What Is a Direct Inguinal Hernia?
The groin area is a triangular area located at the junction of the lower abdominal wall and the thigh. Inguinal hernia refers to a mass formed by the abdominal cavity organs protruding through the defect in the groin area, commonly known as "hernia". According to the relationship between the hernia ring and the inferior abdominal wall artery, inguinal hernia is divided into two types: indirect hernia and straight inguinal hernia. There are two types of inguinal hernias: congenital and acquired. The inguinal hernia protrudes from the deep inguinal canal (ovoids of the transverse transverse fascia) located on the outside of the inferior abdominal wall arteries. It moves inwardly and obliquely through the inguinal canal and then penetrates the shallow inguinal ring (subcutaneous ring) to enter the scrotum. , Accounting for 95% of inguinal hernias. The right side is more common than the left side, and the male to female ratio is 15: 1. A straight inguinal hernia protrudes from the back of the inguinal triangle on the inner side of the inferior abdominal wall directly from the back to the front. It does not pass through the inner ring and does not enter the scrotum. The incidence of straight hernias has increased in elderly patients, but oblique hernias are still common. If not treated in time, it can easily cause serious complications.
- nickname
- Inguinal hernia
- English name
- inguinal hernia
- Visiting department
- General Surgery
- Multiple groups
- male
- Common causes
- Abdominal wall muscle strength decreases and intra-abdominal pressure increases
- Common symptoms
- Inguinal masses protrude outside the masses, and the masses protrude on their own when standing
Basic Information
Causes of inguinal hernia
- Decreased abdominal wall muscle strength and increased intra-abdominal pressure are the main causes of inguinal hernia. In the elderly, muscle atrophy, the abdominal wall is weak, and the groin area is weaker. Blood vessels, spermatic cords, or round ligaments inside the uterus pass through, providing a channel for the formation of hernias. In addition, the elderly suffer from cough, constipation, dysuria caused by prostatic hyperplasia and other diseases, which lead to increased abdominal pressure and provide impetus for the formation of hernias.
Clinical manifestations of inguinal hernia
- Reducible hernia
- The clinical feature is a reducible mass in the groin area. The mass is small at first and only appears when the patient is standing, laboring, walking, running, coughing or crying. The mass can be collected by himself when lying flat or under pressure. disappear. Generally no special discomfort, only occasionally with local pain and involved pain. With the development of the disease, the mass can gradually increase, from the groin to the scrotum or labia majora, inconvenient walking and affect labor. The mass is pear-shaped with a pedicel, with a narrow upper end and a wide lower end. When lying down, the mass can disappear on its own, or the mass can be squeezed and pushed outwards by hand, and it can be absorbed into the abdominal cavity and disappeared. Intestinal whine can be heard when the content of the hernia is the small intestine. The lumps were soft, smooth, and drumming. There is often resistance first when returning; once the return begins, the mass will disappear quickly. When the contents of the hernia is the greater omentum, the mass is tough and inelastic, with dullness and slow recovery. After the hernia is received, the examiner can use the fingertips to gently extend through the scrotal skin along the spermatic cord and extend into the enlarged outer ring. If the patient is instructed to cough, the fingertips will have an impact. Occult inguinal hernias can be confirmed by this test. Compression of the inner ring test can be used to distinguish oblique and straight hernias. The latter can still appear when the patient presses the inner ring to cough after the hernia mass is accepted.
- 2. Sliding oblique hernia
- Clinical features are large irreversible hernias that cannot be fully accepted. The cecum that slides out of the abdominal cavity often adheres to the anterior wall of the hernia sac. In addition to incomplete absorption of the mass, there are symptoms such as indigestion and constipation. Sliding hernias are more common on the right side and the incidence ratio on the left and right is about 1: 6. During surgical repair, the cecum or sigmoid colon, which prevents slipping out, may be mistaken as part of a hernia sac and cut.
