Find disease of inguinal hernia in men. Inguinal hernia: symptoms, causes and treatment options. How is an inguinal hernia treated without surgery

Inguinal hernia is a common disease in which there is a noticeable protrusion of the peritoneum into the cavity of the inguinal canal.

This disease is most common in men: among the total number of patients with inguinal hernias, representatives of the stronger sex account for 90 to 97 percent. Such a frequent manifestation of the disease in men is associated with anatomical characteristic features groin area.

As a result of certain reasons related to lifestyle, the specifics of work or due to hereditary predisposition, specific weaknesses can form in the walls of various cavities of both men (inguinal) and women (abdominal, umbilical). These areas in medical terminology are called hernial gates, through which various internal organs can protrude into the subcutaneous region, thereby forming a hernia.

In almost all cases of inguinal hernia, treatment requires surgery, regardless of the symptoms and location. In men, it often descends into the scrotum, thereby forming an inguinal-scrotal hernia.

Causes

All inguinal hernias are divided into congenital and acquired. Congenital hernias are usually diagnosed in children and account for approximately 90% of all childhood hernias. In adults, only 10-12% of congenital hernias are diagnosed.

This type develops in violation of intrauterine development. They can appear already in the neonatal period or (more often) gradually increase with age. Sometimes congenital inguinal hernias can be combined with other malformations.

Approximately 85% of all hernias are acquired. The occurrence of a hernia is associated with predisposing causes and producing ones.

Predisposing causes this:

genetic predisposition to the occurrence of this problem;
age, the older, the more likely the occurrence of the disease;
body features;
the degree of fatness and weight stability, if a person quickly loses weight, this increases the likelihood of pathology;
paralysis of the nerves responsible for the innervation of the muscles of the abdominal wall.

And all the factors that cause an increase in pressure in the abdominal cavity are considered to be producing, which leads to the appearance of a hernia.

These factors include:

hard work, sports;
constipation;
difficulty urinating;
frequent cough.

And of course, for the occurrence of this trouble, the very presence of the inguinal canal is a prerequisite.

oblique and straight

Inguinal hernia in men can be of two types: a spit and a straight line. The names speak for themselves.

Oblique - passes obliquely along the inguinal canal, protruding through the inguinal opening. Such a hernia in men can descend into the scrotum.
Direct - directly related to the weakening of the posterior wall of the inguinal canal. It passes only through the external opening of the inguinal canal.

The cause of all these problems are weak muscles of the posterior wall of the inguinal canal. Conservative treatment inguinal hernia impossible. To eliminate the causes of its occurrence, an operation is performed to strengthen the posterior wall of the inguinal canal.

Inguinal-scrotal hernia

Inguinal-scrotal hernia is a prolapse of internal organs into the scrotum, due to insolvency connective tissue internal or external inguinal ring, which are natural openings in the abdominal wall. It is formed for various reasons. In children, congenital or hereditary factors play a decisive role. In adults, these are acquired factors.

This hernia is oval. In this case, the protrusion descends into the scrotum, which leads to a stretching of the corresponding type, concentrated on one side and leading to visual asymmetry.

Symptoms of an inguinal hernia in men

In the case of an inguinal hernia, symptoms may appear immediately after birth or throughout life. The primary signs of acquired and congenital inguinal hernia are the same.

Most often, a man himself discovers a swelling or protrusion in the groin area. In most cases, this swelling increases with exercise and even with coughing. To the touch, the appeared formation is soft, elastic, painful sensations are not observed.

Inguinal hernias in men decrease when moving to the prone position and increase in the standing position. When pressed, the protrusion is easily reduced, and a characteristic rumbling is heard. In the reduced state, a wide inguinal ring is easily felt through the skin in the groin. If the hernia is in the scrotum, it will not be symmetrical.

This pathology can be complicated by infringements and inflammation of the hernia, in addition, in some cases, ischemic orchitis begins (the testicles become inflamed), intestinal obstruction due to the fact that stool masses stagnate.

When organs are infringed may need immediate assistance. By the way, you can recognize this condition by the following symptoms:

inability to go to the toilet for the most part;
nausea to vomiting;
groin pain;
non-reduction of prolapse even lying down.

In some cases, the symptoms of an inguinal hernia are confused with a disease such as testicular dropsy. But it is easy to distinguish them by the location of the testicle: with dropsy, it is located in the dropsy, and with a hernia - outside it. In addition, with dropsy, the formation has a tight surface, and with a hernia, it is soft.

