How to operate hernia

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Treatment is always surgical hernia. No way to treat hernia without the use of operational procedures do not exist, the use of different types of bands can only briefly delay the development of pathology. It must be remembered that delaying surgery is extremely dangerous at the first sign of formation of a hernia should be treated in a hospital where there may be a decision on the type of surgery required.

Surgery of hernia is to remove the hernia sac, reposition viscera into the abdominal cavity and strengthening the weak area of the abdominal wall in the hernial way or the other. Currently, there are two methods of operating the external hernias — local tissues and not pull.

Basics first formulated surgeon Bassini of Padua (E. Bassini) in 1884. The principles of leadership were the plastics for a variety of interventions, but their essence is reduced to the following provisions: the restoration of anatomic relationships, strengthening weaknesses aponeurotic dublication, muscles, etc. To date, there are a huge number of modifications and improvements in the methodology.

In the middle 80 —ies of the last century, the theory was developed not pull plastics. In these designs increasingly concerned corrections inguinal hernias, but the principles can be used in the treatment of other hernias localization. It is believed that the main cause of recurrent hernias is linking with the tension of diverse tissues, contrary to biological laws of wound healing. So now used for hernia repair offer a variety of synthetic implants to avoid the tension of tissues in plastic, staple heterogeneous tissue, significantly reduce the number of relapses. Distinguishing after 6 months from the implant's own tissues is practically impossible.

Different types of hernias require their treatments.

Inguinal hernia: treatment

For surgical treatment of inguinal hernias are being used the following techniques:

  • Tummy by Bassini and its variants (plastic in H I. Kukudzhanova etc.)!
  • Plastic on the EE Shouldice
  • Operation IL Lichtenstein.
  • Plastic with PHS (prolen hernia system)
  • Methodology "plug and patch" (plug and patch)
  • Endoscopic hernia repair (JDCorbitt (1992)).

Tummy by Bassini refer to plastics own tissues. The operation comes down to three main provisions:

  • Moving the spermatic cord;
  • Creation of the inguinal canal;
  • Closure of the hernial muscles and fascia.

Tummy by e E.Shouldice characterized by applying a continuous suture in two or three layers. These operations offer 510% of relapses.

Operation ILLichtenstein Traditional means to access and plastic rear wall of the inguinal canal 2 —dimensional polypropylene or Teflon mesh implant. Relapses are about 1%.

Plastic with PHS. The method involves the use of complex hernia repair netatyazhnoy 3 —dimensional prosthesis consisting of nadfastsialnogo flap connector podfastsialnogo flap. Performed traditional access to the inguinal canal. The inner flap is folded prosthesis is introduced through the internal inguinal ring and crushes preperitonealnom in the space below the transverse fascia. The outer flap is formed, allowing passage of the spermatic cord, similar to the plastic is fixed for Liechtenstein.

Methodology "plug and patch" or "plug and patch" can be considered a type of surgery Liechtenstein. When this operation is a typical access to the inguinal canal. As a rule, the operation of hernia sac is not opened, and plunges obturator ("cap") made of polypropylene mesh in the form of a shuttlecock. Obturator its apex pointing towards the hernial sac and is fixed at the base of multiple sutures to the surrounding tissues. The back wall of the inguinal canal reinforced mesh "patch" the way it is done in plastic for Liechtenstein.

Endoscopic hernia repair forms the back wall of the inguinal canal by the type of operation IL Lichtenstein, but are carried out by means of special hardware and software tools through the laparoscopic approach.

Femoral hernia and epigastrocele: treatment

White line of a stomach hernia and umbilical hernia can be operated as a traditional techniques and not pull.

The traditional methods are Mayo ways and Sapezhko, they mean the plastic hernial aponeurotic dublikuturami. In some cases (especially in obese patients and in violation of the genetic structure of the connective tissue) to create dublication mesh implant can be used for reinforcing lines seams.

For large hernial ring is better to use synthetic prostheses, placing them above or below the aponeurosis aponeurosis. In this case, the hernial defect is sutured laterally non-absorbable thread edge-to-edge. Synthetic prosthesis fix similar obvivnym continuous seam at the location of the prosthesis over the aponeurosis or U-shaped cross-cutting sutures with putting the grid under the fascia.

When the giant hernias when suturing the hernia is not possible or leads to severe respiratory failure, plastic is made without using its own tissues. The implant is formed in such a way as to exceed 5 cm of tissue defect, and then stitched the two continuous sutures along the border on the hernial3-4 Cm some distance from the edge.

In addition, in some cases (small umbilical hernia) can be used to strengthen the endoscopic technique hernial implant.

Postoperative hernia: treatment

Plastic postoperative hernia is the same techniques as the umbilical line and a white belly. The only difference is the excision of the old scar and the complexity of the separation of the aponeurosis and the hernia sac from the surrounding tissue.

Choice of treatment for hernia patients need expert help, which will choose the best way to surgery and determine the list of mandatory surveys in the preoperative period.

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