Surgery to remove inguinal hernia

Congenital or acquired inguinal hernia is one of the most common diseases and represents a clinical picture when internal organs and tissues protrude beyond the natural boundaries of the peritoneum into the subcutaneous fatty region. The exit site is the natural openings or weak areas of the inguinal zone. And, at times, the only method to stop the problem is an operation to remove the inguinal hernia, with which we will get acquainted in more detail in this article.

[1], [2], [3], [4], [5], [6], [7]

Indications for operation

If you do not treat this ailment, then there is a high probability of serious complications, which become more difficult with time. Therefore, when the patient addresses the doctor, the specialist conducts an examination and if there are indications for the operation, then with the consent of the patient, appoints him.

Such an indication can be:

• Injury of the hernia - this diagnosis occurs when a part of the squeezed organ is clamped with the aperture flaps. This situation is quite dangerous. She does not always show great pain, flowing unnoticed. Sometimes during the operation it is determined that the strangled tissues are necrotic (dead).
• The ungovernability of the organ that emerged beyond the peritoneum. Such a clinical picture can develop in the case when spikes are formed between the tissue border of the hernial sac and the mucous layer of the inguinal canal, which do not allow the bulging organ to return to its natural place.
• Intestinal obstruction, associated with the loss of the intestinal tract into the hernial foramen, where she was subjected to infringement. At the same time, the passage section is blocked, which blocks the movement of fecal masses through the intestine to the anus.

The precedents described above require immediate surgical treatment.

Preparation

Inguinal hernia therapy is performed solely on the basis of the operative intervention. Other methods do not provide the patient the desired result. But before putting the patient on the operating table, special training is necessary, through which it is necessary to pass through the operated person.

Primarily, a person undergoes a full medical examination. It is advisable that at the time of intervention the patient does not have other medical problems:

• General analysis of urine and blood.
• Blood for biochemistry.
• Analysis for infection.
• Ultrasound examination of the peritoneum - determination of severity of pathology and possibility of infringement. This complication can affect the course of the operation and the time of its operation. When infringed, surgical intervention is prescribed urgently.
• Electrocardiography. The operation is performed under anesthesia. The specialist establishes the possibility of the heart to transfer it.
• Coagulogram - determination of the level of coagulability of blood.
• Clarification of the full history of the patient, existing diseases of a chronic nature.
• Obtaining information about medicines taken for the period of treatment.
• A few weeks before the planned operation, you should give up harmful habits: alcohol, nicotine, drugs.
• If the medical measure is appointed, then 8 hours before the beginning of the patient stops eating.
• Purification of the intestine is carried out with an enema.
• A few hours before the scheduled time, a course of premedication is conducted. Patient at night attributed sleeping pills, and on the threshold can introduce narcotic analgesic.

Based on the clinical picture, the surgeon, together with the anesthesiologist, is determined with the type of anesthesia. It can be general, local and regional. The type of choice for excision is influenced by the level of tolerability of anesthesia by a specific organism, as well as the type of hernia and its dimensional parameters.

If a patient has a history of mental problems, minor doses of a tranquilizer may be prescribed. This will relax and calm down, which is important before such a procedure.

With the propensity of the patient's body to allergic reactions, preliminary antihistamine preparation is carried out.

Immediately before excision, the oral cavity is necessarily examined: dentures are removed from it. It is necessary to remove contact lenses, if any.

The location of the cut is shaved and sanitized. In a number of cases, physicians bandage the legs of the operated person to prevent the development of thromboembolic complications.

Is surgery to remove the inguinal hernia dangerous?

Many patients are ready to endure pain, afraid to seek help from doctors, and the word "operation" plunges them into a real stupor. The first thing that interests the patient is whether surgery to remove the inguinal hernia is dangerous? And what are its consequences?

This surgical treatment makes it possible once and for all to save the patient from a "protruding" problem, which causes pain and discomfort to his master. Its implementation will prevent further progression of the disease with the development of severe complications, prevent the emergence of new foci of inguinal hernia in this zone.