The consequences of an inguinal hernia, if you do not have surgery

If a strange protrusion is found, even if there is no pain, the man should see a doctor. Otherwise, the consequences will be more serious.

A timely visit to a specialist will save the patient from such possible consequences:

inflammation of a hernia or testicle;
transformation from ordinary to infringed, which is of the most dangerous nature, leading to death;
intestinal obstruction, the appearance of constipation and stagnation of feces.

If the doctor noticed the characteristic signs of pathology, then he offers the only option - to carry out the removal. How to treat an inguinal hernia, and what type of operation to choose should be decided by the surgeon together with the patient, in each specific case tactics surgical intervention may be different.

Inguinal hernia in men: treatment without surgery

If an inguinal hernia is found in men, treatment must be performed promptly, but sometimes situations arise when the operation has to be postponed for some time. In this case, patients are prescribed to wear a special bandage, which helps prevent the development of the disease and infringement of internal organs.

You should know that the bandage does not relieve a man of the disease, but can only maintain a hernia in a stable condition. It is more of a preventative than a cure.

With increased training and increased physical activity. Bandages should be worn by men who are engaged in power sports (wrestlers, weightlifters).
The bandage must be worn if there are sharp pains and there is a risk of infringement.
In the postoperative period, this device is attributed to patients to reduce the load on the sutures and restore the normal tone of the muscular system.

The bandage must not be used if the hernial sac is already strangulated and cannot be reduced.

Treatment of inguinal hernia

The presence of an inguinal hernia does not require emergency surgical intervention, so the operation is planned in advance (if there is no infringement).

Unfortunately conservative methods, treatment with folk remedies, various drugs or wearing bandages will not be able to save you from the disease. It is caused due to the human anatomical structure. In the case of an inguinal hernia, treatment in men is possible only by surgery.

The main task of surgical intervention is to return the contents of the hernial sac to its place, as well as to close the hernial orifice so that there is no recurrence of the disease.

Surgery to remove an inguinal hernia is of two types:

Complete removal of the neoplasm with closure of the inguinal opening;
Removal of the hernial sac, strengthening the area where the hernia occurred with a special mesh to avoid recurrence of the disease. Most often, this operation is performed endoscopically.

The operation is characterized classical scheme, according to which the doctor gains access to the inguinal canal, after which the hernial sac is isolated and cut off by the surgeon and the inguinal opening is sutured. Providing access is possible endoscopically, in which a small puncture is made in the abdominal wall.

Doctors also use the Liechtenstein method, in which an incision of 10-12 centimeters is made, which is necessary to remove the hernial sac. To strengthen the area and prevent recurrence, a special mesh is hemmed.

In addition to these 2 methods of treating inguinal hernia in men, today the use of obturation plastics is common, during which a 3-4 cm incision is made, after which the hernial sac is reduced into the abdominal cavity and inguinal canal. For the purpose of strengthening, the mesh is also hemmed.

The operation of an inguinal hernia in men occurs under local anesthesia, but there are times when they resort to a general one. Depending on the method of treatment, the rehabilitation period has a different duration. If obturation plastic is used, it lasts only a few hours. With the complete removal of the inguinal hernia, the rehabilitation period can be extended to several days.

How long does the operation take?

The operation to remove a hernia lasts up to an hour and a half. How long it will take will depend on the size of the hernia, the presence of infringement, as well as the chosen method of surgical intervention.

In addition, the type of anesthesia used will depend on the choice of operation - general, local or combined.

Rehabilitation after surgery

After the operation, strict adherence to the diet is required. You can not eat foods that cause the formation of gases: fruits, yoghurts, sweets. Two days of bed rest are shown, and subsequently a strict restriction of any physical activity. A few days after surgery, dressings begin to be made, and sutures are removed ten days later.

If an inguinal hernia appeared in men, then we are talking not only about an aesthetic defect, but first of all about a dangerous condition. After inguinal hernia surgery, men can also have complications and require recovery.

Treatment without inguinal hernia surgery is possible in a very small number of cases. In such a situation, it is important to determine the most effective method get rid of the problem, as well as to study the causes of inguinal hernia in men in order to prevent its occurrence again.

