Update: October 2018
Hernia is a protrusion of the organs of the abdomen covered with peritoneum.
(intestine, omentum, stomach, etc.) through the anterior abdominal
wall. About 90 – 95% of patients suffering from this disease –
men, this is due to the anatomical features of their inguinal
areas. But there are also congenital protrusions in boys
early childhood. Hernias most often are unilateral, only
left or right, very rarely can be on both sides.
With the loss of normal tone and stretching of the tissues of the abdomen organs
get the opportunity to get out of the abdominal cavity under the skin through
inguinal canal. This is a natural formation, a kind of “move”
which connects the abdominal cavity in men with the scrotum cavity. Through
channel go nerves (ilio-inguinal and genital) and seminal
There are many signs by which you can divide all
inguinal hernia: degree of development, its course (direct, oblique), etc.
The most important is the division into congenital and acquired.
Врожденные выпячивания — результат нарушения
intrauterine development. Boys predisposition to this
обусловлена опусканием яичек в полость мошонки через inguinal canal.
The egg on its way “shifts” the peritoneum, forming its
the vaginal appendix is a kind of “bag”. Normally it grows after
baby’s birth In violation of intrauterine movement of the testicles
the appendix may not overgrow, in the future ensuring the release of organs
belly. Congenital are only oblique hernia.
Для появления приобретенной патологии необходимо
combination of two conditions:
- Weak abdominal wall.
- High intra-abdominal pressure.
The first is associated with factors such as:
- Hereditary violation of the structure of connective tissue.
- Поражение нервов, ответственных за работу мышц belly.
- Injuries of the anterior abdominal wall.
- Transferred operations.
- Low body mass leading to atrophy and muscle weakness.
- Low physical activity.
The reasons for the increase in intra-abdominal pressure can be:
- Heavy physical activity: weight lifting, squatting with
load, slopes with load, etc.
- Constipation, strong straining during stool.
- Straining when urinating.
- Prostatitis, adenoma, prostate cancer.
- Diseases with severe coughing: bronchial asthma, COPD,
tuberculosis, whooping cough, malignant neoplasms of the lungs and
Signs of an inguinal hernia
The symptoms of an inguinal hernia in men are fairly obvious with
visual inspection, the formation has a dense elastic
consistency and easy to feel for yourself. It may be
rounded, and if the hernial sac descends into the scrotum, then
bulging has an elongated shape. As a rule, with genetic
location, the tendency of the body to the appearance of a hernia after
weight lifting and intense physical exertion can
Signs of acquired inguinal hernia are as follows:
- Education can be straightened by pressing, while hearing
- In the prone position, the protrusion is usually either flattened out, or
greatly decrease in size, and, conversely, upright
increases and reappears.
- In the altered state, it is easy to probe through the skin.
enlarged inguinal ring.
- When lowering the hernia sac into the scrotum, its corresponding
half increases in size.
- With a strong cough, straining, sneezing education
increases in size, straining, if you put a hand to it,
it’s easy to feel.
With a small size of the inguinal hernia, there is no longer any
symptoms disturbing the patient. But with a significant increase
bulging may cause the following ailments:
- Dull, prolonged pain in the area of hernia formation.
- Lower back pain, lower abdomen due to constriction of neighboring
- Constipation due to compression of intestinal loops.
- Abdominal distention, loud rumbling.
- Rarely, if part of the bladder is injected
If a man besides the above has increased
fever, abdominal pain, nausea, vomiting, constipation / diarrhea,
general weakness, it can be a sign of appendicitis. Sharp
appendicitis development is triggered by the entry of the caecum into
hernial sac (see appendicitis symptoms in adults).
Signs of abuse
Infringement is the most common complication of this disease.
pathology. It is carried out in several ways:
- Elastic – a sharp hit in the hernial sac of a large number
intestinal loops, while the “gate” remains narrow and drag
- Fecal – overflow of strangulated intestinal loops with their natural
content and a sharp increase in their size.
Symptoms arising from this are similar to signs of intestinal
obstruction, acute orchiepididymitis, inguinal lymphadenitis, cancer
testicle or spermatic cord tumor:
- Pain syndrome that is ahead of the rest of the clinical
the signs. He is so strong that it is difficult for patients to hold back screams.
and moans. Usually, pain occurs on the background of physical stress, not
abating after relaxation.
- Very restless patient behavior.
- Decreased blood pressure and tachycardia with severe
- In children, these symptoms are more pronounced.
The following external signs are characteristic for infringement:
- The tension of the hernial bag.
- No reduction.
