- Anatomical features of the
- zone What happens when a hernia forms?
- Why is a hernia formed?
- Surgical classification
- Characteristic features of
- What are the signs of susceptible infringement?
- What is needed to make a diagnosis?
- Is treatment possible without surgery?
- Do you need a special diet?
- Methods of operative treatment
- Features of the postoperative period
- What to look for during rehabilitation?
- How to prevent the development of a hernia?
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Any hernia, as anatomical formation, always represents an inconsistency of muscle protection in a certain place, when it becomes possible to get inside under the skin. In the hernia of the white abdominal line, such a weak zone is the joining of the straight and oblique muscles of the abdominal wall.
More common in young men in 20-35 years. They account for 60% of cases. But there are also women, children, the elderly. The most typical localization in the epigastric region( 5% of all possible hernias of the abdomen).You can treat the disease only surgically. Other methods provide little temporary relief, but are not able to eliminate the hernia.
Anatomical features of the
zone A white belly line is called a powerful fusion of the tendons of the muscles that runs from the lower end of the sternum to the pubic bone. On the surface of the abdomen, it is not visible. Projected on the median line. Two-sided oblique muscles carry a constant load, provide position and body movements. Their tendons converge in front and represent a relatively thin formation( 1-2 mm), poorly provided with blood supply and nerve endings.
The width of the splice is individual, varies from 20 to 30 mm. Fibers of the aponeurosis( dense muscle shell) are able to twist, form cracks in the form of rhombuses. By quantity, they are located at the top and middle of the line. Normally filled with fatty tissue from the front fiber of the peritoneum( preperitoneal), capable of stretching.
What happens when a hernia forms?
The hernial canal in the white line is formed gradually. Fibers of tendons diverge to a distance of 12 cm. Hernial gates resemble a circle, an oval or a rhombus. There are stages of development. The hernia begins with the extension of the cracks in the fibers of the aponeurosis and the release of fatty tissue under the skin. It forms the preperitoneal lipomas. The holes are small.
With further expansion, there are anatomical hernial gates, to which extends, in addition to peritoneal tissue. Normally, the role of the peritoneum is to cover and protect the inside of the abdominal wall and the outside of the abdominal organs. Here it forms the sheath of the hernial sac.
In the stage of completed formation, the disease has all the classic signs:
- hernia gates - are represented by a hole where the organs bulge;
- bag of peritoneum;
- component of the hernial sac - intestinal loop, omentum, gastric wall, ligaments of internal organs.
Traumatic contents of the bag cause swelling. Herniated gates become narrow for self-reinforcement of the fallen omentum, there is a pinching with all the negative consequences.
Why is a hernia formed?
The widening of the white line in men is more often determined by the discrepancy between the development of muscle tissue and its aponeurosis. Hernias of the abdomen in women arise due to the weakening of the abdominal wall by frequent repeated pregnancies. The causes of pathology are conventionally divided according to the nature: on the factors of growth of intra-abdominal pressure, contributing to the weakening of the tendons of the abdominal muscles.
The first ones are:
- heavy physical work, lifting weights at weightlifters;
- hobby of teenagers, young men and girls bodybuilding, the desire to "pump up the press";
- abdominal enlargement due to abdominal fat for obesity, ascites due to accumulation of fluid caused by venous blood retention( portal hypertension in liver cirrhosis, circulatory failure);
- diseases that lead to prolonged constipation;
- suffered from complicated pregnancy and childbirth;
- diseases that cause prolonged severe coughing, vomiting;
- pathology of the genitourinary system, which contributes to the retention of urination( prostatitis, malignant and benign tumors of the prostate, bladder, urolithiasis);
- in children - a cry for different reasons.
The weakness of the aponeurosis and tendons can be caused by a sharp weight loss
To the weakness of the tendons lead postoperative scars in the zone of the white line. Such a hernia is called ventral. Many surgical procedures on the abdominal organs require a cut along the white line( laparotomy).This improves access to the necessary area, gives more opportunity to examine the entire abdominal cavity, to bandage the vessels and to exclude bleeding during the recovery period. However, there is an increased risk of postoperative hernia.
Traumatic abdominal injuries are most common among athletes, closed and open species arise from bruises, falls from height, in road accidents, gunshot and stab wounds. It is possible hereditary predisposition, caused by a violation of the synthesis of collagen connective tissue.
Most often, the reasons are mixed. But finding out the main factors is important for addressing the issue of treating a particular person, preventing relapse. More information about the reasons for the hernia of the white line in newborns can be found in this article.
