia ligation and repair surgery for more than 10 years, and has performed this surgery on more than 2,000 inguinal hernia patients with excellent results. We have also expanded this surgical technique to dozens of hospitals nationwide.
II. Non-surgical treatment.
Infants and children under 1 year old can be treated without surgery for the time being, and hernia belt treatment is recommended, and some children can be cured. Non-operative treatment can be used for those who are too old and frail or with serious diseases to tolerate surgery. However, in many elderly patients with poor condition in our hospital, we perform minimally invasive hernia repair with small incisions under local anesthesia and receive good results.
Pediatric inguinal hernia.
It occurs days, months or years after birth. Usually, after crying, movement or defecation, there is a bulging mass in the groin that sometimes extends to the scrotum or labia and may disappear on its own after bed rest or sleep.
Infants and children under the age of 1 can be treated without surgery for the time being, and hernia belt treatment is recommended
Surgical treatment: Pediatric hiatal hernia from 2 years old to 13 years old requires high ligation of the hernia. Unlike adult hiatal hernia, pediatric hiatal hernia is mostly caused by non-atresia or incomplete atresia of the sphincter during development, and there is no muscle weakness in the inguinal region or even if there is weakness in the abdominal wall, it can be strengthened later through development. After years of research and practice, domestic and foreign surgical experts agree that pediatric hiatal hernia can be cured by simple high ligation of the hernia sac. Our hospital pioneered miniature laparoscopic surgery for pediatric inguinal hernia in 1994, which was carried out early and with mature technology in China. In 1997, Prof. Hou Dongsheng pioneered the micro laparoscopic pediatric hernia high ligation by the thread-and-needle method, which is a minimally invasive surgical treatment of pediatric hernia with a single hole method, with less trauma, faster recovery and better treatment effect. The abdomen of the patient has only a small (2 mm) wound and the hospital stay is short (2-3 days). It has been promoted in many hospitals in China.
Recommendation: Generally, the treatment plan should be decided by a specialist after consultation and treatment according to the actual situation of the patient.