Herniation of the white abdominal line (synonym: epigastric hernia) is called the penetration of the abdominal cavity organs (more often - intestinal loops) beyond the peritoneum, into the area of the subcutaneous tissue along the midline of the abdominal muscles.
Pathology arises because of the weakness of the tendon fusion of the left and right half of the abdominal muscles, which leads to the formation of hernial gates. This form of the disease is not very common, in contrast to the hernias of other localizations. However, even it can lead to the development of life-threatening complications.
During the disease through the holes and slits in the white line of the abdomen there is a gradual protrusion of the preperitoneal fat with the formation of so-called preperitoneal limes, as well as the formation of a hernial sac, in which a part of the abdominal organs is located. Painful attacks can be triggered by an increase in intra-abdominal pressure as a result of severe physical exertion.
Causes
The causes of the hernia of the white line of the abdomen can be expressed by the insufficiently developed connective tissue of the described area available from birth or acquired during life. In some cases, this becomes the cause of its thinning and subsequent expansion.
Attenuation of connective tissueoccurs under the action of:
- hereditary predisposition;
- excess weight;
- abdominal injuries;
- scars that appeared after the operation;
- rapid rise in intra-abdominal pressure.
Intra-abdominal pressurecan increase due to:
- large physical exertion;
- constipation;
- pregnancy;
- ascites;
- prolonged incessant cough;
- inconvenient urination;
- development of prostate adenoma;
- prolonged crying in infants.
In general, men aged 20-30 and 40-50-year-old women are exposed to the disease. Depending on the localization of the umbilical cavity, the following types of hernias are distinguished:
- supragupoint(located above the navel) - approximately 80% of cases;
- perianopic(located near the umbilical cavity) - occur in 18% of cases;
- podvugal(localized below the umbilical cavity) - come across very rarely, about 1-2%.
The white line of the abdomen should have a width of 1 to 3 cm, whereas when it changes this figure can be equal to 10 cm, this will depend on the degree of diastase.
Symptoms of a herniated white belly line
The hernia of the white abdominal line symptoms, which are mostly of a latent nature, are most often manifested by the appearance of convexity, accompanied by discomfort when you press it.
The main symptomatologyconsists in the following manifestations:
- painful bulging in the midline (usually in the upper part);
- nausea, which periodically turns into vomiting;
- stretching the muscles along the midline;
- pain during sharp movements, bends, slopes;
- pain after eating;
- dyspeptic disorders (eructation, hiccough, heartburn).
When the condition worsenssymptoms intensify:
- When defecating, blood can be released;
- pains increase and become intolerable;
- constantly tormenting vomiting;
- if the hernia can be corrected at an early stage of the disease, then with complicated forms it is impossible.
The strangulated hernia of the white abdominal line occurs when the hernia contents are squeezed in the area of the hernia gates. This condition is accompanied by rapidly growing pains in the abdomen, nausea, vomiting, stool retention, blood in the stool and the inability to direct protrusion.
Hernia belly: photos before and after
How does the hernia look before and after the operation, we propose to view detailed photos.
Diagnostics
In order to properly diagnose a hernia of the white line of the abdomen and subsequently to prescribe treatment, a number of diagnostic measures need to be carried out. First of all, this is a surgeon's examination,after consultation can be appointed:
- radiography of the stomach and duodenum;
- gastroscopy (EGDS, esophagogastroduodenoscopy);
- herniography - an x-ray method, consisting in insertion into the abdominal cavity of a special contrast substance for the purpose of examining the hernia;
- Ultrasound of hernial protrusion;
- computed tomography (CT) scan of abdominal organs.
For accurate diagnosis of a hernia, the radiographic method is used. If the diagnosis is confirmed, a herniography can be performed - an additional radiopaque examination of the hernia.
Treatment of a hernia of the white line of the abdomen
Elimination of pathology in adults mainly occurs with the use of surgical intervention - this is the best option for treating a hernia of the white line of the abdomen. In modern medicine, surgery offers the following options for the removal of the disease:
- Plastic with special synthetic prosthesis- a special mesh made of hypoallergenic materials, which is installed to close the defect of the aponeurosis. This occurs after excision of diastase of the rectus muscles of the white abdominal line. In this case, the probability of recurrence of the disease is very small. In the future, the networks can either completely dissolve, or partially, depending on the material used. Over time, the mesh is fully implanted into the abdominal wall and fouled with tissues. Often the question of implanting synthetic prostheses is solved already during the operation, when it becomes possible to assess the condition of the patient's own abdominal muscles.
- Plastic surgery using local tissues of the patient. In this operation, the removal of the muscle diastase is combined with the suturing of the defect. According to statistics, relapses can be 40% of all cases.
- In case of infringement of a herniathe white line of the abdomen operation is carried out in an emergency and may involve a significant amount of resection.
Access to the hernia is carried out in three methods, each of which has positive and negative sides, and depends on both indications and contraindications. The choice of technique for each patient is individual.
- Laparoscopic accessspend with the use of special tools and video equipment through three small punctures on the abdomen.
- Preperitoneal access, as well as laparoscopic, are performed through small punctures with the help of special instruments and video equipment without penetration into the abdominal cavity due to peeling of the peritoneum with a special balloon and without filling it with gas.
- Open accessare performed with a cut length that corresponds to the vertical dimension of the protrusion.
It is also worth noting that when a hernia of the white abdominal line occurs, treatment without surgery is impossible. The bandage, to which many pin hopes, only to some extent slows the expansion of the abdominal wall defect. Wearing it prescribed only to those patients who have serious contraindications to the operation:
- severe illnesses - cardiovascular insufficiency, oncological diseases, cirrhosis of the liver in the stage of decompensation, etc .;
- the presence of an infection in the body;
- pregnancy at any time;
- unresponsiveness of a hernia.
Taking painkillers in the form of tablets, which is a way to stop pain, can only improve the condition for a short while, but it will not save the problem. Therefore, if there are no contraindications, one of the above operations for the restoration of the white line is performed.
Cost of operation
The cost of surgery to remove a hernia of the white line of the abdomen depends on the size of the hernia and its features, the presence or absence of complications, methods of diagnosis and surgical intervention, selected materials, qualifications of specialists and a number of other factors.
In Moscow, for example, hernia repair of the white abdominal line in a private cliniccosts from 25 000 rubles.
Diet
A special diet will not eliminate the hernial protrusion, but to some extent reduce the rate of progression of the disease, and reduce the chances of developing the infringement. Shouldto limit or exclude from the diet such products:
- asparagus;
- beans;
- peas;
- nuts;
- chocolate;
- tomatoes;
- butter;
- fried and spicy dishes;
- harmful food: chips, canned food, semi-finished products;
- products that cause you bloating.
You need small portions, but often. The last meal should be planned at least 3 hours before bedtime.
Forecast
With the timely and rational treatment of a hernia of the belly, the prognosis is favorable. The probability of recurrence of a hernia is determined by the method of hernioplasty and the way of life that the patient adheres to after the operation.
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