The methods of conducting the surgical intervention under consideration are so sharp that there is no obvious danger to the patient's body. But the operation is an operation and, hoping for the best, one should be prepared for any development of the event.

Methods of inguinal hernia removal

Modern medicine does not stand still, offering innovative therapies and improved surgical equipment to help doctors. To date, methods of removing inguinal hernia, with which surgeons are armed are as follows:

• Stretching hernioplasty. At its carrying out the expert, after survey of the amazed place for a pinch, directs a gut in place and stitches the edges of the hernial gates with a simple surgical suture. This technique is not very effective, since it does not completely eliminate the threat of erection of seams and relapse of pathology.
• A more modern technique of non-stretching hernioplasty - in the process of excision, to close the hernial gates, the doctor uses a transplant. It is a polypropylene mesh, which, after restoring the hernia, is superimposed on the opening. This approach allows us to protect the patient from repeated fallout. This technique is known as the Liechtenstein method.
• Laparoscopy - an innovative technique that allows you to do without large incisions and, accordingly, sutures. A puncture is made in the groin area. With the help of a computer connected to a laparoscope, the monitor can monitor the manipulations performed on the monitor. The procedure is performed with a microsurgical instrument, causing the patient a minimum of discomfort.
• Laser hernia removal.

Technique of the operation

From the above sound techniques, to date, the most commonly used technique is the operation of the method of Liechtenstein, since tension hernioplasty has quite significant disadvantages:

• Prolonged postoperative pain.
• High risk of recurrence.
• Longer recovery period.

The advantage of a non-stretch technique is that the probability of recurrence is eliminated, the recovery period after it is much less, and a moderate pain syndrome is also observed.

The Liechtenstein method assumes the use of synthetic polymeric materials in the closure of the hernial gates, which have a high degree of engraftment. Such materials show inertia when they come into contact with the tissues of the human body.

The sequence of the intervention is as follows:

• Carrying out a small incision in the area of protrusion.
• Examination of the inguinal wall for pinching and adhesions.
• If necessary, the adhesions are excised. If there are necrotic tissues, I also delete them (this operation is considered complicated).
• The surgeon returns the fallen organ to its natural place.
• Hernial gates are covered with a polymer mesh. And, as a tailor, the doctor fixes a "polymer flap", connecting the sashes of the window, closing the hole.
• A layered surgical suture is applied to the cut skin.

The use of polymeric material allows you to escape from the creation of muscle tension, while the grid makes it possible to strengthen the inguinal wall.

Laparoscopic removal of inguinal hernia

Another method that recently appeared on the "arms" of physicians, but has already won the approval of specialists - laparoscopic removal of the inguinal hernia. Its essence is that all manipulations are carried out by a specialist through a small hole in the groin. The procedure itself takes an insignificant amount of time. At the same time, the recovery period is minimal.

During the operation, using a special video probe, the surgeon has the opportunity to observe the progress of the operation and its manipulations on the computer screen, to which the video signal from the camera is transmitted. The removal itself is performed with the help of a microsurgical instrument, causing minimal damage to the organism of the person being operated.

This method has its pros and cons, which should be taken into account before agreeing to an intervention of this nature.

Benefits:

• A small incision - a small seam - a small colloidal scar.
• Inadequate rehabilitation period.
• Significantly fewer postoperative complications, compared to band surgery.
• Minimal risk of developing chronic pain.
• Short stay in the hospital.

Disadvantages:

• Laparoscopy should be performed by an experienced highly qualified specialist.
• If the surgeon does not have much experience with such a procedure, the risk of relapse is high.
• More time spent on the operation.
• With late intervention, after laparoscopy, the probability of repeated fallout is high.

Removal of inguinal hernia laser

Laser vaporization (or laser excision) is an innovative method of treatment that has only recently been introduced in our country, although it has been known world practice since the 80s of the last century.

Removing the inguinal hernia with a laser makes it possible to avoid a classical operation, allowing to relieve the patient of the pain syndrome. The therapy is performed under local anesthesia.

