Abdominal wall hernia operation. Abdominal hernia surgery with mesh or why hernias are formed

Date: 21.10.2019

A hernia of the abdomen is a protrusion of internal organs outside the abdominal cavity. A hernia appears as a swelling that can be painful. Infringement of a hernia, in which the blood supply to the restrained organs is disrupted, is extremely dangerous.

With thinning or the appearance of holes in the muscle wall, adipose tissue, intestinal loops, and other internal organs can come out through it. This leads to discomfort, intense pain, and massive complications. A hernia of the abdomen does not go away on its own - over time, it only increases in size. Hernia treatment is only surgical. Surgery to remove a hernia is called hernia repair or hernioplasty.

The more the pathology develops, the higher the risk of an emergency. If, for example, "run" a hernia of the white line of the abdomen, it will become irreducible. If the operation is not performed, the patient is in danger of entrapment with swelling, rapid infection and tissue death.

The risk zone for hernias, which are treated only by surgery, includes people:

with a chronic cough - for example, smokers have a higher risk of hernias;

often lifting weights - with such work, it is necessary to be regularly examined;

have given birth to a child - during pregnancy, a hernia of the abdominal wall may develop;

overweight, allergic with frequent sneezing, difficulty in defecation, etc.

The doctor issues a referral for the operation after a comprehensive examination of the patient. In addition to mandatory palpation and examination, ultrasound of the abdominal organs, laboratory tests are prescribed. It is worth contacting a doctor when the first symptoms appear.

Symptoms and signs of the need for hernioplasty

With the appearance of weakness, the divergence of the muscles of the abdominal wall, a hernial sac is formed. The process may be asymptomatic, but more often the patient feels itching, burning in the area where the hernia has formed. When entering the bag of the intestinal loop, swelling appears - where the white line passes or in another area. Sometimes, if the patient lies on his back, the visual defect disappears.

Each hernia is individual, and its symptoms are manifested in the same way and an operation is performed. Pain sensations range from discomfort to tearing. The indications for removal may be:

feeling of pressure, burning in the groin, scrotum, abdomen;

bulges and bumps in the abdomen, groin areas, which become visually more noticeable when coughing;

pain when coughing, lifting weights, etc.

In case of irreducible infringement, the operation is performed as soon as possible. Delay is fraught with the appearance of vomiting, blood in the stool, intense and growing pain in the scrotum, groin. With these symptoms, you should immediately call an ambulance or go to the emergency department.

How is the operation going

During the intervention, the hernial contents are immersed through the hernial orifice back into the abdominal cavity, after which the hernia orifice is repaired. During operations, the area of the hernial orifice is strengthened either by the body's own tissues or by implants (polymer meshes). Hernioplasty can be performed laparoscopically (through small incisions under visual control using special equipment).

If you are looking for where to have a hernia removed in Moscow, contact the Family Doctor. In the "Family Doctor", a hernia repair is performed for various abdominal hernias. If possible, laparoscopic hernioplasty is preferred. You can check the cost of surgery for hernias of various localization below.

A hernia of the abdomen is a protrusion of the abdominal organs through openings of a natural or acquired nature. The exit can be subcutaneous or directed into adjacent cavities.

To completely get rid of a hernia will only allow surgical treatment, which implies the intervention of a surgeon. It is important to understand that no other technique will completely eliminate this disease.

Classification

By etiology, all hernias last into two categories:

Congenital ailment. As a rule, it manifests itself immediately after the birth of the child or after a short period of time;
Acquired disease. The formation of a hernia of this type is facilitated by the loss of the tissues of their previous elasticity. This usually happens during the aging or depletion of the body.

In addition, all hernias are divided:

Recoverable. In this case, the fallen abdominal organs are able to move and change their position into the lumen of the hernial sac and back;
If such a predisposition is not observed, then the hernia is irreducible. In some cases, it occurs in the form of repeated hernial protrusion.

According to the type of course, hernia can be divided into two types:

Complete hernias. In this case, the hernial sac with the organs in it begins to exit through the hole in the wall of the peritoneum;
Incomplete hernia. These are called protrusions that do not pass through the resulting defect. They usually occur in the early stages of the disease.

All abdominal hernias can be divided:

Hernia of the white line of the abdomen;
Postoperative hernia;
Direct hernia in the groin area;
Hernia in the navel;
Hernia located at the opening of the inguinal canal;
Femoral hernia.

