Ventral hernia, commonly known as “hernia” and “small intestine pneumonia”, is one of the most common diseases in the general surgery clinic.
What is an extra-abdominal hernia?
The most classic analogy is that the outer tire of a car tire has a hole and the inner tire has a bulge.
Why do you get an extra-abdominal hernia?
1, reduced strength of the abdominal wall: such as certain tissues through the abdominal wall parts; poor healing of surgical incisions, trauma, infection, old age, etc.
2, increased intra-abdominal pressure: such as chronic cough, chronic constipation, difficulty in urination, pregnancy, weight lifting, infants often cry, etc.
Third, what are the common ventral hernia?
Here are a few easily breached defenses.
1. inguinal canal endograft (inner ring): the spermatic cord in men and the round ligament of the uterus in women penetrate the abdominal cavity from here, and the inguinal canal is a potential orifice from which an inguinal hernia protrudes;
2.Direct hernia triangle: the triangle surrounded by the outer edge of the rectus abdominis muscle, subabdominal vessels and inguinal ligament, this area is not covered by abdominal muscles, and the transverse abdominal fascia is also weak here in elderly patients, and direct inguinal hernia tends to protrude from here;
3. femoral canal: below the inguinal ligament, there is a potential gap on the medial side of the femoral vein called the femoral canal, where the femoral hernia tends to protrude;
IV. What is an incarcerated hernia?
Sometimes the hernia ring is small and the hernia sac is large, and when the abdominal pressure suddenly increases, the hernia contents forcibly expand the hernia ring and slide into the hernia sac, after which the hernia ring retracts and the contents are stuck and cannot be retracted, which is called an incarcerated hernia. If the incarcerated hernia is not released, the obstruction of blood flow of the stuck intestine leads to necrosis of the intestine, which is called strangulated hernia. Therefore, emergency surgery is needed when the ingrown hernia cannot be retracted, and even if the ingrown hernia has been reset manually for a long time, it is still necessary to stay in the hospital for observation (at least 24h) to exclude the possibility of intestinal necrosis.
V. How is a hernia treated?
Since hernias are caused by defects in the abdominal wall, there is no medicine that can treat an extra-abdominal hernia except surgical repair.
VI. How to choose the procedure?
Some strangulated hernias combined with severe infection may cause repair failure, so they can also be temporarily ligated and repaired surgically in the second stage.
2. Hernia repair is usually required except for the above cases.
VII. Tension-free repair of inguinal hernia
To use an analogy, if a large hole is broken in a garment, it may be wrinkled when sewn up directly, so a patch is put on this hole to keep the broken area flat, and this patch is a hernia patch.
VIII. The following are commonly used at present.
1.Filled tension-free repair: This badminton-like cone is the filled hernia patch, commonly known as “mesh plug”. After surgery, this method turns the part of the hernia ring that was the lowest point of peritoneal force into the highest point instead, preventing the hernia from protruding from here again and reducing the chance of recurrence.
2.Pre-peritoneal tension-free repair: This method is more demanding than the filling method and requires high freeing of the hernia sac up to the pre-peritoneal space, with the advantage that the patch is large and flat, which is more physiological and less uncomfortable for the patient, and the pre-peritoneal space can cover the entire pubic foramen area, preventing recurrence of hiatal, direct and femoral hernias. This is the most commonly used open tension-free hernia repair at present.
3.Laparoscopic hernia repair: With the increasing improvement of minimally invasive technology, laparoscopic hernia repair is becoming more and more widely performed and mature. Compared with open surgery, laparoscopic surgery starts from the rear of the hernia, i.e. the starting point of the hernia protrusion, so that the hernia protrusion can be observed more directly and the patch placed can be larger and flatter, which is a recommended surgical method at present.
Which hernias do not require surgery
If the patient cannot tolerate surgery, the hernia ring can be blocked with an external hernia belt to prevent herniation protrusion and further expansion.