Inguinal hernia – protrusion of abdominal organs out of limits of the anatomic arrangement via the pakhovy channel. Serve as displays of inguinal hernia an opukholevidny vybukhaniye in a groin, pain, discomfort when walking. Diagnosis of inguinal hernia includes survey of the surgeon, carrying out a gerniografiya, irrigoskopiya; Ultrasonography of an abdominal cavity, inguinal channels and scrotum, bladder; tsistoskopiya and tsistografiya. Treatment of inguinal hernia is carried out by a surgical way by means of a gryzhesecheniye (gernioplastika).
Inguinal hernias meet in operational gastroenterology more often than other types of hernias of a stomach, making from them in total 75-80%. At men inguinal hernias arise more often than at women (in the ratio 6:1) that is explained by distinctions in anatomy of the inguinal channel at persons of a different floor. The Pakhovy channel is formed by an inguinal sheaf (from below), a cross and internal braid muscles (from above), connecting fabrics (inside). The Pakhovy channel at men shorter and more widely, besides, is strengthened by muscular tissue and tendinous layers more weakly, than at women. Inguinal hernias can be formed even at children's age.
Reasons of inguinal hernias
On an etiology inguinal hernias can be congenital or acquired. Congenital inguinal hernias are formed at omission of a small egg (at boys) or an ovary (at girls) of an abdominal cavity in a scrotum or a small pelvis. At a nezarashcheniye of a vaginal leaf of a peritoneum after gonads out of limits of an abdominal cavity also internals can be displaced.
The acquired inguinal hernias develop at weakness of musculotendinous layers of a belly wall in the field of the inguinal channel. Contributing to development of inguinal hernia by factors act age destruction of connecting fabric; the inferiority of muscles caused by system diseases; increase in intra belly pressure at chronic cough, obesity, locks, pregnancy, frequent heavy lifting etc. All this gradually leads to formation of defect – hernial gate in the inguinal channel and to formation of inguinal hernia.
Less often the acquired inguinal hernias develop owing to an abdominal cavity operations: resections of a stomach and 12-perstny gut, removal of a gall bladder, adneksektomiya, hysterectomy, appendicitis operation, etc.
Classification of inguinal hernias
On anatomic features allocate slanting, straight lines and the combined inguinal hernias. Slanting inguinal hernias can have the congenital and acquired origin. In this case elements of hernial contents leave to the pakhovy canal through an internal abdominal ring and settle down along the inguinal channel among anatomical structures of a seed kanatik. Among forms of slanting inguinal hernia distinguish channel hernia (the bottom of a hernial bag settles down at the level of an external opening of the inguinal channel), kanatikovy (the bottom of a hernial bag settles down in the inguinal channel at the different level of a seed kanatik), inguinal hernia (the bottom of a hernial bag goes down in a scrotum, leading to its increase).
Direct inguinal hernias always have the acquired character and are characterized by protrusion of a peritoneum to the pakhovy canal directly through a pakhovy interval, out of a seed kanatik. The combined inguinal hernias are the difficult educations consisting of several hernial bags which are not reported among themselves and leaving through different hernial openings. At this option several straight lines or slanting inguinal hernias, and also their combination can take place.
Also distinguish reducible inguinal hernias which can appear and disappear, and not reducible – independent elimination of which is impossible because of cohesion of a hernial bag with hernial contents. Speak about the sliding inguinal hernia in case the hernial bag is formed not only by a parietal peritoneum, but also its visceral leaf covering the sliding-off body. The bladder wall, a blind gut, ovaries, pipes, a uterus etc. can be a part of the sliding inguinal hernia.
If inguinal hernia renews after operation again, then it is regarded as recurrent. At the same time repeatedly recurrent inguinal hernias caused by the wrong choice of a method of a gernioplastika or technical errors of operation can meet. On a clinical current allocate the uncomplicated and complicated inguinal hernias.
Symptoms of inguinal hernia
The clinic of inguinal hernia can develop gradually or suddenly, sharply. Usually emergence of opukholevidny protrusion in a groin is the first sign. The swelling can have various sizes, increasing during physical activity, a natuzhivaniye, cough and to decrease or disappear in a prone position. Opukholevidny education causes the constants or periodic dull aches of various intensity with localization in the bottom of a stomach or a groin giving to the lumbar and sacral area.
Inguinal hernias of the big size create inconveniences when walking, physical activity. If the blind gut enters a hernial bag, the meteorizm, locks, intestines pains often appears. At the sliding hernias of a bladder dizurichesky frustration are noted: in an urethra, pain over a pubis, elderly patients have an increase of an urination, gripes an urine delay. In case of development of an acute appendicitis - inflammations of the worm-shaped shoot which is a part of hernial contents appear the expressed belly-aches, nausea, vomiting, temperature increase, tachycardia.
At an inguinal moshonochnoy to hernia the relevant party of a scrotum considerably increases in sizes. At women, at hit in a hernial bag of an ovary and uterine tube, the algodismenorea phenomena develop.
At a sudden sdavleniye of a hernial bag with hernial contents in inguinal gate infringement of hernia develops. At infringement inguinal hernia becomes intense not reducible, nausea and vomiting develop, groin pain quickly accrues, the neotkhozhdeniye of gases develops. Complications of the restrained inguinal hernia most often are , ischemic orkhit, an inflammation and a necrosis of the site of a gut or other elements of hernial contents.
Diagnosis of inguinal hernia
The first stage of diagnosis of inguinal hernia is the inspection at the surgeon including studying of complaints, survey and a palpation of inguinal area. At the same time the size and a form of protrusion in vertical and horizontal provisions of the patient, a vpravlyaemost of inguinal hernia are estimated.
For definition of the structures forming contents of a hernial bag resort to performance of a gerniografiya, ultrasonography of an abdominal cavity, ultrasonography of bodies of a scrotum, ultrasonography of a small pelvis at women. At the sliding hernias carrying out an irrigoskopiya, tsistografiya, tsistoskopiya, ultrasonography of a bladder, etc. researches can be required.
Treatment of inguinal hernia
Treatment of inguinal hernias includes surgical elimination and strengthening of defect in a belly wall. Closing of hernial defect and restoration of integrity of a belly wall can be made by means of local fabrics – an aponeurosis (a gernioplastik of inguinal hernia by own fabrics) or a synthetic artificial limb (a gernioplastik with installation of a mesh artificial limb).
Today in surgery not tension methods of plasticity with use of a mesh transplant are even more often used. At the same time hernial gate become stronger from within a special polypropylene grid which serves further as a framework for germination of connecting fabric and interferes with a vykhozhdeniye of internals. Not tension gernioplastika reduces probability of a recurrence of inguinal hernia. Treatment can be carried out by a laparoscopic way.
Forecast and prevention of inguinal hernias
In the remote period the recurrence of inguinal hernia is possible. Especially often a recurrence develops after a tension gernioplastika. In other cases the forecast for working capacity and quality of life favorable.
Problems of prevention of inguinal hernia include strengthening of muscles of a belly wall, fight against locks, refusal of the smoking leading to cough, control of weight, carrying a bandage during pregnancy.