The only way to get rid of a hernia is through surgery. Mayo umbilical hernia repair is the most common treatment option for the disease, quite simple to perform and safe for the patient. The method is most effective for small hernial orifices, not exceeding 3 cm.
The development of pathology is evidenced by the appearance of a protrusion in the navel, decreasing in size or completely disappearing at the moment when the person is in the supine position. In addition, the disease is manifested by abdominal pain that occurs during physical exertion or coughing, nausea, and expansion of the umbilical ring.
Indications for the operation
Surgical intervention, including Mayo plastic surgery for umbilical hernia, is indicated in the presence of protrusion as the main symptom of the disease. In addition, hernioplasty is simply necessary for a strangulated hernia, impaired intestinal patency, blockage of the intestinal lumen, as well as in case of recurrence of the disease after a previous operation.
The essence of the approach
Mayo surgery is most often performed for small or medium-sized hernial formations. In this situation, local anesthesia is used.
If the protrusion is large, then epidural anesthesia is used for pain relief. This is a method of regional anesthesia, which involves the introduction of drugs into the epidural space of the spine using a catheter. As a result, the patient ceases to feel pain. These types of anesthesia have fewer side effects than general anesthesia.
The technique refers to tension-free hernioplasty. During its implementation, the patient's own tissues are used. To strengthen the anterior wall of the peritoneum and prevent recurrence, a double tissue structure is created.
Disadvantages and advantages of the method
Like other methods of treatment, this technique has positive and negative sides. The advantages include ease of implementation and safety for the patient, as well as the ability to perform the operation under local anesthesia. Based on this, Mayo plastic surgery can be recommended for pregnant women when it is not possible to wait for childbirth.
When carrying out hernia, most often the navel remains intact. But in some cases it has to be removed. This is a forced step. It is resorted to in case of pronounced changes in the skin in the navel area in a patient with a large hernia, as well as in the case of a close adhesion of the hernial sac with the navel and thinned skin.
If the navel is not excised together with thinned skin, then a cavity is formed in this place. Over time, serous fluid will begin to accumulate in it, into which pathogenic microbes will easily enter, causing infection and inflammation. And deprived of the necessary nutrition, the skin will undergo necrosis.
Restrictions in the postoperative period
Recovery after surgery takes place in stages. Strict adherence to all doctor's recommendations will speed up this process.
In the first days after the intervention, the patient is prescribed bed rest. In order not to cause complications, it is necessary to lie only on your back. Any physical activity should be excluded to prevent divergence of the seams. After 2-3 days, the patient can roll over in bed and rise briefly.
To reduce the load on the sutures and accelerate the healing process of the postoperative wound, the patient is recommended to wear a medical fixing bandage.
You can eat the next day. It is necessary to adhere to fractional nutrition, divided into 4-5 receptions. It is necessary to exclude from the diet foods containing a large amount of simple carbohydrates that can cause fermentation. This can lead to increased pressure on the abdominal cavity. It is better to give preference to light low-fat dishes: cereals, stewed vegetables. You must follow the diet for at least 2 weeks.
For pain, pain medication may be prescribed. If there is a risk of developing inflammation, then the attending physician prescribes anti-inflammatory drugs.
Disease prevention
To prevent the formation of an umbilical hernia, it is necessary to regularly strengthen the abdominal muscles. Exercise can be done at the gym or at home.
During heavy physical labor or heavy lifting, experts recommend using a special bandage or belt.
This technique will reduce the load on the abdomen and minimize the risk of pinching the internal organs. Often wearing a bandage is recommended for older people. This is due to the fact that with age, the muscular frame weakens, and even a slight load can provoke the formation of a hernia. In addition, wearing a bandage is recommended for pregnant women, especially in the last trimester.
Indications: umbilical hernias.
Tooling:
Model of umbilical hernia;
Scalpel, scissors, grooved Kocher probe, blunt and sharp hooks, anatomical tweezers, surgical tweezers, hemostatic forceps, Hegar needle holder, round curved needle, silk No. 4-6, catgut No. 1-2, silk No. 1-2 (2/0 ).
