What is an inguinal hernia? The hernia sac protrudes through the deep ring of the inguinal canal on the lateral side of the inferior abdominal wall artery, and travels diagonally inward, downward, and forward through the inguinal canal and then out of the superficial inguinal ring, and may enter the scrotum, which is called an inguinal hernia, and accounts for about 90% of all inguinal hernias, and is the most common type of extra-abdominal hernia. Clinical manifestations: The clinical symptoms of inguinal hernia may vary depending on the size of the hernia sac or the presence of complications. The basic symptom is the inguinal area of a reproducible mass, the beginning of the mass is small, only in the patient standing, labor, walking, running, coughing or baby crying, lying down or hand pressure when the mass can be self-recovery, disappeared. Generally there is no special discomfort, only occasionally accompanied by local distension and tenderness. With the development of the disease, the mass can gradually increase in size, from the groin down to the scrotum or labia majora, walking inconvenience and affect the labor. The mass is pear-shaped with a handle, narrow at the upper end and wide at the lower end. Sun Deli, Department of Hernia and Abdominal Wall and Thyroid Surgery, Zhengzhou People’s Hospital, Difficult to recurring hiatal hernia in terms of clinical manifestations, in addition to swelling and pain is slightly heavier. Its main feature is that the hernia block can not be completely retracted. Incarcerated hernia often occurs when there is a sudden increase in intra-abdominal pressure such as strong labor or defecation, and is usually a hiatal hernia. Clinically, it is often characterized by a sudden increase in the size of the hernia mass, accompanied by obvious pain. The mass cannot be retracted by lying down or pushing it with the hand. The mass is tense and hard, and there is obvious tenderness. The incarcerated contents of the omentum, local pain is often gently micro; such as intestinal collaterals, not only the local pain is obvious, but also can be accompanied by paroxysmal abdominal cramps, nausea, vomiting, constipation, abdominal distension and other mechanical signs of intestinal obstruction. Once the hernia is incarcerated, the chance of self-recovery is small; most of the patients’ symptoms gradually aggravate, if not treated in time, will eventually become strangulated hernia. Intestinal wall hernia incarcerated, due to the local mass is not obvious, and does not necessarily have intestinal obstruction manifestation, easy to be ignored. How to treat inguinal hernia Surgery: Hiatal hernia is not likely to heal on its own and may become incarcerated or strangulated, so it should be treated surgically. However, children under one year of age, the abdominal wall with the growth and development, the strength of the increase, it is possible to self-healing, surgery can be postponed. Elderly frail such as suffering from other serious diseases should not be operated, can be used after the hernia block back to the hernia bracket tight pressure on the hernia ring, can be removed at night when resting. Prolonged use of a hernia tray can cause adhesion of the hernia contents to the neck of the hernia sac, and is generally not recommended. The surgical principle of hiatal hernia is high hernia sac ligation and hernia repair. In children, only high hernia sac ligation is performed to avoid interfering with the development of the spermatic cord and testes and disrupting the physiologic masking mechanism of the inguinal canal. Hernioplasty is rarely performed unless there is a large defect in the abdominal wall. High hernia sac ligation: In order to eliminate the residual peritoneal sheath, the hernia sac must be transected and then peeled off proximally to the internal ring, where the extraperitoneal fat layer can be seen, and the deeper surface of which is the mural peritoneum. In this plane, the hernia neck is ligated with a silk thread in a high position, and the distal hernia sac usually does not have to be removed, and the sac opening is left open. Hernia repair: With the development of hiatal hernia, the inner ring is gradually enlarged, and the strength of the peritoneum is further weakened. Therefore, hernia repair is necessary after high hernia sac ligation. Hernia repair should include two concepts: repair of the enlarged inner ring and repair of the weak area of the inguinal canal. The propped-up inner ring must be explored and repaired before repairing the inguinal canal, otherwise recurrence will be inevitable. For this reason, it is necessary to continue the dissection of the levator ani muscle after high forceful ligation of the hernia sac and cut it at the root to better visualize the enlarged inner ring and the interosseous ligament, and suture the interosseous ligament to reduce the inner ring to a size that can only accommodate the spermatic cord to pass through. The main surgical procedures for repairing the weak part of the inguinal canal are as follows: 1. Ferguson’s method sutures the lower edge of the internal oblique muscle, the transversus abdominis tendon arch, and the conjoint tendon to the inguinal ligament on the superficial surface of the spermatic cord to strengthen the anterior wall of the inguinal canal, which is suitable for smaller and oblique hernias