- The main types of hernioplasty
- Types of used nets for
- operations When the operation and contraindications to it are performed
- Preparation of the patient before hernioplasty
- Rehabilitation period after operation
- Possible complications after operation
- Related videos
In surgery there are two stages during surgery onhernias: herniotomy( excision or repositioning of the hernial sac) and hernioplasty of the umbilical hernia( suturing hernial gates).To date, the methodology has approximately 300 methods of conducting operations.
The main types of hernioplasty
The nuances of the most common types of surgical intervention are considered.
Surgical method of eliminating hernial protrusions with the help of synthetic implants( mesh), which are sewn to the tissues in the abdomen. The most widely used for the removal of a hernia of the anterior abdominal wall or in the inguinal zone. This method is the most popular, since it has a low risk of injury, and relapses are extremely rare( in 1-5% of cases).
There are 2 methods of non-stretching hernioplasty: open and closed( endoscopic or laporoscopic).The open method consists in dissection of the skin and other subcutaneous fat layers through an open section of the operating field. This method is most suitable for recurrent hernias or those that are large.
The closed method or laparoscopic hernioplasty is carried out with the help of modern equipment( laparoscope), due to which small incisions of the skin are made. A special video device helps to monitor the progress of the operation. Due to this, the method has many advantages: barely noticeable scar after surgery, short postoperative period and rapid rehabilitation.
Surgical method based on stitching of hernial gates by tightening adjacent tissues. Currently, the operation is not performed so often and is practiced only with a small size of the hernial sac. A prerequisite for the operation is the young age of the patient: the skin and the muscle layer must be elastic and strong.
In the case of contraindications to tensile hernioplasty, the non-stretch method is used. Stretching plastic can be carried out in several ways: plastic according to Mayo, Sapezhko technique, Lexer technology, etc. The merit of these methods is accessibility and ease of execution, in addition, they do not take much time.
The physician will choose the optimal method of surgical intervention
Mixed( combined) hernioplasty
Hernia repair method, which may include several options for removal of the hernial sac.
Other methods of performing hernioplasty
To prevent recurrence of a hernia, it is necessary to choose the correct method for treating the hernial gates. Virtually all operations are performed in an unattended manner. Liechtenstein's method is the most common and popular, does not require special preparation of the patient, practically does not give complications and ritsedivov.
The method is performed under general or spinal anesthesia, open access or laparoscopically. During the operation, an incision is made not more than 5 cm parallel to the inguinal ligament. Then follows the fiber and tendon plate oblique abdominal muscles.
With the help of hernia tools, plunges deep into the abdominal cavity and superimposed a mesh that is first sewn to the periosteum of the lone articulation, and then to the inguinal ligament. After the aponeurosis and the edges of the skin are sutured.
Bassini hernioplasty is most commonly used for inguinal hernias of small size. A cut is made no more than 8 cm slightly above the inguinal ligament, not dissecting the peritoneum. The contents of the hernial sac are placed in the abdominal cavity, and part of the adjacent membranes is cut off. After the hernia is eliminated, a straight muscle of the abdomen is sewn to the ligament, a seed cord is placed on top of it and aponeurosis and other tissues are sutured.
Mei method is recommended for umbilical hernia and refers to tension methods. The skin during the operation is cut longitudinally, to the left of the navel. Then, a layer of skin with fiber is cut off from the hernial contents and the umbilical ring is cut.
After complete isolation of the umbilical hernia, the inner part of it is returned to the abdomen, and the sheath is excised by sewing the serous layer. First, the upper aponeurosis of the rectus muscle is sewn, then its lower edge. This sequence is necessary for the strength of the abdominal wall at the site of the former localization of the protrusion.
Laparoscopic hernioplasty is the most gentle and less traumatic operation of the
. During the laparoscopic operation, three small incisions are made through which the instruments are inserted into the abdominal cavity. The plastic version is considered individually, based on the size of the hernia, its location, anatomical features, etc.
Types of nets used for
operations What the result will be after the operation depends on the choice of the implant. A wide choice allows the specialist to select the necessary material, based on the size of the hernia, the condition of the tissues, the characteristics of the organism and even the price category.
There are 4 types of implants whose properties depend on the material composition:
- Non-absorbable ( made up of polyester, polypropylene or Teflon) are durable for a long period of time. The material does not change its properties under the influence of the body. Promotes active formation of connective tissue, does not cause allergies and does not become infected.
- Partially absorbable ( in the composition of polypropylene coated with a special substance, which helps to bind various tissues) does not contribute to the appearance of suppuration, does not cause allergies. After the mesh has been installed, it begins to dissolve, stimulating the regeneration process, however polypropylene remains and excludes the recurrence of the hernia.