In surgery, the hernia of the white abdominal line is distinguished by its location and the relation to the navel:
- from above is epigastric( supra-buccal);
- in the navel zone - paraumbilikalnaya;
- from the bottom.
Top localization is the most frequent. It is conditioned by the thinnest structure. Below the navel, the fusion of the aponeurosis is much stronger, thicker, with few cracks, so there are rarely hernias here.
It is possible to form several hernias with different stages in one person at once, they are located on a white line in the form of floors.
. Characteristic signs of
. The symptoms of a hernia of the white abdominal line can be noticed by the patient himself at the stage of the lipoma along the median line in the vertical position of the body. Some people are immediately sure that they have a tumor. But unlike the neoplasm it is painless, soft, "leaves" inward in the supine position. The skin above the area of the hernial sac does not change.
As the hernia forms it becomes clear that:
- formation has a clear localization along the median line, does not extend anywhere;
- to the touch elastic, painless;
- diameter varies from 1 to 12 cm;
- if the intestinal loop enters the hernial sac, then there is a rumbling;
- skin does not differ from other sites;
- is characterized by an increase in straining.
Other patients complain of moderate pain when exercising. Less often, the eructation, heartburn, nausea, a feeling of heaviness in the upper abdomen. Such cases require an additional examination to exclude diseases of the stomach, bile ducts, liver and other digestive organs.
On what grounds can you suspect an infringement?
Before infringement, usually something happens with a person, dramatically increasing intra-abdominal pressure( for example, lifting the heaviness, a strong cough) and muscle tension. The strangulated hernia of the white abdominal line is accompanied by the following symptoms:
- protrusion becomes painful, the pain increases with palpation, if you ask the patient to breathe belly;
- nausea and vomiting;
- bloating caused by delayed venting;
- deterioration( weakness, palpitation, pressure fluctuation).
The peculiarity of the hernia of the white line lies in a possible long painless period. But a person usually knows about his illness and does not try to protect himself, can provoke a situation for infringement. Therefore, surgeons insist on timely suturing the hernial gates, until serious plastic is needed to close a large area of the hole and fight the consequences of the infringement.
The most severe complication of a hernia is the necrosis of the wall of the organ entering the hernial sac, with the development of inflammation of the peritoneum( peritonitis)
What is needed to make the diagnosis?
Diagnosis begins with the clarification of complaints, prescription of the disease, examination of the doctor. It is necessary to establish the degree of divergence of the muscles, which organs enter the hernial sac. To do this, the following methods are used:
- ultrasound diagnosis - the study is carried out in the patient's standing position, allows identifying adhesions;
- X-rays of the stomach and intestines with a preliminary reception of a contrasting barium suspension;
- computer tomography in multispiral mode.
Patients should remember that the appearance of any, even painless, education on the body is a serious reason to consult a doctor. Hernia should be distinguished from the diastase( expansion) of the central joint of the rectus abdominis muscles. It is formed after birth in women in the second or third month. The reason for the special physiological looseness of the connective tissue, which provides normal contractions.
If early training starts, a diastasis appears to correct the abdomen. In men, this phenomenon can occur with heavy loads, obesity. In appearance, the diastase differs from the hernial sac by a roll-like strip along the white line, manifested with muscle tension. Symptoms do not differ from hernias.
Is treatment possible without surgery?
You can not listen to the advice of strangers and try to cure the hernia yourself with folk remedies. There is only one way of radical treatment - operational. Other therapeutic options temporarily relieve unpleasant symptoms( pain, increased gas formation), but do not stop the process that has begun, and even more stretch the hernial opening.
The advertised "exercises for getting rid of a hernia" lead to an increased growth of the hernial sac. They are good for prevention, but not at the stage of the already formed hernia. Conservative therapy is indicated for the period of preparation of the patient for planned surgical treatment, for patients with severe general diseases.
Complete restoration of tissues occurs only towards the end of the year after the birth of
The following measures apply to temporary measures:
- The recommendation is to wear a special bandage belt. It should be clearly understood that no bandage will replace the muscular skeleton. Its purpose is to reduce the risk of falling out and infringement of the hernial sac, damage to internal organs. Surgeons believe that prolonged use of the bandage reduces muscle tone, promotes the process of atrophy, reduces strength and elasticity.
- Drugs with spasmolytic and analgesic action. Indeed, good analgesics and antispasmodics are able to relieve pain. But in this case the patient is blocked all pain sensitivity. Symptoms of impairment can be erased, difficult to diagnose. This prevents physicians from evaluating the symptoms, making the right decision on treatment.
