Hernioplasty is a surgical way to eliminate hernias. It can be stretched, and this method is good for newly formed and small protrusions. And it can be tension-free, it is an invasive way to repair a hernia using mesh implants. One of the frequently used methods of tension-free hernia repair is Liechtenstein plastic surgery. The operation is performed with inguinal hernia and does not require special preparation of the patient.
Inguinal hernia: definition, description
Protrusion of the organs of the abdominal cavity beyond the boundaries of its anatomical location through the inguinal canal is called an inguinal hernia. In operative gastroenterology, of all pathological protrusions of the abdomen, about 80% are inguinal hernias. Men are much more susceptible to the disease than women.
The hernia consists of elements, eachof which has its own name.
- The hernial sac is an area closely connected with the wall of the peritoneum, which exits through the weak points of the serous membrane covering the walls of the abdominal cavity.
- Hernia gates are defective places of the abdominal wall through which the protrusion of the hernial sac with the contents occurs.
- Hernial contents are usually mobile organs of the abdominal cavity.
- Shell of a hernia. For direct inguinal hernia - transverse fascia, for oblique - sheath of the spermatic cord or round ligament of the uterus.
Protrusions are classified according to anatomical features and are divided into straight, oblique, combined. In inguinal hernias, the ICD code is 10 K40. This class includes all types of protrusion of organs through an elongated gap in the lower part of the abdominal wall.
Surgical treatment of inguinal hernia
The main and cardinal method of hernia treatment is a surgical operation. The use of a bandage is a dubious measure and is used only if the operation cannot be performed.
It is preferable that the operation be extremely simple and affordable, less traumatic and reliable. Manipulation includes surgical elimination and repair of damage in the abdominal wall. Reconstruction of the integrity of the abdominal wall and closure of the hernial lesion can be done with aponeurosis (own tissues) or a non-biological graft.
The most effective is the use of a tension-free invasive method using a mesh prosthesis. Hernia gatereinforced with a polypropylene mesh from the inside, which is a frame and an obstacle to the repeated exit of organs. In surgery, there are several ways to perform the operation: according to Shuldice, Bassini, according to Trabucco. Lichtenstein plastic is the most preferred in operative gastroenterology. This method of surgical intervention significantly reduces the risk of inguinal hernia recurrence and can be used both in childhood and in old age.
Lichtenstein method: the essence of the operation
Stretch-free hernioplasty is preferred as the risk of reherniation is minimal. Hernioplasty according to Liechtenstein is used not only for inguinal, but also for hernias of the abdominal wall (umbilical) and protrusion of the organs of the abdominal cavity under the skin.
The process itself can be conditionally divided into two main stages. At the beginning of the operation, the surgeon opens the hernial sac, examines its contents for the presence of fecal stones, gallstones, and assesses the likelihood of inflammation. If there are no complications, it is removed back into the abdominal cavity. The final stage of the operation, which is also the main one, is the plasty of the hernial orifice using a composite mesh. The probability of recurrence depends on how professionally the plastic is performed. Unlike other methods, this method does not involve dissection on the muscles. The implant is sutured to the aponeurosis located under the muscles.
Indications and contraindications
Lichtenstein hernia repair is prescribed for everyone who has a pathological protrusion of organsperitoneum to the inguinal canal. Doctors strongly recommend the use of this particular method if the course of the disease is complicated by the following factors.
- Recurrent inguinal hernia. Especially if the protrusion appears due to an incorrectly chosen hernioplasty method.
- High probability of necrosis when squeezing the hernial sac (strangulated hernia).
- Intolerance to previously placed implants.
- Danger of rupture of the hernial sac.
Lichtenstein plasty is not possible with certain indications.
- Individual intolerance to synthetic implants.
- Recent abdominal or reproductive surgery.
- Blood disorders: coagulation disorders, leukemia.
- Cardiovascular disease.
- Chronic respiratory diseases.