With small umbilical hernias in children, plastic can be used by Lexer:
Technique:
I. Online access:
An arcuate incision is made along the lower semicircle of the hernial swelling (Fig. 13.1)
II. Operational reception.
The neck of the hernial sac is isolated from fiber, without disturbing the fusion of the bottom of the hernial sac with the skin (Fig. 12a);
Open the neck of the hernial sac
Set (resect, remove) hernial contents;
The neck of the hernial sac is sutured with catgut and bandaged (Fig. 12b);
Cross the neck of the hernial sac distal to the ligature (Fig. 12c);
After crossing the neck of the hernial sac, together with the ligature, is immersed into the abdominal cavity.
The rest of the hernial sac is excised, except for the bottom, fused with the skin.
2. Hernioplasty:
A silk purse-string suture is applied to the edges of the umbilical ring and tightened;
Over the purse-string suture, 3-4 interrupted silk sutures are applied to the white line (Fig. 12d);
The rest of the bottom of the hernial sac is sutured with silk thread to the white line.
Catgut sutures are applied to the subcutaneous fatty tissue and silk sutures to the skin.
Rice. 12. Umbilical hernia repair according to Lexer:
a - isolation of the neck and body of the hernial sac;
b - suturing the neck of the hernial sac;
c - cutting off the body and the bottom of the hernial sac from the neck;
d - the imposition of interrupted sutures on the white line of the abdomen.
Plastic according to Sapezhko.
Technique:
I. Online access.
Separate skin flaps from the aponeurosis to the right and to the left until the hernial ring appears.
II. Operational reception.
1. Treatment of the hernial sac:
The hernial sac is isolated from the subcutaneous fatty tissue, which is exfoliated from the aponeurosis to the sides by 10-15 cm;
A grooved Kocher probe is inserted between the neck of the hernial sac and the umbilical ring, and the ring is cut up and down along the white line of the abdomen along it.
The hernial sac is opened, the hernial contents are inspected, its contents are set (or removed if necrosis is present), the neck of the hernial sac is sutured, and its distal end is cut off.
2. Hernioplasty:
Placement of the first row of sutures. On Kocher's clamps, the left edge of the aponeurosis is pulled back and bent so as to turn its inner surface as much as possible. The right edge of the aponeurosis is pulled up to it and sutured with separate interrupted or U-shaped silk sutures, trying to bring it as far as possible (Fig. 13).
Placement of the second row of sutures. The free left edge of the aponeurosis is placed over the right one and sutured with silk interrupted sutures. This achieves a muscular-aponeurotic doubling of the abdominal wall (Fig. 13).
III. Suturing the surgical wound:
Rice. 13. Plastic according to Sapezhko.
a - front view: 1 - the first row of seams; 2 - the second row of seams.
b - horizontal section of the abdominal wall:
: 1 - the first row of seams; 2 - the second row of seams.
Plastic according to Napalkov.
Technique:
I. Online access.
II. Operational reception.
Treatment of the hernial sac.
Hernioplasty.
For plasty of the hernia gate, 3 rows of interrupted sutures are applied:
1 row - seams on the white line of the abdomen (Fig. 14);
Before applying the 2nd and 3rd rows of sutures, the anterior walls of the sheaths of the rectus abdominis muscles are dissected in two parallel incisions near their medial edge;
Stitches are placed first on the inner (2nd row), and then on the outer (3rd row) edges of these incisions.
III. Suturing the surgical wound:
Rice. 14. Plastic according to Napalkov:
1 - seams on the white line of the abdomen;
2 - seams on the inner edges of the anterior wall of the sheaths of the rectus abdominis muscles;
3 - seams on the outer edges of the anterior wall of the sheaths of the rectus abdominis muscles.
Mayo plastic.
Technique:
I. Online access.
An oval incision is made in the skin and subcutaneous fat. The skin with the umbilicus is excised. The anterior walls of the sheaths of the rectus abdominis muscles are freed from the pancreas at a distance of 5-6 cm from the hernial orifice. The hernial gate is expanded in the transverse direction along the grooved probe to the inner edges of the rectus muscles.
II. Operational reception:
Treatment of the hernial sac.
2. Hernioplasty:
The parietal sheet of the peritoneum is sutured with a continuous catgut suture;
The upper leaf of the aponeurosis is separated from the underlying muscles;
U-shaped silk seams hem the lower flap under the upper one;
The upper leaf of the aponeurosis is sutured with interrupted silk sutures to the lower one with the formation of a duplication (Fig. 15).