- Laxative medications that reduce gassing and constipation. If the intestine begins to work hard, then, on the one hand, it reduces intra-abdominal pressure and protrusion of the hernial sac, on the other - motor activity contributes to the entry of the intestinal wall into the formed formation. And, of course, medication does not matter to close the hernial gates.
The folk remedies recommended by healers are selected according to the principle of the action of the described medicines. Used decoctions of plants( chamomile, immortelle, Alexandrian leaf, wormwood, senna).They are not able to cause the infection of the hernial gates in the tissues of the tendons, but they facilitate the work of the intestine and relieve bloating.
If a patient has an asymptomatic preneoplushinic lipoma, he is informed of the initial stage of herniation and suggests observation. Treatment in such cases is not shown. Do you need a special diet?
The goal of the diet for patients with a hernia of the white abdominal line is to prevent swelling of the intestinal loops and stagnation of stool( coprostasis).Both processes make it possible to slow down the formation of the hernial sac. Recommendations for nutrition are used both before and after the operation until the integrity of the abdominal wall is completely restored.
Power is excluded from the supply:
- white cabbage, asparagus;
- animal fats and butter;
- all fried food;
- canned food;
- fresh baking and cooking products;
- fast food;
- fizzy drinks;
- spicy sauces and condiments;
- fresh apples.
- milk with good tolerability;
- low-fat meat and fish dishes;
- fresh fruit juices;
- carrots, beets, cucumbers;
- low-fat cottage cheese;
- boiled sausage;
- eggs are not more than two per week;
- broccoli cabbage;
- Citrus Fruit;
- apricots, dried apricots, prunes;
- dried white bread.
Methods of surgical treatment
General opinion of doctors - treatment of a hernia of the white abdominal line without surgery is impossible. After the examination, the patient is prepared for routine surgical intervention. The volume of the operation is related to the size of the hernial sac, the strength of the aponeurosis in the intervention area, the combination with the diastase of the rectus muscles, the concomitant pathology, the age of the patient.
At the best models of a bandage in front is sewn firming plate
Uncomplicated operation is performed under general anesthesia. Anesthesia is provided for the entire period of how long the operation lasts. The abdominal cavity is opened by incisions. Inspect the contents of the hernial sac. It is necessary to exclude damage caused by partial or complete infringement.
If there are no lesions, the omentum and the loop of the intestine fit inside the abdominal cavity. When detecting altered tissues, they are removed. Herniated gates are eradicated with the aid of suturing. At medium and large sizes of hernias, combined with significant diastasis( up to 5-7 cm), various methods of hernioplasty are used. So, the closure and strengthening of the defect in the abdominal wall is called.
Among the developed methods - reinforcement of the own tissues of aponeurosis with two rows of seams, the use of polypropylene mesh. With the usual contraction of the edges of the hole in patients, there are relapses with a frequency of 20-40% for different authors. The use of a reinforcing mesh allows to exclude tension of tissues, the number of relapses is much lower( about 7%).
A promising method is the combination of suturing the hernial sac through a small incision and installing a grid using modern laparoscopic techniques.
Features of the postoperative period
After the operation, the patient is observed, the infection of the wound is prevented( course of antibiotics, dressings with disinfectants).Men often have difficulty urinating. Walk permit for the second day. It is recommended to wear a bandage.
It is prescribed home for 8-10 days, immediately after the removal of stitches, but a full restoration of tissues and wounds will occur only after a few months. At home, it is recommended that the wound be treated with greenery. Compliance with diet. Showering is allowed after two weeks. The doctor can prescribe physiotherapy.
What should I look for during rehabilitation?
To ensure a sufficiently strong adhesion during the rehabilitation period, restrictions are set. They concern:
- the possibility of wearing weights - 2 months not more than 2 kg;
- sports and training - only from the third month at the doctor's permission;
- food - dishes only boiled, light, milk porridge, juices, low-fat soups, kefir, cottage cheese( the rest in accordance with the above dietary requirements).
In the photo neat postoperative suture for 2-3 days
How to prevent the development of a hernia?
To prevent the formation of a white line hernia in a healthy person who does not have congenital abnormalities, it is necessary:
- to control body weight;
- more to move, play sports, walk, swim;
- to follow rational nutrition;
- to exclude constipation;
- to quit smoking.
The appearance of a hernia on the abdomen in the area of the white line requires consultation with the surgeon and a serious attitude towards the recommended treatment.