Treatment of hernias of the anterior abdominal wall

How do hernias form?

Hernias occur in the area of “weak spots” of the anterior abdominal wall, under the influence of intra-abdominal pressure. Factors that cause its increase are called producing factors and include: physical activity, cough, childbirth and all those cases when the abdominal press tenses.

“Weak spot” is the area of the abdominal wall where the muscular aponeurotic part is most thinned. This may be the place of muscle attachment to the aponeurosis or physiological openings (inguinal rings, umbilical ring).

An increased risk of hernias is observed in people with predisposing factors: connective tissue weakness syndrome, damage to the nerves innervating the abdominal wall, as well as the presence of postoperative scars.

Physiotherapy

Often, umbilical hernia in newborn children can be well cured with the help of therapeutic exercises. In our clinic, experienced specialists will select the necessary set of exercises for the child.

You can also do some exercises on your own at home. For example:

before feeding the baby, place the baby on his tummy (for a couple of minutes);
turn the child onto the left and right side alternately for a couple of seconds;
turn the child to face you and, holding his head, tilt him back slightly;
when the baby is lying on his back, carefully lift him by the arms, while supporting his back (the head and legs hang freely);
Also, while lying on your back, carefully turn the baby onto his tummy;
Place the baby on a bulky ball and roll it around, holding it by the legs.

Children under 8 years old can visit a trainer and do exercises with him. Such services are also available in our clinic.

What does a hernia consist of?

All hernias, regardless of location and size, have a common structure and consist of the following components:

A hernial orifice is a defect of the anterior abdominal wall, mainly in the aponeurosis. Through them, the internal organs leave the abdomen and end up under the skin. If the hernial orifice is wide, then through it the contents can freely return to the abdominal cavity.
Hernial sac is a sheet of stretched peritoneum covering organs that extend beyond the abdominal cavity through the hernial orifice. The hernial sac is covered with several membranes, these also include subcutaneous tissue and skin.
The contents of the hernial sac are the internal organs or their individual parts that extend beyond the abdominal cavity through the hernial orifice.

What types of hernias are there?

Depending on the anatomical location, external and internal hernias are distinguished. External ones include:

Umbilical hernia.
Inguinal hernia.
Hernia of the white line of the abdomen.
Postoperative hernia.
Paracolostomy hernia.
Lumbar hernia.
Perineal hernia.
Obturator hernia.
Hernia of the xiphoid process.
Sciatic hernia.

Hernias that form inside the abdominal cavity are considered separately. With such hernias, internal organs can be located in pockets of the peritoneum or penetrate into the chest cavity through the openings of the diaphragm.

Depending on the size of the hernia, they are divided into:

Small: hernial orifice less than 4 cm
Medium: hernial orifice from 4 to 10 cm
Large: hernial orifice larger than 10 cm

Hernias are also classified according to the degree of development:

initial - a small depression is identified in a weak spot of the abdominal wall - a triggering factor for the formation of a hernia;
canal - internal organs begin to sink into the hernial opening;
complete - the internal organs have passed through the hernial orifice and are located under the skin.

According to the clinical course, hernias are divided into:

reducible - the contents of the hernial sac move freely from the abdominal cavity to the hernial sac and back.
irredeemable.
strangulated - a condition in which the hernial orifice puts pressure on the structures of the released organ, which leads to disruption of its blood supply and can lead to necrosis. There are: elastic strangulation, fecal strangulation, parietal strangulation, retrograde strangulation, Meckel's diverticulum strangulation, Broca's hernia.

Causes of the disease and predisposing factors

Premature babies are more often affected by the disease. According to statistics, every third child who was born prematurely is predisposed to the appearance of an umbilical hernia. Pathology is found in newborns, one-year-olds, and even those aged 6 to 8 years. Let's look at the issue “umbilical hernia in children - causes” in detail.

