A protrusion or displacement of an organ or tissue through a normal or abnormal cavity or weakness in the body is called a hernia. Hernias can occur anywhere in the body, but extra-abdominal hernias are the most common. The protrusion of abdominal contents through a fissure or defect in the abdominal wall or a weak area into the skin to form a reversible or irreversible mass is called an extra-abdominal hernia (also known as an abdominal wall hernia). Among them, inguinal hernia is the most common, and the protrusion of abdominal contents (most commonly small intestine) through the weak area of the abdominal wall in the inguinal region (root of the thigh) to form a reversible or irreversible mass is called inguinal hernia, and is commonly known as “hernia” or “small intestine cascade” by the common people. “small intestine cascade”.
The causes of inguinal hernia in humans are twofold: on the one hand, human anatomical and physiological factors, i.e. congenital factors, and on the other hand, acquired predisposing factors. Congenital factors such as weakness of the inguinal region itself and the passage of blood vessels and spermatic cord (round ligament in women) increase the pressure on the inguinal region three times after the human body is upright; acquired triggers include various factors that cause elevated abdominal pressure such as coughing and asthma, constipation, prostate hypertrophy roughly urination difficulties, heavy physical labor, pregnancy, and cirrhosis of the liver with ascites. In addition, modern medical research has found that other factors such as loss of physiological defense of the inguinal canal, abnormal collagen metabolism and smoking are also important factors in the development of hernias.
Knowing the etiology of hernia, the early prevention of hernia can only be done from the aspect of acquired causative factors, that is, avoiding the occurrence of factors that cause elevated abdominal pressure, such as avoiding coughing and sneezing with cold, avoiding constipation, actively treating prostate enlargement, treating diseases that cause coughing and wheezing, and avoiding heavy physical labor.
The incidence of inguinal hernia is very high and it is a common disease, especially one of the most common diseases in middle-aged and elderly people and children. China is conservatively estimated to be 2-4 million cases. Both men and women can get hernias, but inguinal hernias are more common in men, while femoral, umbilical and incisional hernias are more common in women, and the treatment is the same as for men.
The clinical manifestation of inguinal hernia is the presence of a reversible mass in the inguinal region, reversible in the sense that the mass appears when the patient is upright or increases abdominal pressure and can disappear when lying down. Many patients with inguinal hernia can be asymptomatic, with only lower abdominal discomfort and swelling in mild cases, but in severe cases it can affect work and life. Many patients with hernias find a mass in the abdominal wall by chance, accompanied by a feeling of swelling. The process of hernia development is generally a slow one, starting with tension but appearing from time to time, and disappearing automatically after lying down. As the disease progresses, the hernia will become larger and larger, and more and more intestinal tubes will be prolapsed, and the symptoms will become more and more obvious, with discomfort or dull pain in the abdomen gradually becoming obvious, and the patient may feel inconvenient to move around. If the mass suddenly fails to retract and is accompanied by severe pain, the hernia may be ingrown, and once the hernia is ingrown, it has less chance to retract on its own. Most of the patients’ symptoms will gradually worsen, and if not treated in time, it may further develop into strangulated hernia, at which time the intestinal canal will become necrotic due to lack of blood flow, and if not treated in time, it will endanger the patient’s life. Therefore, inguinal hernia should not be ignored and should be treated as early as possible. Inguinal hernia can be fine for decades, but it can also happen at any time, and once the hernia cannot be retracted and become ingrown, abdominal pain, intestinal obstruction, even intestinal necrosis, intestinal perforation and peritonitis can occur and endanger life. The incidence of incarcerated hernia is 3 per 1,000, and although the incidence is not high, it can be life-threatening if not treated in time.
From a medical point of view, inguinal hernias in adults are not self-healing. Conservative treatments for inguinal hernia include hernia belt, hernia brace, Chinese medicine, herbal medicine, injection therapy, etc. Various conservative treatments may help to relieve the symptoms or delay the development of the disease, and some patients with other serious diseases that are temporarily inoperable can also be treated conservatively first, but all these conservative methods have no curative effect on adults. Therefore, surgery is generally recommended before the age of 6, because a child’s hernia can affect the child’s physical and mental health.
Surgery is the only reliable way to cure inguinal hernia in adults. Patients should seek early diagnosis and treatment, and the earlier the surgery, the better the results. Surgical treatment of inguinal hernia is divided into two categories: traditional suture surgery and modern tension-free hernia repair surgery. Traditional surgery emphasizes “sewing”, just like taking thick silk thread to sew up the hole directly when the underwear pocket is broken; modern tension-free hernia repair surgery emphasizes “patching”, which means using various kinds of patches to patch up the hole.
In recent years, there have been many advances in basic research, anatomy, material science, typology and surgery, and many clinical results have been achieved. The concept of tension-free hernia repair has been hailed as a milestone of modern hernia repair and its advantages are obvious to all. It has been carried out in China for nearly 10 years and hundreds of thousands of patients have benefited from it.
The modern surgery of tension-free repair is to repair the defect of abdominal wall by using repair material (patch), which is characterized by tension-free, light pain, quick recovery, can be done on an outpatient basis under local anesthesia, no fasting before and after surgery, less infusion, low complications, no bed rest, no hospitalization after surgery, and low recurrence rate, etc. The recurrence rate is reported to be less than 1% at home and abroad. However, it should be emphasized that the surgery should be performed by a hernia specialist, or at least a surgeon with specialized training in tension-free hernia repair surgery. Hernia and abdominal wall disease is one of the more than ten specialties in general surgery, and it is also one of the fastest growing specialties in recent years. Foreign data show that the treatment effect of hernia specialist surgery is significantly better than that of general surgeons.