Rice. 15. Mayo plastic surgery:
1 - continuous suture on the parietal sheet of the peritoneum;
2 - U-shaped seams;
3 - interrupted sutures.
Plastic according to Menge.
Technique:
I. Online access:
Cross section at the base of the hernial sac. The hernial orifice is dissected to the edges of the rectus muscles.
II. Operational reception:
Treatment of the hernial sac.
2. Hernioplasty:
The imposition of the first (transverse) row of sutures on the back wall of the vagina of the rectus abdominis muscle, the transverse fascia and the peritoneum;
The second (longitudinal) row of sutures - on the medial edges of the rectus muscles;
Third (transverse row) - on the front wall of the vagina of the rectus abdominis muscle.
III. Suturing the surgical wound.
The structure of the inguinal canal
Located within the groin area inguinal triangle, limited:
Below - inguinal ligament Pupartova ligament);
Medially - the outer edge of the rectus abdominis muscle;
From above - a perpendicular lowered from a point between the outer and middle third of the inguinal ligament to the rectus abdominis muscle.
Within the inguinal triangle is located inguinal canal having two holes and four walls.
outer hole- superficial inguinal ring (Fig. 16) - limited:
Laterally and medially - lateral and medial legs formed by divergent fibers of the aponeurosis of the external oblique muscle of the abdomen;
Above - interpeduncular fibers;
Below - a bent ligament.
The dimensions of the surface ring in men are 1.0-4.5 x 0.6-3.0 cm, in women - 0.5-1.8 x 0.5-1.8 cm.
inner hole- deep inguinal ring is located 1 - 1.5 cm above the middle of the inguinal ligament and is an opening in the transverse fascia through which the spermatic cord (round ligament of the uterus) passes. It corresponds to the lateral inguinal fossa, limited (Fig. 16):
Outside - the inguinal ligament, enveloping the edge of the deep inguinal ring and representing a bundle of fibrous fibers in the thickness of the intra-abdominal fascia;
From the inside - the outer umbilical fold, which is formed when the lower epigastric vessels pass under the peritoneum.
Rice. 16. Inguinal region.
1 - pyramidal muscle; 2 - rectus muscle; 3 - bladder, 4 - middle umbilical fold; 5 - lower epigastric artery and vein; 6.8 - vas deferens; 7 - external iliac artery and vein; 9 - testicular artery and vein; 10 - parietal sheet of the peritoneum; 11 - preperitoneal fatty tissue; 12 - transverse fascia; 13 - ilioinguinal nerve; 14.19 - spermatic cord; 15 - femoral artery and vein; 16 - muscle that raises the testicle; 17.20 - inguinal ligament; 18 - interpeduncular fibers; 21 - medial leg; 22 - lateral leg.
The walls of the inguinal canal:
Anterior - aponeurosis of the external oblique muscle of the abdomen;
Posterior - transverse fascia;
Inferior - inguinal ligament;
Upper - overhanging edges of the internal oblique and transverse abdominal muscles.
In the inguinal canal pass:
In men, the spermatic cord, in women, the round ligament;
The ilioinguinal nerve, passing along the anterior-inner surface of the spermatic cord or round ligament of the uterus;
The genital branch of the genitofemoral nerve pierces the transverse fascia medially to the deep inguinal ring and lies on the posterior surface of the spermatic cord or round ligament of the uterus.
The space between the lower and upper walls of the inguinal canal is called inguinal interval(spatium inguinale), whose height varies from 1 to 5 cm.
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Acquired umbilical hernias account for 3-5% of all external abdominal hernias. Especially often they occur in rapidly stout women over the age of 30 years. The reason for their formation is defects in the anatomical structure of the umbilical ring, increased intra-abdominal pressure and stretching of the anterior abdominal wall (pregnancy, obesity, flatulence, abdominal tumors). After the widespread introduction of laparoscopic operations into clinical practice, a significant group of patients appeared in whom hernias develop in the umbilicus, a typical site for introducing a trocar. Umbilical hernias in adults usually increase rapidly in size, which is associated with a progressive weakening of the abdominal wall as a whole.
