How it manifests itself
The typical onset is a soft protrusion in the groin, which appears when straining, coughing, or lifting heavy objects and disappears when the person lies down. There may be no pain at all at this stage, which is why many people put off visiting a surgeon for years. Over time, the protrusion grows, a nagging pain begins to bother you in the evening, and in men the hernia can descend into the scrotum.
- Bulging in the groin area, increasing while standing and with exercise
- A pulling or burning sensation in the groin that gets worse towards the end of the day
- Feeling of heaviness, discomfort when walking and bending
- In men - enlargement of half of the scrotum
- Sometimes - urinary problems if the hernia involves the bladder
Why does it occur
- Congenital weakness or non-closure of the inguinal canal is the most common cause
- Heavy physical labor and heavy lifting
- Chronic cough - smoking, bronchitis, occupational dust
- Chronic constipation and straining
- Difficulty urinating with prostate adenoma
- Obesity and, conversely, sudden weight loss
- Pregnancy and childbirth
- Previous abdominal surgeries
Survey
- Осмотр хирурга стоя и лёжа, с пробой на кашлевой толчок — в большинстве случаев диагноз ставится уже на этом этапе.
- УЗИ паховых областей и мошонки — уточняет размер грыжевых ворот, содержимое мешка и помогает отличить грыжу от водянки оболочек яичка, липомы или увеличенного лимфоузла.
- При нетипичной картине — МСКТ брюшной полости.
- Перед плановой операцией: анализы крови, коагулограмма, ЭКГ, осмотр терапевта и анестезиолога.
Operation: what are the options?
Modern hernioplasty is almost always “tension-free”: the defect is closed with a mesh implant, which over time grows with its own tissue and creates a strong frame. It was the mesh that reduced the frequency of relapses significantly compared to old methods of plastic surgery with one’s own tissue.
- Laparoscopic hernioplasty (TAPP/TER) - through three punctures, the mesh is installed from the inside. Less pain, faster return to work, better cosmetic results, especially beneficial for bilateral and recurrent hernias.
- Traditional (open) hernioplasty according to Lichtenstein - an incision in the groin, a mesh over the defect. A proven method, possible under local or spinal anesthesia, which is important for patients with severe concomitant diseases.
- Plastic surgery with one’s own tissues is used today to a limited extent, mainly in children and young patients with a small defect.
The choice of method is a conversation with the surgeon, and not a universal rule: the size of the hernial orifice, one- or two-sidedness, the presence of relapse, weight, nature of work and concomitant diseases are taken into account.
Recovery
- Первые сутки — наблюдение; при лапароскопии выписка часто в день операции или на следующий.
- Ходить разрешают в день операции: ранняя активизация снижает риск тромбозов.
- Ограничение подъёма тяжестей обычно на 3–4 недели, при физическом труде — дольше, срок называет оперировавший хирург.
- Умеренная боль и отёк в первые дни — норма; синяк в паху или мошонке может рассасываться 2–3 недели.
- Сидячая работа — как правило, через 1–2 недели.
What not to do
- Expect that the hernia will “linger” - the aponeurosis defect does not heal on its own
- Wear a bandage for months instead of surgery
- Trying to reduce a painful, irreducible hernia by force - if it is strangulated, this is dangerous
- Postpone elective surgery until retirement: both hernia and surgical risks increase with age
- Continue working with weights “until the last moment”
