Gernioplasty 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 non-tensioning, this is an invasive way to eliminate a hernia using mesh implants. One of the commonly used methods of non-tensile herniation is plastic according to Liechtenstein. The operation is performed with inguinal hernias and does not require special preparation of the patient.
Inguinal hernia: definition, description
Bulging 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 more susceptible to the disease than women.
A hernia consists of elements, each of which has its own name.
- A hernial sac is a site closely connected with the wall of the peritoneum, which extends through the weak points of the serous membrane covering the walls of the abdominal cavity.
- Hernial gate - defective places of the abdominal wall through which the hernial sac with contents is protruded.
- The hernial contents are usually the mobile organs of the abdominal cavity.
- The hernia shell. For a direct inguinal hernia, the transverse fascia, for oblique, the membrane of the spermatic cord or uterine ligament.
Bulges are classified according to the 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 abdominal wall.
Surgical methods for the treatment of inguinal hernia
The main and cardinal method of hernia treatment is surgery. The use of a bandage is a dubious measure and applies only if the operation is not possible.
Preferably, the operation is extremely simple and affordable, less traumatic and reliable. Manipulation involves surgical repair and repair of damage in the abdominal wall. Restoring the integrity of the abdominal wall and closing the hernial injury can be done using aponeurosis (own tissues) or a non-biological graft.
The most effective is the use of a non-tensioned invasive method using a mesh prosthesis. The hernial gates are strengthened by a polypropylene mesh inside, which is the skeleton and an obstacle to repeated exodus of organs. In surgery, there are several ways to perform an operation: according to Shuldeys, Bassini, according to Trabucco. Plastic surgery according to Liechtenstein 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.
Liechtenstein method: the essence of the operation
Tension-free hernioplasty is preferable, since the risk of repeated hernia is minimal. Hernioplasty according to Liechtenstein is used not only for inguinal, but also for hernias of the abdominal wall (umbilical) and protrusion of abdominal organs 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 fecal stones, bile stones, estimates the likelihood of inflammation. If there are no complications, it cleans back into the abdominal cavity. The final stage of the operation, it is also the main one - plastic hernia gates using a composite mesh. The probability of relapse depends on how professionally performed plastic is. Unlike other methods, this method does not imply dissection on the muscles. The implant is sutured to the aponeurosis located under the muscles.
Indications and contraindications
Lichtenstein hernia repair is prescribed to everyone who has a pathological protrusion of the peritoneal organs in the region of 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 selected hernioplasty method.
- High probability of necrosis when squeezing the hernial sac (infringement of the hernia).
- Intolerance to previously installed implants.
- Danger of rupture of the hernial sac.
The use of plastics according to Liechtenstein is not possible in the presence of certain indications.
- Individual intolerance to synthetic implants.
- Recently undergone surgery on the abdominal organs or organs of the reproductive system.
- Blood diseases: coagulation disorder, leukemia.
- Cardiovascular diseases.
- Chronic respiratory diseases.
- Pathologies in the acute phase.
- The presence of malignant tumors in the abdominal cavity.
- Very old age.
- Inoperable condition.
- Refusal of the patient from the operation.
How is hernia surgery performed according to Liechtenstein.
Gernioplasty can be performed both in the traditional way and with the help of a laparoscope.
Children who have reached the age of seven and have 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 stomach in the navel area. Trocars and a laparoscope with a camera are introduced into them. The camera reflects the progress of the operation on the monitor, and through the tubes (trocars) a tool is introduced into the cavity, with the help of which all stages are performed, as with traditional intervention. Such an operation has several advantages. Small incisions reduce blood loss during the process and provide quick recovery, which is especially important in childhood.
Stages of hernioplasty
The operation is performed under spinal anesthesia or general anesthesia. A 5 cm incision is made in the pubic tubercle parallel to the inguinal ligament.
The surgeon gradually cuts the parenteral fiber, connective tissue membrane, 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 isolated, examined and returned to the abdominal cavity.
Measure the grid, in the lower half of which a longitudinal section is made. Sew the implant with a continuous suture from the pubic tubercle to the inner ring. To fix the mesh to the internal oblique muscle impose separate seams. Manipulation is done with special care, trying not to touch the iliac-axillary and iliac-inguinal nerves.
The extreme tail of the mesh formed as a result of the cut is laid and fixed with one interrupted suture. The operation ends with suturing of the wide tendon plate of the external oblique muscle above the implant with saphenous sutures.
Rehabilitation
For all inguinal hernias, the ICD 10 code is the same, and postoperative measures are similar for all surgical interventions after protrusion treatment.
After hernioplasty, a short medical care is carried out. It includes active drainage, the introduction of painkillers and assessment of the state of the operated organ. If there are no complications, the patient is discharged after a few days. After an operation on an inguinal hernia, rehabilitation passes quickly and without complications, provided that medical recommendations are followed. Usually they are as follows:
- limitation, or better, the exclusion of physical activity for 2 weeks;
- it is highly advisable to wear a bandage for 2 months;
- dieting.
Complications
These include:
- decreased sensitivity 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);
- discrepancy of sutures with subsequent relapse of hernia;
- inaccurate or incorrect fixation of the synthetic mesh with its subsequent migration;
- internal hematomas.
Basically, the operation is normal, mortality is less than 0.1% of all cases.
Advantages and disadvantages of the method
Lichtenstein hernia repair has several advantages over other operations.
- The probability of relapse is almost zero.
- Complications arise only in 5% of patients and in most cases are associated with non-compliance with recommendations in the postoperative period.
- Composite nets are made from high-quality materials, individual rejection of their body.
- Short rehabilitation period, especially if the operation was performed using a laparoscope. The ability to return to normal life after 7-8 weeks.
- The operation can be performed from the age of seven.
The Liechtenstein method, like any other, has its drawbacks:
- scarring near the spermatic cord can lead to impaired circulation in the tissues of the testis 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 was observed in 2% of patients;
- there is a high probability of damage to sensory nerves located near the inguinal ligament, which can lead to disruption of innervation.
When diagnosed with an "inguinal hernia", it is important not to delay surgical treatment. High-quality plastic surgery according to Liechtenstein will help to avoid complications and relapses and again return to the usual rhythm of life.