inguinal hernia surgery

Congenital or acquired inguinal hernia is one of the most common diseases and is a clinical picture when internal organs and tissues protrude beyond the natural borders of the peritoneum into the subcutaneous fat layer. The exit site is natural openings or weak areas of the groin area. And sometimes, the only method of relieving the problem is an operation to remove the inguinal hernia, which we will learn about in more detail in this article.

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Indications for surgery

If this disease is not treated, there is a high probability of developing serious complications, which become increasingly difficult to eliminate over time. Therefore, when a patient contacts a doctor, the specialist conducts an examination and, if there are indications for surgery, prescribes it with the patient's consent.

Such an indication may include:

• Incarceration of a hernia – this diagnosis occurs when part of the extruded organ is pinched by the valves of the opening. This situation is quite dangerous. It does not always manifest itself as severe pain, and goes unnoticed. Sometimes, during surgery, it is determined that the incarcerated tissues have necrosed (died).
• Irreducibility of an organ that has come out of the peritoneum. Such a clinical picture can develop in the case when adhesions have formed between the tissue border of the hernial sac and the mucous layer of the inguinal canal, which do not allow the protruding organ to return to its natural place.
• Intestinal obstruction associated with the prolapse of a section of the intestine into a hernial opening where it has become strangulated. In this case, the passage section is blocked, which blocks the movement of feces through the intestine to the anus.

The above described cases require immediate surgical treatment.

Preparation

Therapy for inguinal hernia occurs exclusively on the basis of the surgical intervention performed. Other methods do not provide the patient with the desired result. But before putting the patient on the operating table, special preparation is required, which the patient must undergo.

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

• General urine and blood analysis.
• Blood for biochemistry.
• Analysis for infections.
• Ultrasound examination of the peritoneum - determination of the severity of the pathology and the possibility of strangulation. This complication can affect the course of the operation and the time of its implementation. In case of strangulation, surgical intervention is prescribed urgently.
• Electrocardiography. The operation is performed under anesthesia. The specialist determines the heart's ability to tolerate it.
• Coagulogram – determination of the level of blood clotting.
• Finding out the patient’s complete medical history and existing chronic diseases.
• Obtaining information about medications taken during the treatment period.
• Several weeks before the planned operation, you should give up bad habits: alcohol, nicotine, drugs.
• If a medical procedure is prescribed, the patient stops eating 8 hours before it begins.
• The intestines are cleansed using an enema.
• A course of premedication is administered several hours before the scheduled time. The patient is prescribed a sleeping pill for the night, and a narcotic analgesic may be administered on the eve.

Based on the clinical picture, the surgeon, together with the anesthesiologist, determines the type of anesthesia. It can be general, local and regional. The type to choose during excision is influenced by the level of anesthesia tolerance by a particular organism, as well as the type of hernia and its size parameters.

If the patient has a history of mental health issues, they may be given small doses of a tranquilizer. This will help them relax and calm down, which is important before such a procedure.

If the patient's body is prone to allergic reactions, antihistamine preparation is carried out in advance.

Immediately before excision, the oral cavity is necessarily examined: dentures are removed from it. Contact lenses, if any, must be removed.

The incision site is shaved and sanitized. In some cases, doctors bandage the patient's legs to prevent thromboembolic complications.

Is inguinal hernia surgery 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 the operation to remove an inguinal hernia is dangerous? And what are its consequences?

This surgical treatment makes it possible to rid the patient once and for all of the "bulging" problem, which causes pain and discomfort to its owner. Its implementation will prevent further progression of the disease with the development of severe complications, and prevent the appearance of new foci of inguinal hernia in this area.

The methods of performing the surgical intervention in question are so refined that they do not pose any obvious danger to the patient's body. But surgery is surgery and, hoping for the best, one should be prepared for any development of events.

Methods of inguinal hernia removal

Modern medicine does not stand still, offering innovative treatment methods and more advanced surgical equipment to help doctors. Today, the methods of inguinal hernia removal that surgeons are armed with are as follows:

• Tension hernioplasty. When performing it, the specialist, after examining the affected area for pinching, puts the intestine back in place and stitches the edges of the hernial orifice with a simple surgical suture. This method is not very effective, since it does not completely eliminate the threat of suture cutting and relapse of the pathology.
• A more modern method of tension-free hernioplasty - during the excision process, to close the hernial orifice, the doctor uses a transplant. It is a polypropylene mesh, which, after the hernia is reduced, is applied to the opening. This approach allows the patient to protect himself from repeated prolapse. This method is known as the Lichtenstein method.
• Laparoscopy is an innovative technique that allows you to do without large incisions and, accordingly, sutures. A puncture is made in the groin area. Using a computer connected to the laparoscope, a specialist can monitor the manipulations being performed on the monitor. The procedure is performed with a microsurgical instrument, causing minimal discomfort to the patient.
• Laser hernia removal.