in which the posterior wall of the inguinal canal is still healthy. (1) The spermatic cord remains in its original position, and the levator ani muscle is sutured (2) The lower edge of the internal oblique muscle, the transversus abdominis tendon arch and the conjoint tendon are sutured to the inguinal ligament (3) The tendon membrane of the external oblique muscle is overlapped and sutured (2) Bassini’s method: the spermatic cord is lifted up freely, and the lower edge of the internal oblique muscle, the transversus abdominis tendon arch and the conjoint tendon are sutured to the inguinal ligament on the deeper side of the spermatic cord to enhance the posterior inguinal canal wall, and the spermatic cord is displaced between the tendon membranes of the internal oblique muscle and external oblique muscle, suitable for smaller and still sound posterior inguinal hernias. The spermatic cord is transposed between the internal oblique and external oblique tendon membranes for larger and weakened inguinal canal posterior wall hernias. The strength of the posterior inguinal wall, the transversus abdominis tendon membrane, and the transversus abdominis fascia can be determined intraoperatively by inserting a finger into the internal ring and ejecting the abdominal wall medially toward the body surface. This procedure is more commonly used nowadays. (1) Lift the spermatic cord, shift it between the internal and external abdominal oblique muscles, and suture the lower edge of the internal oblique muscle, the transversus abdominis tendon arch, and the conjoint tendon to the inguinal ligament on its deep side (2) overlap the tendon membrane of the external abdominal oblique muscle with the overlapping suture. 3. Halsted’s method Lift the spermatic cord, suture the lower edge of the internal oblique muscle, the transversus abdominis tendon arch, and the conjoint tendon to the inguinal ligament on its deep side, and then close or overlap the two lobes of the tendon membrane of the external abdominis tendon on the deep side of the spermatic cord. The spermatic cord is displaced subcutaneously by closing or overlapping sutures on the deep face. This procedure further enhances the posterior wall of the inguinal canal than the Bassini method. The indications are the same as for the Bassini method, but it is generally not indicated in adolescents because the displacement of the spermatic cord under the skin may interfere with its development and that of the testes. (1) Lift the spermatic cord, shift it subcutaneously, and suture the lower edge of the internal oblique muscle, the transversus abdominis tendon arch, and the conjoint tendon to the inguinal ligament. (2) Overlap the tendon membrane of the external oblique muscle in the spermatic cord on the deeper side of the spermatic cord. 4. McVay’s method replaces the inguinal ligament in Bassini’s method with the pubic symphysis pubis ligament (Cooper’s ligament) for repair. In the posterior wall of the inguinal canal and the upper edge of the inguinal ligament, the transversus abdominis fascia is incised, and the upper edge of the incision, together with the lower edge of the internal oblique muscle, the transversus abdominis tendon arch, and the conjoint tendon are sutured with the pubic combs ligament to restore the original normal anatomic relationship. The repair suture site is as deep as the suprapubic branch, which not only strengthens the posterior wall of the inguinal canal, but also changes the direction of intra-abdominal pressure propagation, which is suitable for huge hiatal hernia and straight hernia. However, it is important to note that this procedure does not also mask the inner ring. If the inner ring is significantly enlarged, it should still be repaired or the upper margin of the transversus abdominis fascia should be sutured to the anterior wall of the femoral sheath to narrow the inner ring to the extent that it can only pass through the spermatic cord. This procedure is deep and difficult to perform, and if care is not taken, the femoral vessels may be injured. 1, internal oblique muscle 2, inguinal ligament 3, external oblique tendon membrane 4, transverse abdominal tendon arch 5, pubic comb ligament The lower edge of the internal oblique muscle, the transverse abdominal tendon arch and the pubic comb ligament are sutured together, and then the transversal abdominal fascia is sutured together to rebuild the inner ring so that it can only allow the spermatic cord to pass through to the extent of the 5, preperitoneal repair The advantage of this procedure is that the hernia can be ligated at a higher level of the hernia sac, does not disrupt the anatomical structure of the inguinal canal and its physiological masking mechanism, and does not need to be incised. Without incision of the transversus abdominis fascia at the inguinal canal, the lower edge of the internal oblique muscle, the transversus abdominis tendon arch and the conjoint tendon can be sutured to the inguinal ligament or pubic comb ligament. It is particularly indicated for recurrent inguinal hernia, avoiding adhesions and scar tissue caused by the original surgery. Specific operation method: take Nyhus into the diameter, about 6cm above the inguinal canal, transverse incision of the external oblique muscle tendon membrane, internal oblique muscle, transversus abdominis muscle