- Lack of cough shock (during coughing with stop
finger on the inguinal ring, you can feel the tremors, and in the case
infringements – no).
- Lack of stool, bloating.
- Nausea, vomiting.
A strangulated inguinal hernia is an extremely dangerous condition of the patient, he
needs emergency medical care. The operation follows
as early as possible, since such
- Peritonitis (inflammation in the abdominal cavity).
- Necrosis (death of parts of the gland or loops of the intestine).
For the diagnosis and setting the indications for surgery is not
additional examinations are required. Enough:
- There are symptoms.
- Survey of the surgeon (visual assessment of pathological protrusion,
feeling it, checking the state of the natural inguinal openings
- Cough test (patient is asked to cough, holding his hand on
When strangulated and irreducible hernias may be further
assigned to their ultrasound.
Modern principles of treatment
The only method of disposal is surgical
intervention. It is shown to all people with this pathology, except
cases where a person can not move the operation. Such
a situation may arise in the case of:
- Old age patient.
- The presence of any malignant diseases.
- The presence of severe concomitant untreated pathologies
(uncontrolled jumps in blood pressure, rhythm disturbances
heart, myocardial infarction or stroke in the recent past and
- Poor blood clotting.
Contraindications for surgical treatment simultaneously act
indications for wearing an individual bandage. This is special
a device that artificially supports abdominal organs.
It should be understood that the bandage is not a solution to the problem at its root.
If a person has no contraindications, an operation is performed.
The main stages of which are:
- Incision of the skin with detection of a hernial sac in the wound.
- His autopsy and thorough inspection.
- Immersion of the contents in the stomach (with the viability of organs)
or its removal (at death).
- Elimination of the hernial sac.
- Укрепление фасций и мышц (задней стенки пахового channel).
- Stitches on the wound.
Determining the viability of intestinal loops and gland parts
as part of the content produced in several ways:
- Visual inspection of organs – normally the gut is pink or red,
visible streaks of pulsating vessels in the mesentery, the surface
it is smooth and shiny, there is peristalsis visible to the eye.
- Wrapping organs with warm, moist, sterile wipes
- The use of a 10% solution of NaCl, in response to which
non-viable organ shrinks.
Necrosis of the intestine necessarily removes this area,
a new connection is formed between the remaining ends
Bandage after surgery to remove an inguinal hernia
Strengthening the posterior wall of the inguinal canal can be done
using own tissues (muscle, fascia, aponeurosis, and their
combination), synthetic meshes.
The operating surgeon should own a number of posterior reinforcement technicians.
walls of the inguinal canal: according to Girard-Spasokukotsky, Post-Tempsky,
Basini, Liechtenstein, with the use of PHS (Prolene Hernisystem) and
etc. In each case, the technique is selected individually.
Surgical treatment of congenital inguinal hernia is based on the same
principles. The only distinguishing point is the rejection of the full
excision of the hernia sac. It is either not excised at all, or
partial excision with suturing.
After suturing the patient remains in the hospital for several
days, passes the procedure for changing dressings on the postoperative wound,
takes antibacterial and anti-inflammatory drugs.
Recommended limitation of physical activity for up to 1 month,
wearing a bandage to prevent relapse.
Recurrent inguinal hernia
In 5-10% of patients suffer from re-formation of a hernia – her
recurrence. It’s connected with:
- Violation of the correct technique of operation.
- Not treated diseases with constipation and severe
- Non-compliance with the recommendations of the doctor.
- Suppuration of postoperative wounds.
Prevention is not only relevant to initially healthy people,
but also for patients who have suffered this illness:
- Daily moderate physical activity (minimum of 10,000
steps per day at an average pace).
- Inclusion in the diet fiber.
- Avoid gaining excessive body weight.
- Do not forget about the bandage when performing increased loads.
Is it possible not to notice in my “released” inguinal hernia?
If it has just started to develop and has not had time
go completely into the inguinal canal, under the skin or into the scrotum, she
imperceptible. In other situations, the person still pays attention.
on the emerged unusual protrusion.
For how long can you wait to the surgeon?
At the first suspicion of an inguinal hernia, especially stung,
need to resort to the help of physicians. Infringement threatens bowel necrosis
or gland with the development of complications and the need to form
inter-intestinal anastomosis, which is a traumatic operation. Hernia
without prejudice after a long time is more difficult to adjust
surgical techniques, and even after closing the defect sharply
The number of relapses is increasing.
Can a hernia operation cause infertility
Only in case of damage to the structures of the spermatic cord when
operating a two-way process. Even if the spermatic cord
will be damaged on the one hand, will remain functioning the other,
delivering sperm from the corresponding testicle.