Hernia


Hernia is a disease in which the body cavity is normally found (peritoneal cavity) protrudes through a weakness in the abdominal wall.

Depending on the anatomical location there are several types of abdominal hernias:

  • inguinal hernia, the most common;
  • femoral hernia (base of the thigh);
  • umbilical hernia;
  • epigastric hernia (above the navel);
  • other rare hernias;

Incisional hernia mentioned that or eventration occurs over a consecutive postoperative scars or poor healing weakening of the abdominal muscles.

Causes of hernia

Determinants factors are exercise and anatomical constitution inghino-femoral region. This conduct may engage anatomic and other abdominal organs. The hiring of abdominal organs means that they depart from the peritoneal cavity and down through the pipe to reach the scrotum (hernia is more common in men!), As a result of repeated physical efforts. Most hernias occur after the age of 50 years, as a consequence of diminishing elasticity of the abdominal wall muscle fibers.

Other common factors are:

  • obesity by increasing intra-abdominal pressure;
  • sedentarism;
  • ongoing work of the abdominal muscles deposited at physiological acts as urination (patients with prostate adenoma) or defecation (chronic constipation);
  • chronic cough (such as smokers);
  • other diseases (e.g. cancer).
How does hernia manifests itself?

Discomfort or burning pain, heaviness in the hernia, which is accentuated with minimal exertion or prolonged standing and resolve to stand.

Note the presence of a swelling or swelling gradually in a few weeks or months, or it may occur suddenly after weight lifting, bending, coughing or other effort. These bumps are reduced spontaneously (become invisible) lying down in most cases. But many hernia (especially older) does not cause pain!

But if he protruzionat body outside the abdomen remains stuck in the hernia, this complication cause sudden pain, intense, accompanied by nausea, bloating, vomiting and even stop the bowel.

How could hernia evolve?

Hernias disappear when lying down or slightly pushed back into the abdomen, but usually grow in size over time as abdominal wall muscles become weaker and as many enter the herniated tissue.

Any patient with hernia is at risk of complications which are:

  • hernia incarceration - abdominal tissue or a loop of intestine can block (imprison) hernia sac;
  • hernia strangulation - if an intestinal loop is set very tight hernia, blood flow to that part of the intestine may stop (bottleneck) and intestinal tissue necroses respectively.
What is the treatment of hernia?

Hernia can be treated with drugs!
Wearing a corset or girdle does not prevent complications of a hernia, on the contrary!
Treatment is exclusively surgical hernia!
Surgery is preferably chosen by the patient before installing a specific complications.

Surgery may be laparoscopic or conventional, in both cases being made to strengthen the abdominal wall with textile prostheses (generically known as reinforcement nets), biocompatible (today the risk of rejection is practically zero!) That ensures success rate more than 98%.

In laparoscopic technique are used multiple small incisions placed at a distance of hernia, while the classical method hernia incision is centered. Exemplifying the most common variety of hernia, the inguinal, laparoscopic variant using three incisions placed as follows: one subombilical 1.5 cm and 0.5 cm second side. Through these incisions penetrate muscle and placed behind each bilateral prosthesis (usually polypropylene monofilament) of 15/10 cm, fixed with metal clips or various types of glue.

Duration of surgery is about 1 and 1/2 hours and is performed under general anesthesia.

Laparoscopic approach is associated with:

  • less postoperative pain;
  • lower hospitalization;
  • faster social and professional reintegration;
  • aesthetically superior.

It is recommended to be performed whenever possible, but of choice:

  • active patients, young athletes;
  • patients with bilateral hernia;
  • patients with recurrent hernia.

As a classical incision will be in the groin (10 cm), and surgery (called Lichtenstein) involves strengthening the posterior wall of the inguinal canal with polypropylene mesh, monofilament 10/6 cm, fixed by suture adjacent fibrous structures "tension free".

Duration of surgery is about 45 minutes and is performed, usually with Spinal anesthesia.

Classic surgery is necessary for elderly patients with major hard or if the hernia associated very bulky, old or complicated.


Florin Turcu MD

MD General Surgery

Bariatric surgery, laparoscopic surgery and noninvasive or minimum invasive surgery

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