and transversus abdominis fascia, in the peritoneal fascia of the deep side of the separation to find the neck of the hernia sac, incision of the wall of the sac, retraction of the hernia content, hernia sac ligation of the high level, and the peritoneal anterior hernia repair. If the recurrent inguinal hernia, inguinal area has a serious defect, can take autologous broad fascia or synthetic fiber mesh repair, will transplant the lower edge of the patch medial suture in the pubic comb ligament across the femoral vessels to the lateral continue to sew in the inguinal ligament and iliopubic bundle, the outer edge of the patch cut into a trouser fork shape, wrapped around the spermatic cord, reconstruction of the internal ring, the upper edge of the patch and the medial edge of the patch with transversus abdominis, transversus abdominis and rectus abdominis muscles, respectively, sutured. 6, Shouldice method The principle is to excise the weak transversus abdominis fascia, the upper and lower lobes of the superimposed tile suture, and the edge of the upper lobe and then sewed in the inguinal ligament, and then the tendon of the united tendons, transversus abdominis tendon arches, the lower edge of the abdominal internal oblique muscle and the lower lobe of the abdominal external oblique tendon membrane or inguinal ligament suture on the deep side. This is done by freeing and lifting the spermatic cord, probing the degree and extent of weakness of the transversus abdominis fascia by reaching into the inner ring with a finger, incising the transversus abdominis fascia along the direction of the inguinal ligament from the inner ring to the pubic tubercle, and excising the weak portion of the fascia, freeing the lower lobe to the inguinal ligament, and the upper lobe to the deep surface of the transversus abdominis muscle medial to the posterior sheath of the rectus abdominis muscle, and closing the soundly stacked upper and lower lobes in a tiled fashion, i.e., the cut edges of the lower lobe are continuously sutured outwardly from the pubic tubercle to the upper The deep surface of the upper lobe is closed until it forms a tight inner ring that just passes through the spermatic cord, and then the suture is closed again in the opposite direction by suturing the cut edge of the upper lobe to the inguinal ligament and returning it to the pubic symphysis pubis to be knotted with the other end of the first suture. The lower edge of the internal oblique muscle, the transversus abdominis tendon arch, and the conjoint tendon are then sutured to the deeper surface of the inguinal ligament and the external abdominal oblique tendon membrane, and finally the external abdominal oblique tendon membrane is sutured on the superficial surface of the spermatic cord. This method emphasizes the enhancement of the role of the transversus abdominis fascia in hernia repair and is suitable for hiatal hernias with a posterior inguinal wall, a weak transversus abdominis fascia and an enlarged internal ring. (1) Lift the spermatic cord and incise the transversus abdominis fascia along the dotted line (2) Free the upper and lower lobes of the cut edge of the transversus abdominis fascia (3) Suture the lower cut edge of the transversus abdominis fascia continuously upward and outward from the pubic tubercle to the deeper surface of the upper lobe (4) Suture the upper cut edge of the transversus abdominis fascia continuously with the inguinal ligament up to the pubic tubercle in the opposite direction (5) Suture the lower edge of the internal oblique muscle, the transversus abdominis tendon arch, the tendon of the united tendons and the inguinal ligament or the deeper surface of the tendon membrane of the external abdominal oblique muscle (6) Suture the superficial surface of the spermatic cord to the tendinous membrane of the external abdominal oblique muscle. 7. Madden’s method This procedure only repairs the transversus abdominis fascia. After freeing and lifting the spermatic cord, a finger is inserted into the inner ring to find out its size and the degree of weakness of the transversus abdominis fascia as well as its scope. The transversus abdominis fascia is incised from the inner ring along the inguinal ligament, and the upper and lower lobes of the transversus abdominis fascia are dissected to soundness to excise the weak portion, and the cut edges of the two lobes are then sutured outwardly from the saphenous ligament to the spermatic cord root and the inner ring is reconstructed. The procedure is similar to the Shouldice method, emphasizing the importance of strengthening the transversal abdominal fascia, but without repairing other layers of the abdominal wall, which is more in line with anatomical principles. Due to the low tension at the transversal abdominal fascia repair suture, there is no pulling sensation in the wound after surgery. However, in huge hiatal hernias, this procedure is not indicated due to severe impairment of the strength of the abdominal wall in the transversal abdominal fascia and inguinal region. Lift the spermatic cord, incise the transversus abdominis fascia along the inguinal ligament from the inner ring, and excise its weak part, and then interruptedly suture the upper and lower lobes from the ligament of the trap to the spermatic cord’s milky part, and rebuild the inner ring. Hernioplasty: