How to treat inguinal hernia

  1, non-surgical treatment: infants and children under 1 year old can be suspended without surgery. Because the abdominal muscles of infants and young children can gradually become stronger with the growth of the body, the hernia may disappear on its own. If surgery is contraindicated because of old age and frailty or other serious diseases, the soft pressure pad at one end of the medical hernia belt can be filled against the hernia ring during the day after the hernia contents are retracted to stop the hernia from protruding. Long-term use of the hernia belt may make the neck of the hernia bursa often subjected to friction and become thick and tough, thus increasing the incidence of hernia impaction and the possibility of adhesion between the hernia bursa and the hernia contents. 2. Surgery: The most effective treatment for inguinal hernia is surgery. However, in case of increased intra-abdominal pressure such as chronic cough, urinary difficulties, constipation, ascites, pregnancy or the presence of diabetes mellitus, it should be treated before surgery, otherwise it is prone to recurrence after surgery. The surgical approaches can be categorized as conventional hernia repair, tension-free hernia repair, and trans-laparoscopic hernia repair.  (1) Traditional hernia repair: The basic principles of surgery are high ligation of the hernia sac and strengthening or repair of the inguinal canal wall. High ligation of the hernia sac: The neck of the hiatal hernia sac is exposed, ligated high or sutured through, and then the sac is excised. This blocks the passage of intra-abdominal organs into the hernia sac. A low ligation only converts a larger hernia sac into a smaller one and does not achieve a therapeutic goal.  In infants and young children, the abdominal wall can be strengthened as the abdominal muscles develop and a simple high ligation of the hernia sac is often satisfactory and does not require repair. In some cases of strangulated hiatal hernia with severe local infection due to intestinal necrosis, simple high ligation of the hernia sac is usually used to avoid repair, which often fails due to infection. Defects in the abdominal wall should be reinforced later with another elective surgery. Strengthening or repair of the inguinal canal wall: adult patients with inguinal hernia have varying degrees of weakness or defect in the anterior or posterior inguinal canal wall, and simple high ligation of the hernial sac is not sufficient to prevent recurrence of inguinal hernia.  (2) Tension-free hernia repair: Traditional hernia repairs all have the disadvantages of high suture tension, postoperative pulling sensation at the surgical site, pain and poor healing of the repaired tissue. Modern hernia surgery emphasizes suture repair under tension-free conditions. The commonly used repair material is synthetic fiber mesh. The major advantages are that it is easy to obtain, easy to apply, does not require a separate incision in the patient (e.g., using autologous tissue for hernia repair), saves operative time, and is less painful at the surgical site after surgery.  (3) Transperitoneal hernia repair: there are four methods: ① transperitoneal anterior method; ② completely transperitoneal method; ③ transabdominal method; ④ simple hernia ring suture method. The basic principle of the first three methods is to strengthen the defect in the abdominal wall from the inside with synthetic fiber mesh; the last method, in which the inner ring is reduced with staples or sutures, is used only for smaller and less severe hiatal hernias. Transperitoneal hernia repair is less commonly performed in clinical practice.