- Pathologies in the acute phase.
- Presence of malignant tumors in the abdominal cavity.
- Very old age.
- Inoperable condition.
- Patient refusal from surgery.
How Liechtenstein hernia repair is performed
Hernioplasty can be performed both in the traditional way and with the help of a laparoscope.
Children who have reached the age of seven with a hernia of the abdominal wall are treated with the method of laparoscopic hernioplasty according to Liechtenstein. Three small incisions of 1–2 cm are made on the abdomen in the navel.trocars and a laparoscope with a camera. The camera reflects the progress of the operation on the monitor, and through the tubes (trocars) an instrument is inserted into the cavity, with the help of which all stages are performed, as with traditional intervention. This operation has a number of advantages. Small incisions reduce blood loss during the process and ensure a quick recovery, which is especially important in childhood.
Stages of hernioplasty
The operation is performed under spinal anesthesia or general anesthesia. An incision 5 cm long is made in the region of the pubic tubercle parallel to the inguinal ligament.
The surgeon gradually cuts the parenteral tissue, connective tissue sheath, external oblique muscle to the superficial ring of the inguinal canal. The aponeurosis is separated from the spermatic cord and captured by the holder. The hernia is removed, examined and returned to the abdominal cavity.
Measure the grid, in the lower half of which a longitudinal incision is made. The implant is sutured with a continuous suture from the pubic tubercle to the inner ring. To fix the mesh to the internal oblique muscle, separate sutures are applied. Manipulation is done with special care, trying not to touch the ilio-subcranial and ilio-inguinal nerves.
The extreme tail of the mesh, formed as a result of the cut, is laid and fixed with one nodal seam. The operation ends with subcutaneous suturing of the wide tendon plate of the external oblique muscle above the implant.
Rehab
All inguinal hernias have the same ICD 10 code, and postoperativemeasures are similar for all surgical interventions after the treatment of the protrusion.
After hernioplasty, short-term medical care is provided. It includes active drainage, administration of pain medications, and assessment of the condition of the operated organ. If there are no complications, the patient is discharged after a few days. After surgery for an inguinal hernia, rehabilitation is quick and without complications, provided that medical recommendations are followed. They are usually as follows:
- restriction, and better exclusion of physical activity for 2 weeks;
- highly desirable to wear a brace for 2 months;
- dieting.
Complications
These include:
- decrease in sensation in the lower abdomen;
- high probability of constipation (if the operation was performed on a hernia of the abdominal wall);
- prolapse of the uterus, accompanied by severe pain (may occur when dissecting the circular ligament of the uterus);
- divergence of sutures followed by hernia recurrence;
- inaccurate or incorrect fixation of the synthetic mesh with its subsequent migration;
- internal hematomas.
Basically, the operation is going well, the mortality rate is less than 0.1% of all cases.
Advantages and disadvantages of the method
Lichtenstein hernia repair has a number of advantages over other operations.
- The chance of a relapse is almost zero.
- Complicationsoccur in only 5% of patients and in most cases are associated with non-compliance with recommendations in the postoperative period.
- Composite meshes are made from high quality materials, their rejection by the body is rare.
- Short rehabilitation period, especially if the operation was performed using a laparoscope. The ability to return to normal life in 7-8 weeks.
- The operation can be performed from the age of seven.
The Lichtenstein method, like any other, has its drawbacks:
- scar formation around the spermatic cord can lead to impaired blood circulation in the tissues of the testicle and, as a result, to its atrophy;
- wound infection: although doctors try to maintain sterility, statistics show that the occurrence of infection during the operation period was observed in 2% of patients;
- there is a high probability of damage to the sensory nerves located near the inguinal ligament, which can lead to impaired innervation.
When diagnosing an inguinal hernia, it is important not to delay surgical treatment. Qualitatively performed plastic surgery according to Liechtenstein will allow you to avoid complications and relapses and return to the usual rhythm of life again.