The size of an umbilical hernia in diameter can be very different: from 1-2 cm to 20-30 cm and even more. This hernia is characterized by a significant predominance of the size of the hernial protrusion over the diameter of the hernial orifice. Even with very large hernias, the hernia orifices are relatively small and rarely reach a diameter of more than 10 cm. Narrow hernial orifices, on the one hand, facilitate plastic surgery, and on the other hand, cause complications such as chronic intestinal obstruction and infringement of internal organs. Hernial gates usually have a rounded shape. With large hernias and a sagging abdomen, they are located in the upper section of the hernial protrusion. The aponeurosis and muscles in the area of the hernial orifice are often thinned, atrophic and defibrated. Umbilical hernias are quite often combined with diastasis of the rectus abdominis muscles and epigastric hernias. This must be kept in mind when choosing a method of operation.
The hernial sac is usually thin, firmly fused with stretched and thinned skin and the edges of the hernial orifice. With long-term and repeatedly recurring hernias, the sac wall is represented by a fairly dense scar tissue with multiple chambers and partitions. The hernial contents of umbilical hernias are most often the omentum, loops of the small and transverse colon.
Operations for umbilical hernia
The most appropriate method of anesthesia for surgical treatment of small umbilical hernias is local anesthesia, and for large hernias, endotracheal anesthesia or epidural anesthesia.During local anesthesia, a transverse oval is noted on the patient's abdomen, in the center of which there is an umbilical hernia. The dimensions of the oval are determined not only by the size of the hernia, but also by the need to excise excess skin and subcutaneous fat from the abdominal integument in order to simultaneously unload the abdominal wall and remove its sagging. Along the line of the proposed incision with novocaine, a tight infiltration is carried out throughout the entire thickness to the aponeurosis. After dissection of the skin and subcutaneous adipose tissue, the anesthetic solution is injected under the aponeurosis of the white line and under the anterior wall of the sheath of the rectus abdominis muscles. Then, several injections of novocaine solution are additionally made into the tissue surrounding the neck of the hernial sac, so that it penetrates into the preperitoneal tissue.
With small hernia gates, methods with doubling the aponeurosis are usually used to close them in adults. Of these, we note first of all the method of the Mayo brothers (1901), as well as the method of K.S. Sapezhko (1900). With a significant size of the hernia ring, synthetic mesh prostheses are used. Other methods of plastic surgery are not used in clinical practice due to their unreliability or excessive complexity.
Mayo method
Two bordering incisions in the transverse direction produce excision of the hernial formation along with excess fatty tissue. The aponeurosis is separated from the subcutaneous tissue at a distance of 5-6 cm from the hernial orifice and dissected in the transverse direction to the inner edges of the rectus abdominis muscles. This incision is necessary to facilitate the immersion of the hernial contents into the abdominal cavity and subsequently create a duplication of the aponeurosis. In this case, the parietal peritoneum lying behind should not be damaged. Then the neck of the hernial sac is isolated and opened, which sometimes encounters difficulties due to the omentum or intestine soldered to this part.In such cases, they look for a place free from adhesions in the hernial sac, open it and dissect it in the direction of the free part. The edges of the crossed bag are grasped with clamps so that they do not slip into the depth of the wound. Now the entire removed part is fixed only for the omentum or intestinal loop attached to the wall of the hernial sac. If this is only the omentum, then it is resected in parts between the clamps. Often, the inner surface of the hernial sac is fused with the bowel loop. In this case, the adhesions are separated in a sharp way, trying not to damage the serous cover of the intestine. Small bleeding arising from small vessels of the intestinal wall is stopped by ligation. After the intestine or omentum is released from the wall of the hernial sac, they are immersed in the abdominal cavity.
The edges of the parietal peritoneum are separated from the edges of the aponeurosis by 4 cm up and 1 cm down and sutured with a continuous suture along the edge of the hernial orifice. Then U-shaped sutures are applied in such a way that the lower flap is located under the upper one, and the width of the aponeurosis duplication is 2-3 cm. With the simultaneous tightening of all U-shaped sutures, the upper part of the aponeurosis is pulled over the lower one. In this position, the seams are tied. With the second row of interrupted sutures, the upper flap is sutured to the lower one in the form of a duplication (Fig. 68-12).
Rice. 68-12. Hernioplasty for umbilical hernia according to Mayo.