At present, the most used patch materials for tension-free hernia surgery in China are medical polypropylene and expanded polytetrafluoroethylene, which are all imported and have been used abroad for decades and in China for nearly 10 years.
For many years, hernia treatment has not been taken seriously by most community-based primary care physicians, and many patients can only work and live with a variety of discomfort and pain. Misconceptions about hernia, especially inguinal hernia, among community primary care doctors include
1. it can be done or not, and the hernia is not very dangerous
2. surgery is ineffective and has a high recurrence rate
3. hernia is a minor surgery, simple and does not show the level of the doctor
4. there are many elderly patients with many comorbidities, high surgical risks and complications, etc.
With the aging of the population in modern society, there are more and more elderly hernia patients in the community, and nowadays, people’s living standard is getting higher and higher, human life expectancy is getting longer and longer, so people’s demand for quality of life is getting higher and higher, but suffering from hernia will seriously affect the physical and mental health of the elderly, which also requires our community doctors serving at the grassroots level to change the traditional concept of understanding hernia disease and correct these misconceptions It is necessary to recognize that surgery can improve the quality of life of the elderly, and that high age and comorbidities are no longer a contraindication to surgery, because this new tension-free hernia repair surgery can be done under local anesthesia, has little systemic impact, and is very safe and effective for the elderly.
Due to lack of awareness and many misconceptions about hernia disease in many patients, timely diagnosis and treatment has long been impossible. We summarize the misconceptions and lessons learned about hernia treatment by many patients we see in the clinic to help community physicians better answer patients’ questions, raise awareness, and eliminate their concerns in their clinical work.
These misconceptions among patients include.
1. An indifferent attitude toward hernia and inactive treatment. Many patients think that hernia is not painful and does not delay eating or drinking and does not need treatment, but they do not know that the hernia will get bigger as the disease lengthens and the hole will only get bigger if the broken clothes are not repaired in time. Once the hernia is ingrown, it will be life-threatening and most of them need emergency surgery, and the risk of emergency surgery will be greatly increased, so surgery should be performed as early as possible.
2. Not knowing the regular treatment method, being misled by many false advertisements circulating in the society, or hoping that conservative treatment is effective. Conservative treatment can only temporarily relieve the symptoms, and no drug or hernia belt can cure the hernia. Many patients who fail to treat their hernia with injections spend a lot of money and are not covered by medical insurance, and they can cause anatomical confusion at the surgical site, making surgery difficult. A hernia is a physical defect in the abdominal wall and surgery is the only way to treat a hernia.
3. Fear of surgery, apprehension of anesthesia, fear of adding trouble to children, fear of being bedridden after surgery and having no one to stay and take care of them, etc. Most hernia patients have never had surgery in their life and have fear of surgery. However, surgery is the main treatment method for hernia in modern medicine. Although surgery is an invasive treatment, most of the surgeries nowadays are minimally invasive methods under local anesthesia, and the incision is only 3-4 cm, so the damage is very small, recovery is fast, no catheterization and fasting are needed, and the patient can be discharged one day after surgery, and even “day surgery” can be achieved. In 2007, there was a 75-year-old patient who had suffered from inguinal hernia for 5 years and was usually in good health, but since she had inguinal hernia, she seldom went downstairs and was often bedridden, because her scrotum swelled up like a volleyball when she moved around, and it was uncomfortable and difficult to move around. After watching the program “Talking to the Elderly about Hernia” produced by CCTV “Health Road” and the Hernia Surgery Department of Chaoyang Hospital, they took the old man to Chaoyang Hospital to see a specialist outpatient clinic as if kidnapped. Before discharge from the hospital, the old man said his heartfelt words, “I want to know that the surgery is so simple, I will never suffer for so many years for nothing.
Modern tension-free hernia repair has significantly reduced the recurrence rate from more than 10% in the past to less than 1% compared with traditional hernia repair. Modern hernia surgery is developing rapidly, and there are more than ten new minimally invasive surgical methods, and hernia specialists can choose more reasonable surgical methods according to different conditions of patients, and the recurrence rate after surgery is also lower.
5, fear of foreign body reaction, modern tension-free hernia repair uses synthetic organic materials to repair defects in the abdominal wall, so there is a common concern among hernia patients as to whether this material will cause harm to the body. The repair material used now is mainly high purity polypropylene material, which is very inert, not easy to react chemically with tissues and has a good tissue compatibility, and has been used in humans for more than 50 years.
6, fear of spending money, hernia mostly occurs in the elderly, when most of the patients have retired and their income is reduced, some repair materials in the past can not be reimbursed. However, there are many kinds of materials used for hernia repair, and the cheap ones only cost a few hundred yuan, which is completely acceptable to most patients, and the patches used for inguinal hernia surgery are now fully reimbursed for most patients with Beijing health insurance.
Some elderly patients are reluctant to inform their families and seek medical treatment because the inguinal hernia mass appears near their external genitalia, and they suffer in silence. It is only when an incarcerated hernia occurs that they have to go to the emergency room, which is not only more painful but also has a higher risk of surgery and failure.
Surgery is the only effective treatment for hernia, and modern tension-free hernia repair is a minimally invasive and safe treatment method. Both hernia patients and primary care community physicians should pay attention to hernia and get out of the misunderstanding. Community doctors who encounter hernia patients at work should try to let patients know the new concepts, technologies and methods of modern medical understanding and treatment of hernia, and advise them to receive formal treatment as early as possible, and should recommend them to receive further consultation and treatment from hernia specialists so as to get the best treatment effect and maximize patient satisfaction.