Causes, symptoms

The causes of inguinal hernia in men are as follows:

cough in a chronic form;
predisposition;
diseases of the intestinal system;
redundant physical exercise;
injuries of the intimate area;
weight loss;
overweight;

Clinical picture

The symptoms of the disease include:

the appearance of pain in the lumbar region and in the lower abdomen;
aching pain in the area of protrusion of education;
disruption of the digestive system;
the appearance of frequent constipation;
in some cases, there are problems with urination.

Treatment

Removing an inguinal hernia in men is the only medically recognized way to treat the disease, although there are others. In addition to surgical methods. there are also such as the use of funds traditional medicine, visceral therapy, exercise therapy, conservative treatment.

However, one should not rely too much on non-surgical methods of getting rid of the disease, since they are often ineffective.

conservative method

The only way of conservative treatment is the use of a bandage. The device is necessary to reduce the load on the inguinal muscles, which facilitates the patient's condition.

However, some cases of wearing a bandage not only do not give an effect, do not lead to the desired result, but also aggravate the patient's condition, give various complications.

The doctor, after examination, may allow the wearing of a bandage only in cases where the pathological area can be easily reduced or there are serious contraindications that prevent excision of the protrusion or surgical reduction.

These contraindications include:

patient's age over 65 years;
blood diseases, insufficient blood clotting;
heart diseases;
HIV AIDS;
the presence of infections in the body.

Visceral method, exercise therapy and traditional medicine

As for visceral therapy, it can be used to mechanically set tissues into the peritoneum. After such an event, the patient experiences significant relief. For visceral therapy, you need to contact a qualified doctor-manual. Under no circumstances should you self-correct in this way.

Treatment without surgery for an inguinal hernia is possible with the help of exercise therapy, however, most experts completely prohibit physical activity with such an ailment, since there is a risk of pinching the pathological area and aggravating the situation.

In very rare cases, some exercises help get rid of the pathology, however, it is best to resort to physiotherapy exercises only as a preventive measure. As for folk remedies, it is difficult to judge their effectiveness.

However, there are the most common recipes for getting rid of pathologists:

to prepare the product you will need a golden mustache, plantain and onions. The ingredients are passed through a meat grinder or crushed using a combine. A small amount of pork fat is added to the resulting mixture so that a homogeneous composition is obtained. The prepared ointment is used at bedtime and applied to the sore spot;
sauerkraut juice is suitable for a night compress;
also for a compress use a liter of water mixed with 4 tbsp. apple cider vinegar.

Surgical methods of disposal

Among the surgical methods of treatment are the following.

The price for the operation varies not only depending on the method, but also on the type of bulge, anesthesia, the stage of development of the disease, the qualifications of the specialist and the location of the medical institution.

On average, an operation to remove an inguinal hernia in men costs from 20,000 to 90,000 Russian rubles. The table below shows the average cost of various operations.

Conclusion

You should not give preference to non-surgical methods of treating an inguinal hernia, it is better to contact a qualified surgeon as soon as possible and perform an operation. Consequences and a long rehabilitation period in most cases are not required.

Among the various hernias of the abdominal cavity - inguinal (PG), the most common.

It is characterized by protrusion of various organs located in the abdominal cavity into the slit-like gap as a result of stratification of muscle tissue in the groin area.

The structure of the hernial sac consists of the mouth, neck, body and bottom. Formed from parietal thin sheets of peritoneum. Can be filled with various intraperitoneal organs:

large omentum;
part of the small, blind, or sigmoid colon;
appendix;
bladder;
female reproductive organs.

The inguinal canal performs the "role" of the hernial ring. Men are affected by this pathology almost ten times more often than women. The reason lies in the anatomical features. The gap between the broad muscles of the abdomen of a woman is much longer and narrower, has a stronger structure, is well strengthened by ligaments, muscles, and tendons.

In this material, we will consider an inguinal hernia: we will get acquainted with the photo, and also find out the symptoms and methods of treating this problem in men.

Provoking factors

The formation of a hernial protrusion in the groin contributes to many reasons:

the impact of heavy physical work;
prolonged, reflex cough;
a consequence of violations of the functions of the gastrointestinal tract;
acute urinary retention;
anomalies in the anatomical structure of the posterior wall of the canal;
closed injuries of the abdomen;
weak muscular-aponeurotic layers of the abdominal wall.