The wound is sutured in layers over the drainage brought to its bed. The drainage is brought out through the counter-opening, connected to the suction and left for one day.
It is considered cosmetically unsightly to remove the navel. It has to be forcedly excised only with pronounced skin changes in the umbilical region in patients with large hernias. In this case, the hernial sac is closely soldered to the navel and severely thinned skin. If you do not remove the navel and the thinned part of the skin, a cavity forms under them, where an easily infected serous fluid accumulates, and the skin, deprived of nutrition, becomes necrotic. With small umbilical hernias, the navel is preserved. To do this, instead of a fringing incision, an arcuate dissection of the tissues in the lower part of the navel is used. Such an incision provides sufficient access to the umbilical ring zone and becomes hardly noticeable in the long-term after the operation. After treatment of the hernial sac and plasty of the hernial orifice, the navel is sutured from the inside to the aponeurosis with one suture.
When the hernia gate is repaired according to the Mayo technique, the duplication of the aponeurosis of the white line is located in the transverse direction. It is proved that the seams imposed in the transverse direction experience less tension than the longitudinal ones. The longitudinal suture during healing is under the constant action of tensile forces caused by contraction of the oblique and transverse abdominal muscles. Due to its greater reliability, the Mayo technique has become the most popular among surgeons.
Sapezhko's method
Two longitudinal incisions bordering the hernia are made to excise the flabby altered skin along with the navel. The navel can be saved only with small hernias. Isolation, processing and removal of the hernial sac is performed, as in the previous method. The aponeurosis is dissected up and down to places where the white line of the abdomen narrows and looks little changed. The upper part of the incision also captures the gate of the epigastric hernia, if any. For tight contact of the fascia of the rectus abdominis muscles and the formation of a dense scar, the parietal peritoneum is separated with scissors 2-3 cm from the posterior surface of the vagina of one of the rectus abdominis muscles. The peritoneum is sutured edge to edge with a continuous suture.Then one edge of the dissected aponeurosis is sutured with a number of interrupted sutures to the posterior wall of the sheath of the rectus abdominis muscle of the opposite side, where the peritoneum was previously separated. The other, remaining free, edge of the aponeurosis is placed on the anterior wall of the sheath of the rectus abdominis muscle of the opposite side and fixed with interrupted sutures. Thus, a longitudinally located duplication of tissues 2-3 cm wide is formed. The disadvantages of this technique are the significant tension of the sutures and tissues in the region of the plasty zone, the low strength of the scar, and the increase in intra-abdominal pressure.
This method of plasty is used mainly when an umbilical hernia is combined with epigastric hernias or diastasis of the rectus abdominis muscles. With large sizes of the umbilical ring, it is not always possible to close it with your own tissues without significant tension on the sutures. In such cases, tension-free plasty of the hernial orifice using a mesh synthetic explant is used. In this case, the technique of the operation is similar to that for postoperative hernias.
B.C. Saveliev, N.A. Kuznetsov, S.V. Kharitonov
Treatment of umbilical hernia in adult patients is possible only by surgical intervention. Physicians are familiar with many methods of performing operations, but Mayo's hernia repair of an umbilical hernia is most often used. This technique is easy to perform and safe for the patient.
An umbilical hernia is a protrusion of internal organs beyond the anterior wall of the peritoneum through the umbilical ring.
Symptoms of the disease
An umbilical hernia is a protrusion of internal organs beyond the anterior wall of the peritoneum through the umbilical ring. It decreases in volume or completely disappears when a person is in a prone position.
The development of this pathology is characterized by the appearance of pain in the abdomen when coughing or physical exertion, nausea and expansion of the umbilical ring.
The severity of the symptoms of the disease depends on the size of the hernia, the presence of adhesions in the abdominal cavity or infringement of the hernial sac, as well as on the general condition of the patient.
Indications for the operation
Mayo plastic surgery for umbilical hernia should be carried out without fail in the presence of a hernial protrusion, regardless of whether the disease proceeds painlessly or causes pain and discomfort.
The appearance of a sharp pain indicates the infringement of the contents of the hernia, which leads to necrosis and peritonitis. This condition requires immediate medical attention.
The essence of the approach
Mayo plasty belongs to the category of tension-free operations, for which the patient's own tissues are needed. The main task of the procedure is to eliminate the hernia and its remnants with further strengthening of the anterior wall of the peritoneum to prevent recurrence. This is important because abdominal hernias tend to recur.