- 3. Incarcerated hernia
- It often occurs when a sudden increase in intra-abdominal pressure such as labor or defecation is usually oblique hernia. The clinical feature is a sudden increase in hernia mass with significant pain. Lying flat or pushing the lump by hand cannot be accepted. The lump was tense and hard, and there was obvious tenderness. When the incarcerated content is the omentum, local pain is usually mild; if it is intestinal dysentery, not only the local pain is obvious, but also with mechanical intestinal obstruction such as paroxysmal abdominal cramps, nausea, vomiting, constipation, and bloating Symptoms. Once the hernia is incarcerated, the above symptoms gradually worsen. If not treated in time, it will eventually become a strangulated hernia. When the intestinal wall hernia is incarcerated, it is easy to be ignored because the local mass is not obvious, and the intestinal obstruction is not necessarily present.
- 4. The clinical symptoms of strangulated hernia are more serious
- The patient showed persistent severe abdominal pain, frequent vomiting, vomit containing coffee-like blood or bloody stools; abdominal signs showed asymmetric abdominal distension, peritoneal irritation, and bowel sounds weakened or disappeared; puncture or lavage of the abdominal cavity was bloody effusion; X On line examination, isolated swollen bowel or tumor-like shadows were observed; temperature, pulse rate, white blood cell count gradually increased, and even signs of shock appeared.
- A straight inguinal hernia is a reproducible mass in the groin area. It is located above the pubic tubercle and is semi-spherical. It is mostly painless and other discomfort. Hernias appear when standing and disappear when lying down. The mass does not enter the scrotum, and the neck of a straight hernia is wide and rarely incarcerated. After being resuscitated, it can be directly palpated in the groin triangle and the abdominal wall defect, and the fingertips have a bulging impact when coughing. Can be identified with oblique hernia. Hernias of bilateral straight hernias are often symmetrical to each other on both sides of the midline.
Diagnosis of inguinal hernia
- Most inguinal hernias can be diagnosed based on the patient's clinical symptoms and physical examination. If the hernia is small and atypical, the diagnosis can be basically confirmed by B-ultrasound.
Differential diagnosis of inguinal hernia
- Identification of oblique and straight hernias
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Inguinal hernia treatment
- Treatment of inguinal hernia includes conservative and surgical treatment. Once the inguinal hernia cannot be absorbed, it can cause intestinal obstruction, even intestinal necrosis, perforation, and even death.
- Conservative treatment
- Conservative treatments include hernia bands, hernia supports, traditional Chinese medicine and traditional Chinese medicine. These methods can alleviate symptoms or delay the development of the disease, but they cannot be cured. Some improper conservative treatments can also aggravate the condition. This method is only applicable to infants under 2 years old, frail elderly or with severe illness. Special hernia bands are often used to press the hernia ring to relieve symptoms.
- 2. Surgical treatment
- Surgery is the only reliable method for treating inguinal hernias in adults with fewer recurrences. Easily recurrent hernia can be treated with elective surgery, while refractory hernia should be limited to short-term surgery. Incarcerated hernia and strangulated hernia must be treated with emergency surgery to avoid serious consequences. Surgical treatment is divided into traditional tissue-to-tissue suture repair and tension-free hernia repair techniques. At present, internationally recognized tension-free hernia repair techniques include open surgery and laparoscopy.
- (1) Traditional surgery Patients fast before and after surgery, stay in bed for several days, receive fluids, and place urinary catheters. Patients experience severe postoperative pain, slow recovery, and high recurrence rates. Many patients have heart, lung, and cerebrovascular disease. The patient could not undergo surgery because he could not tolerate general or local anesthesia.
- Open tension-free hernia repair was rapidly popularized after being introduced from abroad. Surgery can be performed under local anesthesia, the recurrence rate is low, and the pain is small. Generally, it only requires 2 to 5 days of hospitalization, and the operation can be completed in an outpatient setting. Postoperative recovery is fast.
- (2) Laparoscopic inguinal hernia repair In recent years, significant progress has been made in laparoscopic surgery. Laparoscopic total peritoneal repair (referred to as TEP) requires only two 0.5, 1 incisions, does not enter the abdominal cavity, the hernia bag is pulled back to the abdominal cavity outside the peritoneum, and the protruding hernia is covered with artificial mesh. This method is suitable for the treatment of bilateral inguinal hernia and recurrent hernia, and has small trauma, rapid recovery, and low recurrence rate.