The procedure begins with the needle pointing, through the internal channel of which a quartz fiber is fed into the inguinal zone. The energy of the laser leads to the evaporation of liquid substances, which reduces the internal pressure, allowing the "loss" to return to the place, and the edges of the valves to "glue together".

Advantage of this method:

• Bloodlessness.
• Painless in the postoperative period.
• High security.
• The activity of the patient is allowed already after 40 minutes after the procedure.
• High efficiency.
• Absence of incision, postoperative scars and scars, which is cosmetically welcomed.
• Muscular tissues, in this case, are practically not damaged.

Removal of inguinal hernia in men

Inguinal hernia is a pathology, which, due to the peculiarities of the anatomical structure, is more diagnosed in representatives of the strong half of humanity. With the development of this disease a man can observe the manifestation of a tumor-like protrusion, which often, for a short time, descends into the scrotum. Such a clinical picture of a doctor is often referred to as inguinal - scrotal hernia.

At this time, removal of inguinal hernia in men occurs with minimal damage. This gives the patient the opportunity, after a short period of time to return to a full and familiar life. But such a result can be obtained only by fulfilling all the requirements and recommendations that were given by the treating doctor.

The duration of the recovery period in all patients is different, depending on the severity of the pathology, the choice of anesthesia and the method of excision.

Removal of inguinal hernia in women

Due to its structure, the female organism is less susceptible to "aggression" from this pathology. But there are cases of establishing the diagnosis in question and they are not isolated. Especially a large percentage of manifestations occur in the postpartum period, or associated with age-related changes in the female body.

The most effective and more common treatment for this pathology is the method of surgical intervention. Removal of inguinal hernia in women is carried out by the same methods, which have already been described above. But due to female physiology, to such patients the doctor gives an additional set of recommendations. For example, when entering a hospital for surgical treatment, it is desirable for patients to have personal hygiene products, since pre-operative stress can provoke an earlier onset of menstruation.

Removal of inguinal hernia in children

If the child is not yet five years old and ultrasound does not show an infringement of the hernia, the treatment is usually conducted by conservative methods. The essence of this therapy is the constant wearing of a special supporting bandage. If there is infringement there is an emergency operation.

After fulfilling the child for five years, he undergoes a second examination and if the problem persists, the inguinal hernia is removed from the children.

In the absence of concomitant complications, surgical treatment is performed by one of the methods that are quite effectively used in adult therapy. Performing this operation in boys is somewhat more difficult due to their anatomical structure.

Postoperative period

In many ways, the effectiveness and duration of the recovery period depends on the type of anesthesia used. In case of using local anesthesia, the postoperative period will be much less. And after a few hours, the operated can be released home.

When carrying out the operation under general anesthesia, the patient will have to stay in the hospital for a couple of days. But in either case, he still needs to visit the hospital more than once, coming to the bandages and consulting a doctor.

If there are no complications, the patient is discharged, otherwise physicians have to fight with the arisen pathology.

The outpatient period of postoperative recovery usually ranges from seven to ten days. At this time, bed rest and diet prevail. Monitoring of the attending physician is obligatory. Physical exercises and exercises are prohibited, but this taboo applies only to the first few days of rehabilitation. Subsequently, they allow you to quickly recover and return to normal life.

What can I do after an inguinal hernia?

To answer this question is both simple and difficult at the same time, because the body of each person is so individual. But a qualified specialist, answering the question what can be done after the removal of the inguinal hernia, nevertheless forms a number of aspects that work for the speedy recovery of any organism.

• Correction of the diet, both in preoperative (enhanced nutrition) and in the postoperative period (excluding a number of products prone to cause mismatch in the intestine).
• Physical stress: minimal in the first few days after the operation, with a gradual increase.
• A set of special exercises that will strengthen the inguinal muscles, increasing their tone.
• Depending on the severity of the surgical intervention and the patient's health condition (his history, the presence of chronic diseases in him), the attending physician can correct the recommendations by expanding the permitted or, conversely, tabulating some of them.