If the hernial formation is small or medium in size, the operation is performed under local anesthesia. If the formation has a large volume, epidural anesthesia is used, which involves the introduction of drugs into the epidural space of the spine through a catheter. The patient remains conscious in both cases. Compared to general anesthesia, these methods of pain relief bring fewer side effects.
Disadvantages and advantages of the method
Like any other method of treatment, this method has advantages and disadvantages. They are taken into account in a situation where the surgeon has an alternative method of hernia repair. The choice of the method of surgical intervention is carried out individually, based on the patient's condition and the severity of the pathology.
Among the main advantages of the hernioplasty method, first of all, safety for the patient and the ability to perform the operation under local anesthesia are noted. In addition, the simplicity of the operation technique is taken into account. Based on this, it can be prescribed even to pregnant women in a situation where it is not possible to wait for childbirth.
Among the shortcomings of the method, the presence of a prolonged pain syndrome was noted, as well as the likelihood of relapse after removal of a large hernia. Pain in the navel can persist for a long time. In addition, postoperative rehabilitation can take up to 4 months. These circumstances should be taken into account when choosing a treatment method.
The Mayo technique is most suitable for removing small hernias. This minimizes the risk of relapse.
Preparation for surgery
Before the plastic surgery of the umbilical hernia according to Mayo, the patient is assigned a number of studies. Their results will allow you to more carefully prepare for the operation and prevent the development of complications.
Before the operation is assigned:
- Analysis of urine.
- Clinical and biochemical blood tests.
- Blood clotting tests.
- Electrocardiogram.
- Tests to detect infectious diseases that are transmitted through the blood: HIV infection, hepatitis, syphilis.
- Allergy tests.
Operation progress
At the first stage of the operation, access to the hernial protrusion is provided. To do this, the surgeon makes 2 transverse incisions at the site of the greatest accumulation of adipose tissue. After that, using a transverse incision, the aponeurosis is separated from the subcutaneous tissue. Then the hernial ring is dissected and the doctor gets access to the “body” of the formation.
The walls of the hernial sac are dissected. This allows you to examine its contents, evaluate and study the state of the organs that are located there. After examination, the organs are set to their anatomical places. If there are adhesions on the inside of the hernial sac, they are dissected and removed.
After that, they begin to suture the abdominal muscles. The Mayo technique involves the use of a special method of applying surgical sutures, the purpose of which is to securely strengthen the place of protrusion. The seams are made in the form of the letter "P". First, they are applied to the aponeurosis flaps in such a way that they overlap each other. The edge of the top flap is sutured to the bottom. With this method of suturing, the least tension is provided during contraction of the abdominal muscles.
Most often, during the operation for hernia repair, the navel remains in place. However, there may be such a situation that its removal becomes mandatory. The indications for this step are:
- the presence of a hernia that is too large;
- thinning of the skin around the hernial protrusion;
- the presence of a close adhesion of the hernial sac with the navel.
The Mayo technique involves the use of a special method of applying surgical sutures, the purpose of which is to securely strengthen the place of protrusion.
If the navel is not removed along with the thinned area of the skin, after the operation, a cavity will remain that will be filled with serous fluid, which will lead to infection and the development of inflammation. Skin deprived of the necessary nutrition will undergo necrosis.
Restrictions in the postoperative period
Quick recovery after surgery depends on how well the patient follows the doctor's recommendations. After the operation, bed rest must be observed for several days. After discharge, the patient is recommended to wear a bandage to maintain the muscles. This avoids recurrence and keeps the sutures immobile.
Eating is allowed the next day. Nutrition should be fractional, divided into 4-5 doses. The menu should include low-fat light meals. This will avoid strong pressure on the peritoneal area. You need to stick to the diet for at least 2 weeks.
If an urgent operation was performed to remove a strangulated hernia, then the patient must wear a tighter bandage, inspect postoperative wounds daily and make dressings. A course of antibiotics may be prescribed to prevent purulent inflammation.
Regardless of the complexity of the operation, patients are advised to limit physical activity for 4 months. If professional activity is associated with hard physical labor, then a change of profession will be required.