PG types

According to the classification, protrusions in men are divided according to anatomical features, stages of development and origin.

According to anatomical features, they are:

oblique;
straight;
combined.

The formation of pathology goes through four stages of development:

1) In the initial stage, the protrusion can be easily felt when coughing or abdominal tension in the patient.
2) In the second stage, a canal protrusion develops, located at the very opening of the inguinal fissure.
3) The third stage is characterized by the formation of an oblique hernia located along the canal through the lateral fossa;
4) The fourth stage is characterized by the descent of the hernial contents into the scrotum.

By origin, PG have a congenital and acquired form.

Oblique type PG

Oblique type of hernia, occurs only with one-sided localization and manifests itself in males in early and middle age. Hernial gates have a beveled direction, only in the initial stage of the disease.

In the process of increasing the hernial sac, the gap in the transverse muscle expands towards the epigastric vessels, pushing them inward. The expansion of the hernial inlet more medially than usual causes weakening and good expression of the vascular and muscular lacunae in the posterior wall of the canal.

1) Congenital types of PG in men are due to the gradual lowering of the fetal testicle into the musculocutaneous scrotum. Before birth, the testicle must reach the bottom of the scrotum, and the exit behind it closes. If this does not happen, fragments of the abdominal organs can penetrate into the open passage of the musculocutaneous scrotum, forming a congenital form of inguinal hernia.

Running processes cause an increase in hernial sacs, as a result of which the musculocutaneous scrotum stretches and increases in size, hiding the genital organ under the skin. Self-management of such an education is impossible. When attempting to reposition, rumbling sounds are heard in the intestines.

2) Acquired types of PG are caused by the formation of protrusions of organs located in the abdominal cavity, in a closed peritoneum, passing from the inner to the outer opening of the canal.

Inguinal hernia in men photo:

Variety

1) The location of the hernial sacs in the region of the posterior inguinal interval is referred to as inguinal-intermediate types of hernial formations;
2) Two-chamber formations that have communication with each other and lie in different places - located in the canal itself and in the parietal tissue, belong to the inguinal-preperitoneal type.
3) Inguinal-superficial view - has two capsules, is located in different places and lies in different directions - in the canal itself and under the skin of the fascial case, in the bundle of the external oblique muscle.
4) Encapsulated PG - are two hernial bags enclosed in each other.
5) Perigroin - characterized by access to the subcutaneous fatty tissue.

Direct PG

This type of protrusion, as a rule, is always acquired. The prerequisite is atrophic ligamentous and muscular pathologies of the peritoneal wall resulting from age-related changes. The formation of a hernial sac is localized near the pubic tubercle of the inguinal gap, without touching the spermatic cord, protruding the fascia that serves as a covering for the posterior wall of the inguinal canal.

The combined type of PG includes anatomically different hernial sacs in its classification.

Another type of PG, up to 2% of formation, is a sliding type of hernia, one wall of which is adjacent to a nearby organ that is not covered by the peritoneum.

Types of localization of PG in men

Depending on the location, inguinal hernia in men are:

1) With bilateral localization - characterized by the same or different sizes of protrusion in the peritoneum on both sides of the inguinal or scrotal regions.
2) Left-sided localization of PG - manifested due to the anatomical features of the peritoneum. A protrusion on the left side can be from the side of the internal organs - the intestines or Bladder, greater omentum or ovaries.
3) Right-sided protrusions - a consequence of an imbalance in pressure between the surrounding muscles and internal organs. Initially, depressions are formed in the abdominal cavity, followed by the introduction of intestinal loops, omentum or bladder into it, increasing local pressure.

As a result of stretching of the tissues of the peritoneum, a hernial membrane is formed, with subsequent transformation into a hernial sac.

Symptoms of an inguinal hernia in men

Clinical symptoms of PG are manifested in the following moments:

tumor-like protrusion;
pains;
belching and nausea;
constipation or frequent urination;
feeling of discomfort and burning in the groin.

The most objective symptom of an inguinal hernia in men is a characteristic protrusion, which manifests itself in the place where the hernial orifice arose (see photo). Quite often, an inguinal hernia can descend into the scrotum, thereby increasing its volume.

Probability of Consequences

Men should know all the consequences of not being treated, and they are very serious. The most formidable complication is the incarceration of the hernia, which may result in necrosis of the incarcerated organs and the development of purulent-inflammatory diseases of the internal organs.