Symptoms and Causes

Photo: excision of a part of the hernial sac

The main symptom of a hernia of the abdomen is a protrusion, which sometimes disappears. At the initial stages of the development of the disease, the patient practically does not feel any inconvenience. Only sometimes a dull pain can be noted. At the next stages of the progression of the disease, characteristic pain sensations are observed, they acquire an acute character and become sharp. So the patient is observed:

Belching, poor work of the gastrointestinal tract;
Constipation;
Frequent nausea, in rare cases, vomiting;
Deterioration of general well-being.

The causes of hernia include a hereditary predisposition. If there is one, then you should definitely wear a special corset. He will prevent the development of the disease.

Acquired abdominal hernia can be caused by:

Obesity, overweight;
Pregnancy;
Lifting weights or over-tightening your abdominal muscles;
Persistent cough, vomiting;
An injury to the abdomen may also be considered a cause.

Complications

Possible complications include intestinal gangrene, part of which was strangled by the hernial sac. During the infringement of the hernia, the contents of the bag can press down on other digestive organs. In most cases, the vessels responsible for the nutrition of the intestine are affected. They narrow, which is especially dangerous for the human body.

Other possible complications include:

Intestinal obstruction. It usually occurs in severe cases;
Inflammation of the walls of the peritoneum. This ailment is called peritonitis. This is one of the most dangerous complications that can be fatal;
An excess of toxins in the body;
Renal failure

If the hernial sac is located in the lower abdomen, then the bladder can enter it. This is a serious complication, which in the form of the course and symptoms is similar to the acute degree of cystitis. If the patient does not receive the necessary assistance in due time, he will die. That is why it is imperative to consult a doctor when the first signs and symptoms of a hernia appear!

Treatment. Surgical intervention

Only surgery can cope with a hernia of the abdomen. Today, for this, a technique such as laparoscopic hernioplasty is used. This method fully allows you to reduce the pain syndrome in the postoperative period.

The essence of the procedure: the operation is carried out through small incisions, the size of which, even in severe cases of hernial protrusion, does not exceed two centimeters. This leads to the fact that the abdominal wall is not injured during surgery.

During the operation, a professional technique is used, which includes a laparoscope and trocars. To prevent complications after the operation, the surgeon observes the patient's internal organs on a special video monitor during hernioplasty.

Operation progress

Using a trocar, the surgeon inserts the grasper. It is necessary to close the protrusion of the muscle wall. Using another trocar, he introduces all the necessary instruments to secure the suture;
The first step is to exfoliate the peritoneal cavity, which covers all the muscles from the back;
Then the surgeon removes the hernial protrusion;
The next step is to fix the mesh endoprosthesis;
The final stage is suturing.

Differences in operating techniques

Photo: polypropylene mesh for hernioplasty

The difference between hernioplasty and the traditional outdated technique is that the elimination of the sac occurs in a different way. If, during conventional surgery, the pathological defect is sutured according to the standard method, then a large load will be exerted on the seams.

This can lead to the occurrence and development of complications. During hernioplasty, the mesh graft is located on the back of the peritoneum, so the load is evenly distributed over it. This reduces the potential for relapse.

Another difference is that with the traditional technique, a permanent scar will heal and form in four months.

During this period, overstrain, physical activity, sports, even driving a car are strictly prohibited. When using the hernioplasty method, the rehabilitation period is significantly reduced.

Advantages and disadvantages of hernioplasty

Photo: a bandage for the treatment of a hernia on the abdomen

Greater cosmetic effect, after a few years the seams are invisible;
Reduced rehabilitation period of no more than two weeks. After it, you can lead a normal life: go in for sports, drive a car;
In the postoperative period, patients do not feel any pain syndromes or discomfort;
The risk of complications or recurrence is reduced to a minimum;
The operation is available to all patients.

There were no drawbacks to this technique. If after the operation there is a slight pain in the area of punctures and sutures, then after two days it completely disappears.

Prophylaxis

Preventive measures after surgery include a ban on lifting weights. It is allowed to carry bags, but their weight should not exceed a certain norm, which is individually set by the attending physician.

The first time after carrying out hernioplasty, you will definitely need to wear a corset. After a few weeks, it can be removed, but if the doctor deems it necessary, the patient should continue to wear it.

Also, once every six months, you will need to be examined by a doctor. It will reveal a predisposition to relapse, that is, the reappearance of hernial protrusion.