because of the serious weakness of the posterior inguinal wall of the huge hiatal hernia, the arch of transversus abdominis tendon, transversus abdominis muscle, and internal oblique abdominis muscle are atrophic, and it is impossible to use these tissues to carry out the repair, and it can be used to use the autogenous broad fascia, silk sheet, or various kinds of synthetic fiber mesh to carry out the hernioplasty. Hernioplasty can be performed using autologous broad fascia, silk sheet or various synthetic fiber mesh. The anterior sheath of the rectus abdominis muscle can also be used to reinforce the posterior wall of the inguinal canal by turning the suture to the inguinal ligament outward and downward. Incarcerated hernias should be operated on urgently, with incision of the narrow hernia ring, release of the incarceration, retraction of the hernia contents and ligation of the hernia sac in high position. Hernia repair can be performed at the same time if there is no local edema. Pediatric incarcerated hiatal hernia can be first tried non-surgical treatment. If the hernia is strangulated, surgery should be performed urgently regardless of age. The aim of the operation is to release the incarceration, remove the necrotic hernia contents and ligate the hernia sac in a high position. Hernia repair is contraindicated. Preoperative preparation is important to increase the safety of surgery for strangulated inguinal hernia. Inguinal hernia eat what is good for the body? 1, the general patient 6 to 12 hours after surgery can enter the fluid, such as rice soup, dilute lotus root powder, vegetable juice, fruit juice, etc., the second day into the soft food or general food, such as soft rice, noodles, egg cake, chopped cooked vegetables and meat, etc., in order to nutritious and easy to digest light diet. 2, diet can eat more nutritious food. Eat more crude fiber foods, such as leeks, celery, cabbage, coarse grains, beans, bamboo shoots, various fruits. 3.Keep the bowel movement smooth, available jellyfish, bitter melon, sweet potato and so on. What are the best foods not to eat inguinal hernia? 1, avoid eating easy to cause intestinal tension food, such as milk, soy milk, eggs and so on. 2, avoid smoking, alcohol, greasy, fried, moldy, pickled food. 3, avoid raw garlic, mustard and other spicy food. Inguinal hernia is mainly caused by what: fetal peritoneal sheath is not atresia and abdominal cavity is connected to the congenital hernia, abdominal organs or tissues from the residual peritoneal sheath is very easy to inguinal tube protruding from the outer ring to form a hiatal hernia. In women, the round ligament of the uterus passes through the inguinal canal, so there is a similar peritoneal protrusion and descends into the labia majora, which can also form a hiatal hernia if it is not atretic. In addition, congenital dysplasia, which results in a defect in the physiologic masking mechanism of the inguinal canal, is also an important cause of inguinal hernia. Hernia common complications and clinical manifestations are: (1) intestinal tube incarceration: under normal circumstances, the contents of the hernia (often intestinal tube) can be in the abdominal cavity under the action of pressure, through the hernia ring into the hernia sac, and can be self (or by external force) back to the abdominal cavity. When a variety of reasons (such as friction, adhesion, etc.) so that the contents of the reversible hernia suddenly can not be returned to the local mass increased, indicating the complication of intestinal incarceration, this time is called incarcerated hernia. The main clinical manifestations of intestinal obstruction after intussusception. (2) intestinal strangulation: if the incarcerated hernia persists and fails to be handled and treated in a timely manner, and the contents of the hernia (mainly intestinal tube) suffer from blood circulation disorders, intestinal obstruction, intestinal necrosis, or even intestinal perforation and other serious consequences, a strangulated hernia has occurred. The clinical manifestations of intestinal strangulation are: ① paroxysmal, persistent, severe abdominal pain. ② Shock manifestations such as rapid pulse, shortness of breath and elevated white blood cell count. ② Peritoneal irritation signs (localized pressure, rebound pain, muscle tension, etc.). Bowel sounds from hyperactive to weakened or disappeared, and “gas over water” can be heard. ⑤ Vomiting blood (or bloody fluid), blood in stool. (6) Obvious swelling, bulging and lumps can be touched in the abdomen. (7) X-ray examination shows that there is a swollen and protruding isolated intestinal tube in the abdomen or changes in the area of small intestine, widening and raising of the intestinal hiatus, and accumulation of fluid in the peritoneal cavity. ⑧ do abdominal puncture can be extracted bloody fluid Prevention: in addition to a portion of infant cases, inguinal hernia generally can not be self-healing. Reproducible inguinal hernia symptoms are generally mild. The symptoms are usually mild in a reversible inguinal hernia. That is, the symptoms are intense, if not handled in time, there can be hernia content (mostly omentum or intestinal tube) of the strangulation necrosis, the healing is quite serious. Therefore, patients with hernia are generally advisable to early surgery to avoid adverse consequences.