Rehabilitation after removal of the inguinal hernia

Mostly planned surgery takes place in the morning, and by the evening the patient receives the first dressing and examination of a specialist. During an evening examination, the doctor can observe minor discharge from the wound, which is considered the norm. The dressings are changed daily, and if there is no suppuration, then the patient gradually begins to return to the usual stresses for his body.

Rehabilitation after the removal of the inguinal hernia involves sparing loads (no more than three to five kilograms) for two to three weeks. The patient can also be prescribed wearing a special supporting bandage (but this is up to the doctor's discretion).

At the end of this period, physical activity gradually increases. Here, and useful bandage (for safety). At a certain stage, a specially designed set of exercises is recommended, which allows to strengthen the muscles of the small pelvis and shift the functions of the bandage to them.

Signs and special diet. The selection of products should be "tracked" to prevent constipation, diarrhea and flatulence in the intestines that cause discomfort.

If the doctor's recommendations are followed, rehabilitation after removal of the inguinal hernia will go without complications, and the recovery period itself will be markedly reduced.

Seam after removal of inguinal hernia

If there was a question about the need for surgery, some patients (mostly women) are interested in the size of the scar, worrying for the cosmetic side of the intervention. The seam after the removal of inguinal hernia (its size and contour) directly depends on the method that was chosen by the doctor to solve the problem.

If it is a cavitary operation, the colloidal suture can reach 5-8 cm, whereas if the treatment was performed with a laparoscopy or a laser, a slightly noticeable point will remain on the skin in the course of time.

Nutrition after removal of inguinal hernia

Nutrition in the treatment of many diseases plays an important role in the recovery of the body. Before surgery, the patient should gain strength, so the diet should be diverse, rich in vitamins and minerals. Nutrition after the removal of the inguinal hernia pursues several other goals.

In the postoperative period, in order to reduce the burden on the operated zone, a person should be fed in such a way that there are no problems with emptying. Since diarrhea, constipation, and bloating leads to increased discomfort and stress of the digestive system, which includes the intestines.

During this period you should eat at least four to six times a day. In this fasting, as well as overeating is not welcome. Proper formulation of the diet will make it possible to prevent complications in the postoperative period. At the same time, rehabilitation is much easier.

Diet after removal of inguinal hernia

One of the main food elements of the recovery postoperative period is protein. Therefore, the diet after the removal of the inguinal hernia, is basically based on:

• Chicken meat.
• Groats, especially buckwheat.
• Fish, preference is given to marine.
• Seafood.
• Chicken eggs.
• Vegetables and fruits that do not cause increased gas separation.
• Low fat curds.
• Milk low in fat.
• Olive oil.
• And other.

Protein is a very important "building element" of the human body. It is he who will give strength and opportunity for quick recovery.

A number of products on the contrary should be excluded from the diet of such a patient. The ban on products that cause increased gas production, diarrhea or constipation:

• Candy and chocolate.
• Beans.
• Sweet fruits and berries.
• Cabbage (especially sauerkraut).
• Coffee and strong tea. It is possible to replace for a while with coffee from chicory.
• Dairy products.
• Alcohol.
• Nicotine.
• It is necessary to reduce the consumption of vegetables.
• Smoked dishes.
• Baking.
• Carbonated drinks.
• Fatty food.
• Yogurt.

If you follow a diet that has been recommended by a doctor, you can avoid many troubles of the postoperative period.

[8], [9], [10], [11], [12], [13]

Sex after inguinal hernia removal

A number of patients are puzzled by the problem, how to deal with intimate relationships? Is sex possible after removal of inguinal hernia? The doctor advising the patient usually explains that having sex in the first days after the surgery is undesirable. They are capable of provoking the appearance of some pathological and unpleasant consequences:

• Postoperative pain may worsen.
• Are able to increase the scale of puffiness.
• Sex can contribute to the appearance of a hematoma.
• In yet not tightened up wound can get an infection with all the ensuing consequences.
• This process can provoke bleeding.
• Lead to the divergence of the seams.
• If a non-stretching hernioplasty was performed, the implant shift is likely.