In addition, infringement is fraught with various complications in the form of:

acute urinary retention;
dysfunctions of the gastrointestinal tract;
constipation and;
potency disorder;
violation of spermatogenesis, which leads to.

Treatment of inguinal hernia in men

Diagnosis for hernia in the groin is carried out during examination and palpation of the protrusion, to assess the position, shape and size of the formation. Further refinement is carried out during the operation.

The only effective treatment for inguinal hernia in men is surgical intervention. Now the operation is performed mainly by the laparoscopic method, using 3-4 punctures in the lower abdomen the size of a pencil in diameter, or in the old fashioned way, through a regular incision in the groin. It all depends on the desire of the man, the presence of contraindications and financial possibilities.

Conventional surgery can be performed under local anesthesia, while laparoscopy uses only general or combined anesthesia. In any case, the person is unconscious during the entire operation. Because of this, some people prefer a standard incision under local anesthesia, as they are afraid of the "waste" from a stronger anesthesia.

1) Surgical intervention is carried out using the methods necessary for this case, created by various authors;
2) The most effective method is the creation of a surgically supporting fold or plastic of the posterior wall of the canal using a special mesh;
3) Operation of herniotomy with the use of abdominal wall plasty;
4) Congenital types of PH are treated by intraperitoneal and extraperitoneal access laparoscopic hernioplasty.

Conservative treatment of inguinal hernia in men is used only in exceptional cases, when there are contraindications to surgery. The protrusion is injected with drugs in order to eliminate them and turn them into scar tissue. This method is fraught with serious complications and is used in hopeless situations.

In addition, it is possible to use a special bandage that will support the PG and prevent it from falling out. However, this is a temporary measure, because the hernial orifice cannot be closed in this way, and as soon as you remove the bandage, the inguinal hernia will come out back. Therefore, surgery is indispensable.

Operations performed for inguinal hernia

How long the operation will take will depend on the technique chosen. On average, it lasts no more than 90 minutes. Preference is given to the following methods:

1) Lichtenstein operation. The bottom line is to strengthen the posterior wall of the inguinal canal with a specialized mesh. Strengthening is done behind the spermatic cord. This technique has its undeniable advantages among other methods of treatment and is a "classic". The main advantages of the Liechtenstein operation include: an extremely low recurrence rate (close to zero), a short rehabilitation period, a minimal risk of traumatic damage to the urinary tract, as well as a minimal possibility of developing postoperative complications from the cardiovascular and respiratory systems, mild pain syndrome, the ability to perform the operation under local anesthesia;
2) Operation Trabucco. It is one of the modifications of the Liechtenstein method. More often, it uses a one-component flat prosthesis, which is not fixed with sutures (there is no need for hemming due to the high rigidity of the mesh material);
3) Endoscopic hernioplasty. This technique is performed under the mandatory control of specialized endoscopic equipment. The reinforcing mesh can be placed by abdominal preperitoneal or extraperitoneal methods. In the first case, the mesh is located between the muscular-aponeurotic layer and the peritoneum itself. In the second case, the intervention is performed without penetration into the abdominal cavity: the mesh is installed between the peritoneum itself and other layers of the anterior abdominal wall. The main advantages of such an intervention are: the ability to simultaneously assess the situation from two sides, a low percentage of possible recurrence, weakness of the pain syndrome, the minimum size of surgical incisions (punctures) and postoperative scars, quick rehabilitation, the ability to perform physical activity after a short time after the transferred operation;
4) Obstructive hernioplasty. A feature of this type of treatment is the obturation of the hernial orifice with a mesh prosthesis. Hemming when strengthening the inguinal canal is not used. This operation, like the previous one, allows you to control the course of manipulations from both sides. In addition, it has a short postoperative period, the ability to perform exercise a few days after the therapeutic intervention, a low percentage of relapse, minimal pain;
5) Application of UHS, PHS systems. Obturation of the hernial orifice is performed using implants made of semi-absorbable or polypropylene materials. For the purpose of obturation, a monoblock implant is used. It has 2 parts: one of them is attached to the preperitoneal space, and the second is somewhat more lateral (between the layers of the anterior abdominal wall).

Which doctor should I contact for treatment?