Disease prevention
To prevent the development of an umbilical hernia, it is necessary to constantly train the rectus abdominis muscles and pump the press. You can work out at home or at the gym.
When doing heavy physical labor or when lifting weights, the load on the abdomen increases and the risk of pinching the internal organs increases. In this situation, doctors recommend using a special bandage or belt. Wearing it can be recommended for older people, since their muscular frame is no longer so strong and even a minimal load can cause a hernia. The use of a bandage is also prescribed for pregnant women.
An operation to remove an umbilical hernia is indicated for children and adults who have encountered a congenital or acquired pathology. This disease is diagnosed in 3% of newborns against the background of intrauterine disorders and poor tissue fusion after removal of the umbilical cord. In adults, such an ailment occurs against the background of muscle weakness and with high physical exertion, when intra-abdominal pressure rises.
Hernia repair is performed as planned, an operation on an umbilical hernia is prescribed from the moment the disease is detected in adults, and in children under 6 years of age, attempts are still being made to conservative treatment. In 85% of newborns, a hernia is reduced on its own if parents follow a preventive regimen, do gymnastics with the child, turn to a nutritionist and gastroenterologist to select an effective symptomatic treatment.
Removal of an umbilical hernia in adults is always carried out, because the protrusion will no longer be reduced on its own, unlike children who have active growth and formation of muscle tissue.
Everyone should be operated on without exception when there are complications. It can be infringement, peritonitis, intestinal obstruction, internal bleeding. Under such conditions, the internal organs die off, and after a few hours of the pathological process, it will no longer be possible to restore their structure and function.
An umbilical hernia in women can cause infertility, when necrosis and inflammation occur during infringement, and the infection spreads to neighboring organs, including the ovaries and fallopian tubes.
Indications for urgent surgery
Urgent surgery to remove an umbilical herniaadultshas the following indications:
- infringement. This is a life-threatening condition that leads to intoxication of the body, impaired local blood flow, pulmonary and cardiovascular insufficiency. A strangulated hernia can cause death. This complication is manifested by acute pain in the abdomen, an increase in education and the inability to set it in the wrong place. The protruding navel becomes dense and hard to the touch.
- TOintestinal obstruction. Stagnation of feces in the large intestine without regular emptying leads to necrosis and peritonitis. This condition often causes sepsis, blood poisoning with a fatal outcome.
- Emicrobial hernia. Removal of an umbilical hernia and an operation to eliminate the consequences of such a congenital anomaly are performed on the first day after birth.
In other cases, in the absence of contraindications, hernioplasty is performed as planned, taking into account the needs of the patient and the severity of his condition. In some cases, the removal of the protrusion should be carried out as soon as possible in order to prevent complications.
Technique
Umbilical hernia repair is performed by several methods, but the most commonly used is the Liechtenstein operation with the installation of a mesh implant. Herniotomy is done under local or conduction anesthesia by chipping the skin around the navel.
Preference is given to local anesthesia, because after the conduction the patient's condition is somewhat worse, he is worried about nausea, dizziness, weakness, problems with memory and attention.
The intraperitoneal removal method is indicated for embryonic hernia in newborns. During the operation, the surgeon opens the hernial sac, returns the organs to their place and removes excess tissues. If the contents of the hernial sac are not resorbed embryonic tissues, they are also removed. After all manipulations, the tissues are sutured in layers.
Mayo plastic surgery is performed for adults and children over 5 years of age. The operation can be performed with the removal of the umbilical ring, which must be discussed with the patient before the intervention.
An umbilical hernia repair begins with a skin incision just above the navel. Then the surgeon allocates the hernial sac, restores the anatomy of the abdominal cavity, removes excess tissues, sutures the defect in layers, closing it with his own tissues. In case of an uncomplicated umbilical hernia, the operation is performed with the installation of a mesh implant, which grows together with the tissues, preventing the organs from protruding through the umbilical ring.
Rehabilitation after Mayo plastic surgery is long, the patient needs to wear an inguinal bandage for more than a month, regularly go for dressings, follow a strict diet, and exclude physical activity. These are standard preventive measures after hernia repair, but when closing the defect with one's own tissues, they are of particular importance, because the risk of recurrence of the disease is much higher.
The mesh is an additional and reliable protection against prolapse of organs, but own tissues can disperse during high physical exertion and with an increase in intra-abdominal pressure. Frequent coughing, bloating and constipation will be factors in the appearance of a relapse of the pathology.