Price

The cost of operations differs in different clinics:

Clinic name	Location city	Hernioplasty cost	Cost of traditional intervention
"ABIA"	Saint Petersburg, Primorsky district	From 32.000 rubles	From 22.000 rubles
"K + 31"	Moscow	From 33.000 rubles	From 23.500 rubles
Delta Clinic	Moscow	From 32.700 rubles	From 22.700 rubles
"Scandinavian Health Center"	Moscow	FROM 30.900 rubles	From 21.500 rubles

You should never delay with the treatment of a hernia of the abdomen. As a result, this can lead to irreversible consequences. More serious diseases may occur, in some cases there is a lethal outcome.

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All materials on the site have been prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and cannot be applied without consulting your doctor.

A hernia of the anterior abdominal wall is a dangerous disease that leads to serious complications. It is characterized by the appearance of a defect (discrepancy, rupture) between tissue fibers. Through such a defect, the fat layer protrudes with the formation of a hernial sac and the internal organs are displaced into it. Manifesting in minor discomfort with coughing or physical exertion, this disease leads to pinching and necrosis of the intestine, followed by the development of peritonitis. That's why surgery for a hernia of the abdomen should be carried out in the early stages of detection of pathology.

Hernia of the white line of the abdomen: types and causes

The human abdominal wall has developed muscles that fix the internal organs in the abdominal cavity and protect them from loss. However, there is a weak point in the muscle wall - the white line. It runs between the xiphoid process and the pubis and is composed of connective tissue and does not contain muscles. Due to the complete absence of musculature, the likelihood of protrusion of the subcutaneous fat at the place where the white line passes is much higher than in other areas of the abdominal wall.

Normally, the width of the white line should not exceed 1-3 centimeters, but with thinning of the connective tissue and its stretching, muscle divergence appears, and a hernial gate is formed. The severity of the disease depends on their width. In terms of severity, a hernia of the white line of the abdomen is:

Within 3-5 centimeters (1 degree);
More than 7 centimeters (2nd degree);
With obvious organ prolapse and abdominal prolapse - grade 3.

There is also a classification according to the location of the protrusion. After all, it can be located:

Above the navel (supra-umbilical)
Below the navel (sub-navel);
On the side of the navel, on either side (paraumbilical).

Regardless of the location, pathology most often appears in people exposed to high stress on the muscles of the abdominal wall(men engaged in heavy physical labor, pregnant women, patients suffering from hemorrhoids and chronic constipation). This disease is characterized by:

Pain in the abdomen that occurs with sudden movements, bending or straining;
A bulge in the midline (may be painful and hard to the touch)
Belching, nausea and vomiting.

The listed signs require a mandatory visit to a doctor and an examination.

Methods for removing a hernia of the abdomen

There is an opinion that it is possible to get rid of a hernia with the help of special diets or gymnastics. But this opinion is erroneous, since the connective tissue defect does not go away on its own and is not eliminated without the intervention of a doctor. This means that the removal of a hernia of the abdomen is possible only by a surgical method. Any gymnastics only increases the risk of pinching the internal organs and the subcutaneous fat layer. As for diets, they are also not effective for this ailment. Dietary adjustments can provoke temporary improvement through weight loss. However, stress on the abdomen or awkward movement will again lead to bulging.

Besides, doctors do not recommend replacing surgical treatment with wearing a bandage. The bandage is indicated only for pregnant women to prevent the development of a hernia. Otherwise, it has the opposite effect. After all, all the load on the muscles of the abdominal wall will be transferred to the bandage. As a result, the muscles will weaken, the connective tissue will stretch, and the hernia will enlarge even more.

An exception for the operation is often children's age, since in a child the defect can close on its own up to 5 years old. However, even here the need for surgical treatment depends on the size of the hernia. The larger it is, the less chance of self-healing. With a large defect, the child needs surgery at preschool age, while the tissues are elastic and easily amenable to correction.

How is the abdominal hernia surgery performed?

Surgical treatment of the disease can be planned or emergency. Planned is prescribed for patients who experience unpleasant (sometimes painful) sensations in the area of protrusion, but do not suffer from pinching. In case of pinching, the patient needs an urgent operation to remove a hernia of the abdomen, since any delay leads to the death of internal organs (due to impaired blood flow) and the subsequent development of an inflammatory process in the abdominal cavity (peritonitis).

You can draw conclusions about pinching based on:

Acute abdominal pain;
Inability to reposition the protrusion even while lying on the back;
Nausea and vomiting;
Lack of defecation or blood in the stool.

A symptom of a pinched abdominal hernia can also be a profuse discharge of gas.