If, after reading the article, you assume that you have symptoms characteristic of this disease, then you should

Inguinal hernia in men, the symptoms of which in most cases cause only aesthetic discomfort, is almost always subject to only surgical treatment. It should be borne in mind that the painlessness of the existing protrusion can persist throughout life, but the risk of complications is not excluded. If the hernial sac is infringed, in addition to the occurrence of intense pain, if qualified medical care is not provided in a timely manner, everything can end badly.

A hernia occurs as a result of the prolapse of organs from the cavity through weakened places - the hernial orifice. In addition to changing their normal anatomical position, the organs are not damaged. There are many reasons for the formation of an inguinal hernia. This may be heredity, intense physical labor, physique, frequent constipation, and so on.

When conducting a visual examination of the patient, in men, the symptoms of an inguinal hernia are characterized by the presence of a kind of protrusion. It is soft and if there are no pathological complications, then it does not cause pain on palpation.

The form of the hernial protrusion, which is lowered into the scrotum, is elongated. However, the hernia can also take on a rounded shape.

According to medical observations, the causes of neoplasms in the groin in a man who has a genetic predisposition to hernia are intense physical activity.

Signs of an acquired form of pathology are as follows:

Hernial protrusion can be independently set into place. To do this, you need to click on it. As a rule, at the moment the contents of the hernial sac return to their place, the patient will hear a characteristic rumbling.
The hernial protrusion may decrease in size or disappear completely when the man assumes a horizontal position. When he gets up again, the protrusion reappears.
When probing after reduction, the hernial ring is easily detected.
When lowering the hernial sac into the scrotum, this is recognized by its increase several times.
Hernial protrusion increases in size when lifting weights, sneezing and other physical exertion.

This symptomatology is typical in the presence of a hernia of a small size. If the protrusion is large, then the symptoms manifest themselves more clearly. The patient may complain about pain at the site of the pathogen. Unpleasant sensations can radiate to the lower back or spread to the entire abdomen. Due to the compression of the intestinal loops in the hernial sac, the patient may have problems with the stool. Frequent constipation will only exacerbate the current situation. The problems with the health of the digestive tract do not end there. A man may complain of frequent bloating.

In the event that part of the bladder disappears into the hernial protrusion, the patient has difficulty with the act of emptying it.

If the cecum enters the hernial sac, the patient may experience the following symptoms:

acute pain in the abdomen;
increase in body temperature;
constipation;
diarrhea;
general feeling of malaise.

Symptoms of strangulated inguinal hernia

Infringement of the hernial protrusion is one of the most common complications. The symptomatology of this pathological process is manifested in the form of the onset of pain. It is so intense that the man is unable to restrain his screams.

In most cases, infringement is preceded by physical activity. The victim begins to experience pain that does not go away even if you completely relax. This process is explained by the fact that the vessels and nerves of the omentum or intestines are squeezed. It is possible to presumably diagnose the infringement of a hernial protrusion by the following signs:

tension of the hernial sac;
inability to correct a hernia;
pain syndrome in the lower abdomen;
lack of coughing impulse;
bloating;
constipation;
signs of intoxication;
lowering blood pressure;
tachycardia.

When an infringement is diagnosed, the patient is shown immediate medical attention. If no action is taken in a timely manner, the patient's well-being will continue to deteriorate. After some time, the process of inflammation of the abdominal cavity - peritonitis - will begin to occur. The tissues that get into the hernial sac will begin to die.

If a man with an inguinal hernia develops dangerous symptoms and treatment is delayed, a fatal outcome is possible.

Treatment of pathology

As a diagnostic, in addition to a general survey and examination by palpation, ultrasound may be required to determine the pathology.

Despite numerous advances in the field of medicine, today the only possible treatment for inguinal hernia in men is surgery.

In the event that there is a need to delay the date of surgery, the man is shown wearing a special supporting bandage. It helps prevent an increase in hernial protrusion, and is also a means of preventing infringement.

Male disease does not need emergency assistance if the symptoms do not indicate a complication. Therefore, the operation is carried out as planned. Its purpose is to remove the protrusion and strengthen the hernial ring. There are 2 types:

Partial removal. Only the hernial sac itself is subject to excision. The hernia gate is reinforced with a special mesh. This is necessary in order to avoid future recurrences of the disease.
Complete removal is performed in conjunction with suturing the inguinal opening.

Surgery can be classical or laparoscopic. If possible, preference should be given to method 2 of surgical treatment. The fact is that laparoscopy involves the introduction of all the necessary tools into the body through several punctures that are made in the lower abdomen.