Technique of the operation

Of the above-mentioned techniques, the most frequently used today is the Lichtenstein method of performing surgery, since tension hernioplasty has quite significant disadvantages:

• Long-term postoperative pain.
• High risk of relapse.
• Longer recovery period.

The advantage of the non-tension method is that the likelihood of repeated hair loss is eliminated, the recovery period after it is significantly shorter, and moderate pain syndrome is observed.

The Lichtenstein method involves the use of synthetic polymeric materials with a high degree of engraftment in closing the hernial orifice. Such materials show inertness when in contact with human tissues.

The sequence of the intervention is as follows:

• Making a small incision in the area of the bulge.
• Examination of the inguinal wall for impingement and adhesions.
• If necessary, adhesions are excised. If there are any nicrosive tissues, they are also removed (such an operation is considered complicated).
• The surgeon returns the prolapsed organ to its natural place.
• The hernial orifice is covered with a polymer mesh. And, like a tailor, the doctor fixes the "polymer flap", connecting the window sashes, closing the hole.
• A layer-by-layer surgical suture is applied to the cut skin.

The use of polymer material allows to avoid creating muscle tension, while the mesh makes it possible to strengthen the groin wall.

Laparoscopic inguinal hernia repair

Another method that has recently appeared in the "arsenal" of doctors, but has already won the approval of specialists is laparoscopic removal of inguinal hernia. Its essence is that all manipulations are carried out by a specialist through a small opening in the groin. The procedure itself takes a short period of time. At the same time, the recovery period is minimal.

During the operation, with the help of a special video probe, the surgeon has the opportunity to observe the operation and his manipulations on the computer screen, to which the video signal from the camera is transmitted. The removal itself is performed using a microsurgical instrument, causing minimal damage to the patient's body.

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

Advantages:

• Small incision – small suture – small colloid scar.
• Short recovery period.
• Significantly fewer postoperative complications compared to open surgery.
• Minimal risk of developing chronic pain.
• Short hospital stay.

Flaws:

• Laparoscopy must be performed by an experienced, highly qualified specialist.
• If the surgeon does not have much experience performing such a procedure, there is a high risk of relapse.
• More time spent on the operation.
• In case of late intervention, after laparoscopy, there is a high probability of recurrent prolapse.

Laser removal of inguinal hernia

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

Laser removal of inguinal hernia allows avoiding classical surgery, allowing the patient to get rid of pain syndrome. The therapy is performed under local anesthesia.

The procedure begins with puncturing with a needle, through the internal channel of which a quartz light guide is fed into the groin area. The laser energy causes the liquid substances to evaporate, which reduces the internal pressure, allowing the "fallout" to be returned to its place, and the edges of the valves to be "glued together with a laser".

The advantage of this method:

• Bloodlessness.
• Painlessness in the postoperative period.
• High security.
• Patient activity is permitted 40 minutes after the procedure.
• High efficiency.
• The absence of incisions, postoperative scars and marks, which is cosmetically welcome.
• Muscle tissue, however, is practically not damaged.

Inguinal hernia removal in men

An inguinal hernia is a pathology that, due to the peculiarities of the anatomical structure, is more often diagnosed in representatives of the strong half of humanity. When this disease develops, a man can observe the manifestation of a tumor-like protrusion, which often, for a short time, descends into the scrotum. Doctors often call such a clinical picture an inguinal-scrotal hernia.

At the moment, inguinal hernia removal in men occurs with minimal damage. This gives the patient the opportunity to return to a full and normal life after a short period of time. But such a result can only be achieved by following all the requirements and recommendations given by the attending physician.

The duration of the recovery period varies for each patient, depending on the severity of the pathology, the chosen anesthesia and the excision method.

Inguinal hernia removal in women

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

The most effective and widespread treatment for this pathology is considered to be a surgical intervention. Removal of inguinal hernia in women is carried out using the same methods that have already been described above. But due to female physiology, the doctor gives such patients an additional set of recommendations. For example, when admitted to the hospital for surgical treatment, it is advisable for patients to have personal hygiene products, since preoperative stress can provoke an earlier onset of menstruation.