Preparing for surgery

Before surgery, the patient is advised to undergo special training, namely:

Do not drink alcohol 3 days before surgery.
Do not take medications containing acetylsalicylic acid 2 weeks before the procedure (it reduces blood clotting).
Provide yourself with adequate nutrition and vitamins 2 weeks before treatment.
Do not eat since 20.00 the previous day.

Besides, the procedure is contraindicated for people who have recently had colds and inflammatory diseases. After recovery, 2 weeks should pass (an exception is emergency indications for surgical treatment).

In addition to self-preparation, the patient requires a medical examination, which is prescribed by a doctor. In private clinics, the cost of treatment may include a full course of examination. Otherwise, it is charged separately. On average, the cost of surgical treatment for a hernia of the abdomen ranges from 30 to 50 thousand rubles. This indicator depends on the level of the clinic, the number of procedures performed, the cost of the used surgical equipment and the quality of the implants. However, hernia treatment is available in the Russian Federation and is free of charge within public hospitals. In order to get to the operation, you need to have a health insurance policy and a referral from a general practitioner from a polyclinic.

The standard preoperative examination includes:

General blood analysis;
Analyzes for sugar, group and rhesus, prothrombin index, APTT, biochemistry;
Tests for infectious diseases (syphilis, hepatitis, HIV);

Based on this examination and studying the medical history, the doctor draws conclusions about possible complications and subsequent treatment.

Hernia surgery

In the absence of pinching, the procedure is quick and does not cause complications. To eliminate defects of small sizes, modern equipment is often used - a laparoscope. This is a special probe that can be used to carry out diagnostic and therapeutic procedures without extensive damage to the abdominal wall. It minimizes soft tissue damage and the risk of bleeding, allows you to observe what is happening on the monitor, ensures precise manipulations and speeds up the healing process. However, this method is contraindicated in patients with other diseases of the abdominal cavity, so it is prescribed with extreme caution, based on a medical opinion.

Traditional treatment of a hernia of the abdomen is carried out by stretching the weakened layers with fixation with a synthetic thread. This method is effective only in 60-80% of cases. In 20-40% of cases, reviews of operated patients speak of temporary improvement and subsequent relapse. This picture arises due to the high load on the seams. As a result of their strong tension, the weakened connective tissue is cut with a thread, and a new defect appears.

The most optimal method of treating a hernia is considered to be prosthetics using a synthetic mesh material. It is installed on the area of the defect and compensates for the weakness of the connective tissue, taking on the entire load. Its advantage is complete compatibility with the body and the absence of a rejection reaction. Over time, the area with the mesh grows with connective tissue and acquires a homogeneous, strong structure that is resistant to stretching and tearing.

An operation to remove a hernia of the abdomen is performed under local or general anesthesia. In adults, an unrestrained hernia is preferably operated under local anesthesia, since this method of anesthesia does not affect the heart, does not require long-term postoperative observation, does not cause nausea, and allows food to be taken immediately after the procedure. In special cases, the patient may be prescribed spinal anesthesia.

Postoperative recovery

Long-term treatment after surgery is required only for patients with a strangulated hernia, complicated by necrosis and peritonitis. In this case, the excision of dead tissue (intestines, fat layers), sanitation of the abdominal cavity and antibiotic treatment under the supervision of a physician is carried out. In other cases, recovery after surgery is quick and painless, since the patient's internal organs were not damaged.

The operated patient does not need bed rest and can be discharged from the hospital the very next day after the procedure. He is allowed to:

Move independently within your home (walking speeds up the healing process);
Drink and eat as usual;
Leaving home on the third day after surgery.

But, Despite the flexibility of the postoperative regimen, the patient must comply with some restrictions. For example, he must:

If you follow all these rules and be attentive to your health, you can achieve a quick recovery and avoid serious complications of the postoperative period.

Video: a doctor about an operation to remove a hernia of the abdomen

How is an umbilical hernia repaired after surgery? This question, like many others, will be answered by the doctor. A hernia in the navel is one of the conditions in which internal organs (such as the intestines) protrude beyond the boundaries of the anterior abdominal wall through an opening located in the navel. The disease manifests itself in the form of a protrusion in the navel, which can increase or, conversely, become less noticeable when taking a horizontal position. Sometimes education can take up a large area.

A surgeon treats this complex disease, and you need to contact him immediately, as soon as unpleasant sensations appear. Symptoms of an umbilical hernia include the following:

pain in the abdomen when coughing or exercising;
the presence of nausea;
expanded umbilical ring.