A congenital disease can be caused by the following factors:

being born prematurely;
heredity;
infection in the womb;
negative environmental factors, poor ecology in the region;
weakness of the child's abdominal muscles inherited through genes.

What causes acquired pathology? The disease can occur due to the following conditions:

colic in the abdomen;
problems with the gastrointestinal tract (constipation, gas, bloating);
lactase deficiency;
early walking;
hysterical crying or severe and frequent coughing, other reasons.

The disease can appear without certain prerequisites.

What are the symptoms of a hernia?

In the initial stages, a hernia may manifest itself as discomfort or slight pain during physical activity at the site of hernia formation. As the aponeurosis thins or the tissues of the anterior abdominal wall weaken, a painless protrusion appears, disappearing when pressure is applied to it. With each new episode of increased intra-abdominal pressure, the hernial orifice will increase in size, and the sac will stretch due to an increase in the volume of contents.

External abdominal hernias that occur without complications are characterized by such general symptoms as: the presence of a hernial protrusion, discomfort in the hernia area, dysfunction of the organs that make up the hernial contents.

Why is a hernia dangerous?

Any hernia is dangerous for the development of complications. The most serious complication of a hernia is strangulation. It occurs when the blood supply to the contents of the hernial sac is disrupted and tissue necrosis occurs.

An equally serious complication is intestinal obstruction. As a result of the prolonged presence of intestinal loops inside the hernial sac, they are compressed, the movement of intestinal contents through them is disrupted, and intestinal obstruction forms.

It is very important to understand that the development of complications can occur suddenly, against the background of complete well-being: on vacation, at the dacha, while traveling - in situations where qualified medical care is difficult to access or not available at all. Treatment of hernia complications requires emergency intervention, and delay can lead to a sharp deterioration in a person’s condition and significantly worsen the prognosis of delayed treatment.

Therefore, it is better to get rid of the hernia before complications develop.

Using an adhesive patch

This remedy can be used for newborns as soon as their umbilical wound has healed. The patch is glued so that a small fold is formed. The course of wearing the patch is 10 days. Typically, three courses are required with breaks in order to completely eliminate a hernia in an infant. The patch must be selected from a hypoallergenic material that allows air to pass through, so as not to irritate the baby’s sensitive skin. To ensure that the treatment of the disease is as effective as possible, it is recommended to combine the use of the patch with other methods. In this case, the result is more stable.

Hernia treatment

It is only possible to completely get rid of a hernia through surgery. There are also conservative methods to alleviate the condition of a hernia, but their use is possible only if there are contraindications to surgery.

Contraindications to elective surgical treatment include severe concomitant diseases, malignant processes in advanced stages, acute diseases and pregnancy. It is important to note that complicated hernias must be operated on urgently for health reasons.

The smaller the size of the hernia, the easier the operation for both the surgeon and the patient. In turn, the treatment of giant hernias represents a major surgical problem and requires the use of non-standard approaches to its elimination.

Hernioplasty (hernia repair) is the name of an operation to “liquidate” a hernia with plastic surgery of a defect in the anterior abdominal wall.

Prevention

Many people are interested in the question of how to remove an umbilical hernia in a child? In this regard, disease prevention is very effective. Here are some preventive measures to help your baby stay healthy:

breast-feeding;
diet of a nursing mother, which excludes the consumption of foods that cause gas formation;
It is necessary that the mother who is breastfeeding her baby eats a balanced diet, eats healthy and nutritious food;
if the child is bottle-fed, it is necessary to carefully select the milk formula;
it is necessary to ensure that the baby does not catch a cold and cries as little as possible - coughing and crying can also cause a hernia;
It is useful to engage in physical education, swimming, and therapeutic massage sessions with your child.

What are the methods of anterior abdominal wall plastic surgery?

Plastic methods can be tension or non-tension.

Tension is a type of plastic surgery performed using the patient’s own tissues. This method received this name because, in order to eliminate a hernia defect, the tissues must be “tightened” and sewn together. The resulting tension in the tissues can cause pain after surgery and result in a possible relapse. At the present stage of development of medicine, this method of closing hernias defects is significantly inferior to non-tension methods.