If the recovery period proceeds, without any complications, intimate relationships can be resumed no earlier than two weeks after the recovery procedure. At occurrence of even the slightest complication the given period can be increased. After all, at this time should not allow increased pressure on the affected area of the peritoneum, eliminating excessive tension.

Bandage after inguinal hernia removal

The medical bandage was developed by scientists as a means of preventing the appearance and growth of hernias, as well as preventing infringements (in the presence of falling out). Modern methods of getting rid of people from these problems make it possible to do without this supporting framework. But it is better to be safe, applying it, than to allow the stretching of the muscles in the inguinal zone. After wearing a bandage can remove some of the burden on the peritoneum, which reduces the risk of complications and relapses.

Indispensable service has a bandage after the removal of inguinal hernia and when the patient begins to gradually increase physical activity, trying to return to the usual life. Thanks to this device, it is possible to distribute more evenly the external pressure and intra-abdominal tension that occurs as soon as a person exerts an effort to lift the load or overcome resistance. This fact creates favorable conditions for the early healing of the wound.

The period during which the patient is required to wear a bandage is determined by his treating doctor. This parameter depends on a number of factors: the severity and time of the operation performed, the size parameters of the protrusion, the contents of the emerge cap.

But, as it was said above, such measures are not mandatory, as innovative technologies allow to protect the patient from such negative consequences. Therefore, the question of using a bandage during rehabilitation remains with the attending physician.

[14], [15], [16], [17]

Loads after inguinal hernia removal

Adult people are used to living in their rhythm with their loads and pressure situations, the child is just as difficult to explain why he should lie or sit, when the other kids are running around the playground? Therefore, the question of the permissible load after removal of the inguinal hernia is quite acute. And from how accurately the specialist's recommendations are fulfilled, the speed of healing of the wound depends, the probability of relapses and complications.

Typically, doctors recommend surgery on inguinal hernia patients to reduce their physical activity (the first days in general it is desirable to lie more than to move, but hard bed restraint is unacceptable). Within a month after the operation, a rise of not more than five kilograms is allowed, but if the pain starts to build up, or other negative symptoms appear, the load should again be ruled out and consult a doctor.

After a couple of weeks of physical activity, if the recovery is without complications, you can increase. But with high loads it is still necessary to wait and sustain this mode for about a year.

If you disregard these specialist advice, new relapse of the disease is possible.

Exercises after removal of the inguinal hernia

After the operation for several days, the patient is shown peace, but then gradually increasing and correctly calculated loads should only accelerate recovery. To help the patient recover faster and reduce the risk of relapse, specialists developed a medical complex. Exercises after removal of the inguinal hernia should improve the tone of the inguinal muscles, strengthening their ability to effectively support the internal organs in their natural position.

Doctors recommend a series of exercises:

The first two exercises are performed lying on your back, stretching your arms along your body:

• Extend the legs to raise above the floor, holding the angle of 45 degrees. We begin to make "scissors", crossing our legs and again spreading them. Start-up perform three to four approaches per foot, gradually increasing the amplitude and number of approaches.
• We lift straight legs over the floor and perform "riding a bike." Start with five approaches.
• Accept position on all fours. Support is made on the elbows, socks and knees. We start slowly without lifting up one leg, leaning on the other. We make five approaches, and change our foot.
• Position - lying on the right side, legs straight, resting on the hands. We begin to slowly raise the left leg. Five repetitions, then change your leg.
• Squat, leaning on the right leg, the left is stretched forward, hands lie on his knee. We begin to produce a slight wiggle with a straightened leg. Change the supporting leg.
• Take the emphasis lying down. Push ups. It is possible to facilitate the execution of the exercise, resting on the floor not with your toes but with your knees.
• Stand up, putting your feet to the width of your shoulders. We do sit-ups. Their amplitude depends on the patient's well-being and physical capabilities.

These exercises should be performed daily, listening to their feelings. If there is pain or other discomfort, you must interrupt the session. If everything goes well, the load can be gradually increased.

If there is a desire to add a number of other exercises, this can be done only with the permission of the doctor.