There are several ways to diagnose an umbilical hernia:

Get examined by a narrow specialist.
Make an X-ray of the stomach and duodenum.
Make an ultrasound.
Undergo a gastroscopy procedure.
To make a procedure such as herniography - an X-ray method, which consists in the introduction of a special contrast agent into the abdominal cavity, which allows you to examine the hernia.

Umbilical hernias can be of two types: congenital and acquired. Congenital can be detected immediately after the birth of the child. In the area of the navel, where the umbilical cord was, there is a spherical protrusion with a wide base, passing into the umbilical cord. If the baby cries violently, the hernial protrusion increases. How different congenital or acquired hernias can be can be seen in the video that is shown to patients in a medical institution. How is an umbilical hernia treated? Usually, surgical treatment of a hernia is not performed until the age of five. They are trying to eliminate it with the help of massage and physiotherapy exercises. If all else fails and the navel does not shrink, you have to resort to hernia surgery.

Hernia surgery

Removal of an umbilical hernia in adults is carried out only by an operative method, treatment is prescribed immediately, and strictly in a hospital setting.
The traditional type of plastics (the Sapezhko and Mayo method) has some disadvantages:

the recovery period of the body can last long enough (heavy loads are prohibited for one year);
a high risk that the formation after surgery will reappear in the same area.

Hernia removal is practiced using mesh implants, which can be installed in several ways. Advantages of the operation:

recovery can take no more than one month, the operated patient can engage in physical activity and even sports;
a small percentage of disease recurrence - 1%;
the operation can be performed with any type of long-acting anesthesia, not necessarily general anesthesia.

The laparascopic method for removing a hernia of the abdomen is one of the most gentle forms of surgery, since it can proceed without incisions on the body, several punctures are enough. Rehabilitation is quick and easy, but this method has contraindications. These include:

state of immunodeficiency, including HIV,
liver dysfunction,
time of menstruation in women.

Often, the operation is performed in combination with a mesh implant. Operations to remove an umbilical hernia in adults are performed according to the following scheme. First, the patient is placed in a hospital for examination and preparation for surgery. If the patient is admitted in an emergency, preparation for umbilical hernia surgery in adults is minimized.

Then the patient is given anesthesia (local or conduction; general anesthesia, as a more complex one, is used in case of recurrent manifestations). If the formation is small, the operation on the umbilical hernia is reduced to the fact that the umbilical ring is sutured. If the mass is larger, it must be closed surgically. The resulting adhesions are dissected, which allows the internal organs to remain in the hernial sac. You can also deal with the prevention of hernias. Usually doctors recommend following some simple rules:

training the abdominal muscles (this will keep them in good shape);
proper nutrition, which will help control body weight;
during pregnancy, you must wear an umbilical band;
avoid strenuous physical activity.

Why does an umbilical hernia appear? In babies, the cause of the appearance may be a delayed fusion of the umbilical ring. The adult population is more likely to develop an umbilical hernia after 40 years. This is especially true for pregnant women.

Predisposing factors include:

weakness of the connective tissue;
slow fusion of the umbilical ring;
obesity;
postoperative scars.

Risk factors that can lead to increased intra-abdominal pressure:

frequent crying and screaming in babies;
overvoltage in the physical plane;
constipation;
period of pregnancy;
ascites;
prolonged severe cough.

What are the contraindications?

Children under the age of five. There is a certain probability that the hernia will be removed on its own along with the growth of the body. If it does not cause severe discomfort and does not create any complications, the operation is postponed for several years. After five years, boys are also not always advised to have surgery right away. But the girls need to remove the hernia. This is due to the growth of the reproductive system.

They do not perform operations with active infections in the body, because the operation is a certain risk, complications are possible.

Diseases that are not curable. Since a hernial tumor is not a dangerous disease, especially when it is in the early stages, terminally ill patients are not exposed to the risks associated with the operation.

Second half of pregnancy. Any operation is stress for the body and, accordingly, a risk for both the mother and the baby. Therefore, it is better to avoid such situations during pregnancy. If the formation does not carry certain risks, surgery is postponed until breastfeeding is stopped.

A contraindication is a stroke or heart attack. In such cases, anesthesia is difficult for patients to tolerate, because of this they are not exposed to such a risk.

Disturbances in cardiovascular and pulmonary activity are also an obstacle to surgery.

Large formations in people over seventy years of age are rarely removed. Surgical intervention is poorly tolerated by such patients.

Surgery to remove an umbilical hernia is contraindicated in patients with diabetes, as well as in severe renal failure, liver cirrhosis with complications, esophageal varicose veins.