- Reversible ( formulated with polyglactin 910 and polyglycolic acid) provides increased strength.3-4 months after the formulation, they completely resolve and completely tighten the damage with a connective tissue.
- The PHAS system ( multicomponent non-resorbable material) consists of 3 layers: the endoprosthesis covers the internal damage, the central prosthesis is localized in the hernial gates, the upper prosthesis is installed from the outside. When using such implants, a minimum number of seams is applied.
When the operation and contraindications to it are performed
All hernias that appear are recommended to be treated only surgically. Conservative method is only able to stop progression and remove unpleasant clinical manifestations. That is why the formed hernial protrusion is an occasion to turn to the surgeon, although many specialists are in no hurry with the operation.
Before performing laparoscopy or open surgery, a physician assesses the possible benefits and risks of complications of
This is particularly true for elderly people. Pre-planned operations are carried over, most often, well. But sometimes there are cases when living with a hernia is much safer than performing an operation, especially under general anesthesia.
There are several options in which the conduct of hernioplasty is simply necessary:
- strangulated hernia;
- recurrent hernia after a previous operation;
- protrusion at the site of postoperative sutures;
- high risk of rupture of the hernial sac, the skin over it is hyperemic and thinned;
- violation of intestinal permeability as a result of adhesive process in the abdominal cavity;
- is an obstruction of the intestinal lumen.
But there are a number of contraindications to the operation. For example, the elderly, who are over 70 years of age and have heart or lung disease, are not operated, even if the hernial sac has a huge size. An exception is only an infringement, in fact at this pathology there is an urgent help.
Pregnant women in almost 97% of cases, doctors will advise to postpone the operation until the time of delivery. Laparoscopy during this period is strictly prohibited. Sepsis, shock, acute infectious diseases, hypoxia of all tissues are absolute contraindications for any type of hernioplasty.
In addition, there are a number of other pathologies, conducting operations in which there is a high risk for the life of patients: cirrhosis of the liver, ascites, varicose veins of the esophagus, diabetes mellitus, acute renal failure, disruption of the blood clotting process, malignant neoplasms in the abdominal cavity.
Preparation of the patient before hernioplasty
Preparation before hernioplasty practically does not differ from any planned surgical intervention. The doctor is assigned the date of the operation and before that time, a number of examinations are necessary:
- clinical and biochemical analysis of blood and urine;
- cardiac electrocardiogram;
- studies for HIV, hepatitis, syphilis;
- blood test for the group and Rh factor;
- Coagulation assay;
- Ultrasound examination of abdominal organs.
Complex diagnostics is an obligatory stage of preparation of
. If the patient is taking any medications, then it is necessary to inform the treating doctor about it without fail. Some of these can affect clotting( eg, aspirin) and cause bleeding.
You should also tell a specialist about allergies to certain medications. On the eve of the operation, it is worth emptying the intestines with the help of special preparations or a cleansing enema in order to prevent possible postoperative complications.
Rehabilitation period after operation
Most often, after the operation, there are no complications. The patient is allowed to get out of bed in the first day. For the rehabilitation process to pass faster and easier, it is necessary to follow certain rules:
- during the first month it is necessary to wear a postoperative bandage when using reticular implants;
- shows exercises of curative gymnastics not earlier than 2 weeks after the operation in order to strengthen the abdominal muscles( while exercises for abdominal muscles are prohibited);
- after surgery, dressings are performed at least 2 times a day, where seams are removed on the 7th day( with the exception of bioresorbable sutures);
- it is possible to take painkillers for severe pain;
- if necessary, antibiotics, vitamin complexes, immunostimulating drugs are prescribed.
Possible complications after operation
Even such surgical intervention as hernioplasty can be accompanied by some complications. Most often, they are associated with the onset of wound infection. This is why, after any surgery, the course of antibiotic therapy
is mandatory. Some time ago, surgeons were sure that the cause of suppuration was mesh implants, but after conducting a series of studies, specialists did not find this fact of confirmation. Seroma - one of the types of postoperative complications, which is characterized by the accumulation of serous fluid in the area of operation.
Symptoms of seromy, if it appears, can be seen in a few days. Its main features are puffiness and soreness in the site of the incision, which are often confused with a recurrent hernia. It can be treated both medically and surgically.
The prohibition of physical activity at the time of recovery will prevent the development of a number of complications of
Hematoma - a limited accumulation of blood, which usually does not bring any discomfort. On average, hematomas pass independently 1-2 weeks after the onset. Very rarely they can fester or develop cicatricial deformity, which will limit the mobility of adjacent tissues.
Postoperative neuralgia manifests itself in the form of burning, tingling, lowering the sensitivity of certain parts of the body. Repeated laparoscopy does not give a 100% guarantee of getting rid of unpleasant symptoms.