Laparoscopic surgery is indicated for the removal of an umbilical hernia in children and adults in the absence of complications.
Almost always, this method of hernia repair is combined with the installation of a mesh implant. The use of a laparoscope makes it possible to exclude a postoperative hernia of the abdomen, because there is no wide scar left on the abdominal wall, which in other cases will contribute to the occurrence of pathology.
Contraindications
PA hernia is not operated on when there are the following contraindications:
- Pacquired hernia under the age of 5 years. There is a possibility of self-reduction of the protrusion. But this applies only to an uncomplicated disease that does not cause discomfort to the child.
- INsecond half of pregnancy. Hernia repair will be stressful for the body, which will undesirably affect the health of the child. The operation, in the absence of complications, is postponed until the birth of the child or, if possible, until the end of the breastfeeding period.
- Tsevere pathologies of the cardiovascular and respiratory systems. Pathologies such as heart attack, varicose veins, thrombocytopenia will be absolute contraindications to surgery.
- ABOUTsevere inflammatory processes, infections inperiodexacerbations,virus carrier.
- Xchronic incurable diseases at any stage when there is a risk of deterioration of the patient's condition.
- Pkidney failure, diabetes mellitus, complicated liver cirrhosis.
Most of the contraindications will be relative restrictions to the removal of an umbilical hernia, and each case is considered by the surgeon on an individual basis.
Training
Before hernia repair, special preparation is required, including the sanitation of infectious and inflammatory foci in the body, as well as the exclusion of contraindications and risks. A month before the planned operation, the patient undergoes a series of examinations. The surgeon will need the results of blood and urine tests, ultrasound images, the conclusion of a gastroenterologist, oncologist and gynecologist.
A week before the operation, the doctor will cancel some medications. Drugs that thin the blood, anticoagulants can affect hernia repair.
Dabouthernia repairyou need to do the following tests:
- electrocardiogram;
- esophagogastroduodenoscopy;
- x-ray of the abdominal organs;
- Ultrasound of the stomach;
- fluorography.
Postoperative period
The first two weeks after the operation, a sparing regimen is prescribed. The patient is discharged from the hospital on the 2-7th day, depending on the surgical technique performed. The therapeutic diet is shown for the first 3 weeks, after which you can return to your usual diet with minor changes.
The postoperative bandage is prescribed for a month, but its long-term wearing will be determined by the doctor, because recovery in the early period does not exclude the occurrence of ventral abdominal hernia. When there is a risk of postoperative hernia or recurrence of the umbilical cord, the supporting corset should be worn longer, alternating it with therapeutic compresses.
The bandage is also important in order to reduce pain by reducing the load on the muscles of the anterior abdominal wall. If the pain after hernia repair remains a constant symptom, this may indicate complications, and then the corset will be useless and even harmful.
When a month has passed since the operation, you can gradually return to an active life, include new foods in the diet and engage in physiotherapy exercises.
In the earlypostoperative period there is a risk of the following complications:
- infection - after hernioplasty it happens extremely rarely, because this is a “clean” operation, but patients after 60 years of age, when a lesion is detected, antibacterial drugs are prescribed for the purpose of prevention;
- neuralgia- damage to the nerve endings occurs in 10-17% of cases, while the patient is worried about burning, soreness, loss of sensitivity and itching in the area of the surgical scar, this violation often resolves on its own after 4-7 months, while the restoration of nerve endings occurs;
- bowel obstruction- after the operation, stagnation of feces occurs, therefore, in the early period of rehabilitation, patients are shown laxatives, breathing exercises and drugs to improve peristalsis;
- seroma - this is swelling of the tissues in the operated area, more often occurs after the installation of a mesh implant, as a reaction to a foreign body, the formation resolves on its own after 1-3 weeks.
There are about 15 cases of complications per 100 operated patients. Surgeons, due to the high risk of consequences, strongly recommend abandoning attempts to self-treat a hernia and agree to surgery as soon as possible.
The prognosis largely depends on how much time it takes to prepare for the operation. As soon as the doctor makes a conclusion, it is worth comparing the importance of hernia repair with its risks, and after listening to several specialists, agree to remove the hernia with fewer risks.
