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Abstract: A hernia is a part of an organ or tissue in the body that leaves its normal anatomical position and enters other parts of the body through a congenital or acquired weak point, defect or orifice. As in this case patient, a mass came out of the inguinal region after exercise and ultrasound examination suggested inguinal hernia, which was treated clinically mainly by surgery. During surgery, it was found to be a hiatal hernia with a small amount of small intestine in the wall of the hernia sac, which also belonged to small intestine hernia. After surgery, the patient had no abdominal pain, the inguinal mass disappeared and the incision healed well.
Basic information】Male, 40 years old
Type of disease】inguinal hernia
Hospital】Harbin First Hospital
Date of consultation】April 2021
Treatment plan】Laparoscopic inguinal hernia repair without tension
Treatment Period】5 days of hospitalization
Results】The patient had no abdominal pain, the inguinal mass disappeared, and the incision healed well.
I. Initial Consultation
The patient reported that a small mass suddenly appeared in the left inguinal region after exercising in the gym 1 week ago. The patient was in good health, no hypertension, coronary heart disease, diabetes mellitus, no history of surgery and drug allergy. On physical examination, a mass about the size of an egg yolk was visible in the left inguinal region when the patient was standing, soft to palpation, with a percussive sensation when the patient coughed under pressure. The patient’s symptoms were consistent with the diagnosis of inguinal hernia, and the patient was given an inguinal ultrasound examination, and the results were returned: left inguinal hernia.
II. Treatment process
After communication, the patient agreed to be admitted for surgical treatment, and was admitted with inguinal hernia. The treatment of hernia includes traditional open surgery for hernia and laparoscopic hernia repair, both of which require placement of a patch, while traditional open hernia incision is larger and lumbar anesthesia and epidural anesthesia are usually sufficient. Laparoscopic hernia repair, on the other hand, requires general anesthesia and is usually performed with a small hole in the abdomen. Although the cost of laparoscopic surgery is higher than that of the open approach, the postoperative incision is less painful, recovery is faster, and the hospital stay is shorter. General anesthesia requires access to the abdominal cavity, and although the cost of laparoscopic surgery is higher than that of open surgery, the incision is less painful and the postoperative recovery is faster. Therefore, the patient decided to choose a minimally invasive approach for laparoscopic hernia tension-free repair, which was found intraoperatively to be a hiatal hernia with a small amount of small intestine in the wall of the hernia sac, which is a small intestinal hernia and also a sliding hernia.
III. Treatment results
The patient underwent laparoscopic tension-free repair of the left inguinal hernia under general anesthesia, carefully freeing the hernia sac to avoid damaging the intestinal canal and inserting a patch. The patient’s inguinal mass disappeared after surgery, and because the procedure was aseptic, no intravenous anti-inflammatory medication was required after surgery. The patient recovered smoothly after the operation. On the first day after the operation, the patient had gas and could eat liquid food, and on the evening of the first day after the operation, the patient could defecate, and was hospitalized for 5 days in total.
(Blood routine at discharge)
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but the following points should be noted in the living habits and diet after discharge.
1. Pay attention to changes in the incision, such as redness, swelling, and pain. Patients need to be seen in outpatient clinic 2 days after discharge for incisional dressing change and observation of changes in the incision. The patient’s incision should not be exposed to water for 2 weeks, depending on the healing situation.
2. Patients are advised to use a hernia belt to lightly compress the inguinal area after discharge, avoid intercourse for 1 month, avoid strenuous activities for 1 month, and avoid heavy physical labor for 3 months.
3. The diet should be light and easy to digest, and the intake of rich dietary fiber can be increased to promote normal bowel movement, avoid overeating, violent coughing and constipation that may lead to increased intra-abdominal pressure, which can reduce the risk of hernia recurrence.
V. Doctor’s insight
Hernia is common with extra-abdominal hernia, of which inguinal hernia is the most common. Hernia contents of extra-abdominal hernia are most common in small intestine, followed by large omentum, in addition to cecum, appendix and colon. Small bowel hernia is actually a hernia with small intestine contents. Combined with this patient, the treatment of inguinal hernia disease includes two types of treatment, one is conservative treatment, applying hernia belt compression, which can relieve symptoms and slow down the disease process, but has no substantial therapeutic effect. The other is surgical treatment. For the treatment of adult hernia, surgery is the most effective means of treating hernia, and there are no drugs that can treat hernia. The causes of hernia can be attributed to two main categories, one being the reduced strength of the abdominal wall and the other being the result of increased pressure in the abdominal cavity. Common causative factors are violent cough, constipation, sudden heavy lifting, and large amounts of ascites in the abdominal cavity. The formation of this patient’s hernia was considered to be a congenital underdevelopment of the left inguinal canal, which, together with the factors of weight lifting within the patient’s gym, led to an increase in intra-abdominal pressure.