[18], [19], [20], [21], [22], [23]

Hospitals for the removal of inguinal hernia

Today the patient has a wide choice of medical institutions, which he can use to get rid of his problem. It's all about the amount that he can afford to spend. Modern hospitals for the removal of inguinal hernia are ready to offer their clients not only different methods of coping with the problem, but also a diverse accompanying service.

If the patient is difficult in the means, he will have to confide in the doctors of the municipal clinic. But anyway, no matter how free our medicine is not known, we will have to spend at least a medicine.

For more affluent customers, the doors of numerous private centers and medical clinics are open.

So our respondents can offer clinics as state subordination - these are any state medical institutions on the basis of which there is a surgical department. Another issue is that due to problems in equipping, such a hospital is not always ready to offer patients the most innovative methods of treatment.

The most equipped in this issue are such medical institutions:

• Clinical hospital of state submission "Theophany". Address: Ukraine, Kiev, st. Academician Zabolotnogo, house 21.
• GZ "Road Hospital of the State Enterprise" Odessa Railway "Address: Ukraine, Odessa, Pavel Shklyaruka St., House 4-a.
• Lviv Regional Clinical Hospital. Address: Ukraine, Lviv, ul. Chernihiv, house 7.
• City Clinical Hospital. S.P. Botkin. Address: Russia, Moscow, 2-nd Botkinsky travel, house 5.
• City multidisciplinary hospital № 2. Address: Russia, St. Petersburg, Lane Training, house 5.

Private medical institutions. These include:

• "ANA-COSMO", located at: Ukraine, Kiev, st. Belarus, house 11-B.
• Clinic of laser cosmetology "El. En. ", Which has the address: Ukraine, Kiev, st. Rognedinskaya, house 5/14.
• Institute of Plastic Surgery "VIRTUS". Address: Ukraine, Kharkov, ul. Chernyshevskaya, house 30.
• "MedSwiss in Zhukovka" Address: Russia, Moscow region, Odintsovo district, village. Zhukovka, Rublevo-Uspenskoe highway, house 123 B.
• Multidisciplinary medical holding company "SM - Clinic". Address: 19, Udarnikov Avenue, St. Petersburg, Russia.
• Clinic of aesthetic surgery and cosmetology. Address: 3, Ligovsky Ave., St. Petersburg, Russia.

Cost of inguinal hernia repair

Today, the operation that interests us can be performed in almost any medical institution that has a surgical department.

As it was stated above, the cost of removing the inguinal hernia largely depends on the status of the institution in which this operation is carried out.

When making the calculation, private clinics include in the price:

• Directly conducting the operation, taking into account the price of a particular method (laparoscopy or, for example, stretching or stretching hernioplasty).
• The cost of anesthesia (local or general).
• Cost of the implant, if applicable.
• The price of the accompanying services, the cost of the night in the clinic.

The approximate price range of the transaction in question can range from 4,500 to 24,000 hryvnia.

You can voice some prices of one of the elite clinics. For example, intravenous anesthesia, "working" for half an hour, is paid in a tariff of 1200 hryvnia, up to an hour - 1500 hryvnia; directly removing the hernia of the first category will cost 9000 hryvnia, the second category - in 14100 hryvnia.

Agree, for an average person, the prices are impressive.

In a municipal hospital, such an operation will cost a little less, but you can not count on it for free.

Any surgical intervention is a violation of the integrity of tissues. And how much it is effective in many respects depends on the experience of the surgeon and the patient himself. Today, the operation to remove the inguinal hernia, thanks to innovative methods, allows you to effectively remove the patient from the problem, reducing the risk of relapses and complications to a minimum. But in the event of undesirable discomfort, one should not seek advice from relatives or on the forum pages. More reliable will be the answers and recommendations of a qualified doctor when you contact him for advice. If the question arose about the need for an operation, there is nothing to think about, one should agree, but with one reservation. It is advisable to choose a clinic (or a doctor) with a good reputation and extensive experience in conducting such operations. And do not forget about your positive attitude. And then the positive result of the operation is guaranteed to you!

[24], [25], [26]