Tension-free plastic surgery involves the use of modern mesh prostheses to strengthen the anterior abdominal wall. The prosthesis is a polypropylene network, which, due to its flexibility, strength and high degree of tissue “germination”, has shown its reliability and safety when used in hernia repair. Mesh prostheses come in different sizes, from small ones with a diameter of 5 cm for umbilical hernias, to large ones of 50 x 50 cm for giant incisional hernias. Modern three-dimensional mesh systems make it possible not only to strengthen the hernia defect in the form of a “patch”, but to completely fill it, significantly reducing the risk of relapse. In some situations, a special mesh is installed, the surface of which is coated with a special composition that allows it to safely contact the abdominal organs and avoid the formation of adhesions between them.

The open hernia repair operation consists of several stages:

Isolation of the hernial sac. A skin incision is made above the hernial protrusion, the hernial sac is freed from the surrounding subcutaneous fatty tissue. The “hernial orifice” is distinguished.
The hernial sac is opened, the condition of the contents of the hernial sac is assessed, and if there are no complications, the contents are immersed in the abdominal cavity.
The hernial sac is excised, stitched and plunged into the abdominal cavity.
The integrity of the anterior abdominal wall is restored (plasty is performed).

Massage

This procedure is allowed within a couple of weeks after the baby is born. Namely: as soon as the umbilical wound has healed well. A pediatrician at our clinic can teach you this. Having mastered the principle and technique of therapeutic massage, you will be able to carry out the procedure yourself at home. What is the difference between massage for an umbilical hernia in a child? Its peculiarity is that before the manipulation, the hernia site is sealed with an adhesive plaster. This action is necessary in order not to injure the hernia and prevent its prolapse. Massage movements of the hands should be light and not forceful. There is no need to put pressure on the baby’s belly; try to do everything gently and carefully.

Is it possible to operate a hernia without incisions using modern mesh prostheses?

Yes, you can!

At the moment, laparoscopic hernioplasty is the operation of choice for the treatment of various types of hernias. This operation is performed through punctures in the anterior abdominal wall. The surgeon inserts a video camera into the abdominal cavity and, using additionally inserted manipulators, releases the hernial sac from its contents. In the second stage, the surgeon separates the peritoneum of the hernial sac from the tissues of the anterior abdominal wall, dissects it and places a special mesh prosthesis on the hernial orifice. Then, the mesh is reinforced on top with the previously separated peritoneum.

Thanks to this, the prosthesis does not form adhesions with internal organs. This method of plastic surgery avoids tissue tension and greatly reduces the likelihood of relapse. The absence of large incisions on the anterior abdominal wall contributes to a comfortable course of the postoperative period.

How does the postoperative period proceed?

After laparoscopic hernia repair, pain is practically not felt and is therefore easily controlled using tablet painkillers.

The only reminder of the operation was discomfort in the area of small punctures on the anterior abdominal wall.

In uncomplicated cases, discharge from the hospital occurs within 2-3 days. The time frame for returning to work, on average, does not exceed 10-14 days.

Traditional open surgery is characterized by pain in the postoperative period. However, carrying out comprehensive pain relief in a hospital allows you to reduce its severity and feel comfortable throughout the entire recovery period.

After discharge from the hospital, you will be advised to limit physical activity for a period determined by your attending physician based on the complexity of the treatment performed.

Who deals with surgical treatment of external abdominal hernias?

You can always contact the clinic of coloproctology and minimally invasive surgery for surgical treatment.

Qualified specialists regularly perform laparoscopic interventions for hernias of the anterior abdominal wall. In some cases, we also use traditional open surgery.

At KKMH, treatment of hernias is carried out both on a paid basis and under the compulsory medical insurance policy.

Sign up for a consultation by phone +7 (499) 11-03-222.