Removal of inguinal hernia in children

If the child is under five years old and the ultrasound does not show strangulation of the hernia, treatment is usually carried out using conservative methods. The essence of such therapy is the constant wearing of a special supporting bandage. If strangulation is present, an emergency operation is performed.

After the child reaches five years of age, he undergoes a repeat examination and if the problem has not gone away, the child undergoes inguinal hernia removal.

In the absence of concomitant complications, surgical treatment is performed using one of the methods that are quite effectively used in adult therapy. Performing this operation on 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 the case of using local anesthesia, the postoperative period will be significantly shorter. And after a few hours, the patient can be sent home.

When performing the operation under general anesthesia, the patient will have to stay in the hospital for a couple of days. But in both cases, he will still need to visit the hospital more than once, coming for dressings and a doctor's consultation.

If there are no complications, the patient is discharged; otherwise, doctors have to fight the pathology that has arisen.

The outpatient postoperative recovery period usually lasts from seven to ten days. During this time, bed rest and diet prevail. Monitoring by the attending physician is mandatory. Physical activity and exercise are prohibited, but this taboo only applies to the first few days of rehabilitation. Subsequently, it is they that allow you to recover faster and return to normal life.

What can you do after inguinal hernia removal?

Answering this question is both simple and difficult at the same time, because each person's body is so individual. But a qualified specialist, answering the question of what is possible after the removal of an inguinal hernia, still forms a number of aspects that work for the fastest recovery of any organism.

• Adjustment of diet, both in the preoperative period (enhanced nutrition) and in the postoperative period (exclusion of a number of products that tend to cause disruption in bowel function).
• Physical activity: minimal in the first few days after surgery, with a gradual increase.
• A set of special exercises that will strengthen the groin muscles, increasing their tone.
• Depending on the severity of the surgical intervention and the health of the patient (his medical history, the presence of chronic diseases), the attending physician may adjust the recommendations, expanding what is permitted or, conversely, imposing a taboo on some of them.

Rehabilitation after inguinal hernia removal

Mostly, planned surgical interventions take place in the morning, and by evening the patient receives the first dressing and examination by a specialist. During the evening examination, the doctor may observe minor discharge from the wound, which is considered normal. The dressings are changed daily, and if there is no suppuration, the patient gradually begins to return to the usual loads for his body.

Rehabilitation after inguinal hernia removal involves gentle loads (no more than three to five kilograms) for two to three weeks. The patient may also be prescribed to wear a special support bandage (but this is at the discretion of the doctor).

After this period, physical activity gradually increases. This is where the bandage comes in handy (for backup). At a certain stage, a specially designed set of exercises is recommended to strengthen the pelvic muscles and shift the functions of the bandage to them.

A special diet is also prescribed. The selection of products should "ensure" that constipation, diarrhea and flatulence do not occur in the intestines, causing discomfort.

If you follow the doctor’s recommendations, rehabilitation after inguinal hernia removal will proceed without complications, and the recovery period itself will be significantly reduced.

Suture after removal of inguinal hernia

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

If this is an abdominal operation, then the colloid suture can reach 5-8 cm, whereas if the treatment was carried out using laparoscopy or laser, a slightly noticeable point will remain on the skin over time.

Nutrition after inguinal hernia removal

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

In the postoperative period, in order to reduce the load on the operated area, a person should eat in such a way that there are no problems with bowel movements. Since diarrhea, constipation, and bloating lead to increased discomfort and loads on the digestive system, which includes the intestines.

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

Diet after inguinal hernia removal

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

• Chicken meat.
• Cereals, especially buckwheat.
• Fish, preference is given to sea fish.
• Seafood.
• Chicken eggs.
• Vegetables and fruits that do not cause increased gas production.
• Low-fat cottage cheese.
• Low-fat milk.
• Olive oil.
• And other things.

Protein is a very important "building block" of the human body. It is what will give strength and opportunities for the fastest recovery.

On the contrary, a number of products must be excluded from the diet of such a patient. Products that cause increased gas formation, diarrhea or constipation are prohibited:

• Sweets and chocolate.
• Legumes.
• Sweet fruits and berries.
• Cabbage (especially sauerkraut).
• Coffee and strong tea. Can be replaced with chicory coffee for a while.
• Fermented milk products.
• Alcohol.
• Nicotine.
• Vegetable consumption should be reduced.
• Smoked dishes.
• Pastries.
• Carbonated drinks.
• Fatty foods.
• Yogurt.

If you stick to the diet recommended by your doctor, you can avoid many of the unpleasant aspects of the postoperative period.

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Sex After Inguinal Hernia Removal

A number of patients are concerned about the problem of what to do with intimate relationships? Is sex possible after an inguinal hernia removal? The doctor consulting the patient usually explains that having sex in the first days after the operation is undesirable. They can provoke the occurrence of some pathological and unpleasant consequences:

• Postoperative pain may increase.
• The extent of swelling may increase.
• Sex can contribute to the formation of a hematoma.
• An infection with all the ensuing consequences can get into a wound that has not yet healed.
• This process can cause bleeding.
• Cause the seams to come apart.
• If a tension-free hernioplasty was performed, there is a high probability of implant displacement.

If the recovery period proceeds without any complications, intimate relations can be resumed no earlier than two weeks after the health procedure. If even the slightest complication occurs, this period can be extended. After all, during this time, it is necessary to avoid increased pressure on the affected area of the peritoneum, eliminating excessive tension.

Bandage after removal of inguinal hernia

The medical bandage was developed by scientists as a means of preventing the appearance and growth of hernias, as well as preventing (in the presence of prolapses) strangulation. Modern methods of ridding a person of these problems allow you to do without this supporting frame. But it is better to play it safe when using it than to allow a muscle strain in the groin area. After all, wearing a bandage allows you to relieve some of the load on the peritoneum, which reduces the risk of complications and relapses.

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

The period during which the patient must wear the bandage is determined by his attending physician. This parameter depends on a number of factors: the severity and time of the operation, the size parameters of the protrusion, the contents of the capsule that came out.

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

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Loads after inguinal hernia removal

Adults are used to living at their own pace with its loads and pressure situations, it is also difficult to explain to a child why he should lie down or sit down when other children are running around the playground? Therefore, the question of the permissible load after the removal of an inguinal hernia is quite acute. And the speed of wound healing, the likelihood of relapses and complications depend on how accurately the specialist's recommendations are followed.

Usually, doctors recommend that patients who have had an inguinal hernia operation reduce their physical activity (in the first few days, it is generally advisable to lie down more than move, but a strict bed rest is also unacceptable). During the month after the operation, lifting no more than five kilograms is allowed, but if the pain begins to increase, or other negative symptoms appear, loads should be excluded again and a doctor should be consulted.

After a couple of weeks, physical activity can be increased if recovery is uncomplicated. But it is still worth holding off on heavy loads and maintaining this regime for about a year.

If you ignore this specialist advice, new relapses of the disease are possible.

Exercises after inguinal hernia removal

After the surgery, the patient is advised to rest for the first few days, but then gradually increasing and correctly calculated loads should only speed up recovery. To help the patient recover faster and reduce the risk of relapse, specialists have developed a treatment complex. Exercises after the removal of an inguinal hernia should increase the tone of the inguinal muscles, strengthening their ability to effectively support the internal organs in their natural position.

Doctors recommend a number of exercises:

The first two exercises are performed lying on your back with your arms extended along your body:

• Raise your extended legs above the floor, maintaining an angle of 45 degrees. Start doing "scissors", crossing your legs and then spreading them apart again. Initially, do three to four approaches for each leg, gradually increasing the amplitude and number of approaches.
• Raise your straight legs above the floor and perform a "bicycle ride". Start with five sets.
• Get on all fours. Support yourself on your elbows, toes and knees. Start lifting one leg slowly without jerking, leaning on the other. Do five approaches and change legs.
• Position - lying on the right side, legs straight, support on the hands. We begin to slowly raise the left leg. Five repetitions, then change the leg.
• Sit down, leaning on your right leg, the left leg is stretched forward, hands are on the knee. We begin to make slight swings with the straightened leg. Change the supporting leg.
• Assume a prone position. Push-ups. You can make the exercise easier by resting your knees on the floor instead of your toes.
• Stand with your feet shoulder-width apart. Do squats. Their amplitude depends on the patient's well-being and physical capabilities.

These exercises should be performed daily, listening to your feelings. If pain or other discomfort occurs, you must stop the session. If everything goes well, the load can be gradually increased.

If you wish to add a number of other exercises, this can only be done with the permission of a doctor.

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