Laparoscopic surgery is considered less traumatic for the patient, which makes it possible to avoid a long recovery period.

The operation to remove the hernial sac in the groin area is mainly performed using general anesthesia. Local anesthesia is practiced in conventional (classical) surgery.

The time it takes a doctor to repair an inguinal hernia will depend on the size, presence of the infringement, the anesthesia used, and the type of surgical treatment chosen.

rehabilitation period

With a complete removal, the recovery period takes much longer.

Rehabilitation therapy consists of:

Dieting. Food products should not irritate the mucous membranes and cause increased gas formation.
Physical restrictions. The first 2 days a man is not recommended to get out of bed. But so that adhesions do not form, if there are no complications, bed rest should be supplemented with periodic walks around the room.
Regular dressings and treatment of postoperative wounds.
Wearing an inguinal bandage. This recommendation is especially relevant for patients who are overweight.

If the postoperative wound heals according to the established norms, then after about 7-10 days the sutures are removed. For some time, you will need to limit yourself from lifting weights and playing sports. When exactly a man can return to a full life, only a doctor can determine. It is based on the degree of tissue regeneration, the general well-being of the patient and other individual characteristics.

Inguinal hernia is a fairly common disease in which there is a protrusion of the peritoneum into the inguinal canal.

According to statistics, in men, an inguinal hernia is formed 10 times more often than in women, which is associated with the peculiarities of the anatomical structure of the inguinal region in men. However, cases of inguinal hernia in women are not so rare. Usually the disease occurs in women who have given birth several times.

The appearance of a hernia can cause obesity, chronic cough, constipation, pregnancy, excessive sudden physical activity.

Causes of development and provoking factors

Inguinal hernia in men is much more common, due to the structural features of the inguinal canal. Inside it passes the spermatic cord, and in early childhood the testicles descend from the abdominal cavity into the scrotum. That is why the entrance to the inguinal canal remains expanded, and the canal process of the peritoneum does not overgrow. Soon, the boy is growing, and in the presence of provoking factors, the abdominal organs can go into the "free space".

In older men, the inguinal canal is a "weak spot" for the same reasons. Acquired ones join the congenital risk factors, the muscles of the anterior abdominal wall weaken, and a hernial protrusion forms.

Factors that contribute to the appearance of hernias of the anterior abdominal wall include:

heavy physical activity - sports and professional;
diseases that cause increased pressure in the abdomen - chronic obstructive pulmonary disease, bronchial asthma, acute bronchitis and pneumonia,
diseases of the gastrointestinal tract, cirrhosis of the liver;
bad habits - smoking (causes a long, unproductive cough) and alcoholism;
obesity is a common factor in men over 40 years of age, which increases the load on the anterior abdominal wall, and does not allow a hernia to be detected for a long time.

Classification

Inguinal - a hernia is located in the inguinal canal, near its external opening.
Cord - a hernia descends lower, is located in the scrotum, near the spermatic cord, but does not descend to the level of the testicle.
Inguinal-scrotal - a hernia descends into the scrotum, located next to the testicle

Types of inguinal hernias depending on the location of the hernial sac:

Oblique - pass through the inguinal canal, next to the spermatic cord;
Direct - go into the inguinal canal, bypassing its internal opening, through a weakened abdominal wall;
Combined - two or more hernias on one side that are not connected.

Symptoms of inguinal hernia, photo

Symptoms that reveal the presence of an inguinal hernia in men can vary greatly. But there are a number common manifestations this problem. Groin hernia (see photo) makes itself felt as follows:

a noticeable protrusion in the groin, which can be of different sizes;
redness of the skin at the site of the neoplasm;
tangible discomfort when lifting weights, heavy physical exertion;
pain in the lower abdomen;
a burning sensation at the site where the hernia is located;
pain, nausea, vomiting.

With a groin hernia, a person feels relief when taking a horizontal position. Hernial formations of large sizes cause discomfort when walking. At the same time, a hernia may not appear at all for a long time. But if even a small tumor occurs in the groin area, you should immediately contact a specialist. This will help to establish the correct diagnosis.

Infringement of inguinal hernia

This condition develops as a result of sudden compression of the contents of the hernial sac in the hernial orifice. There are two mechanisms of infringement:

The elastic mechanism is the sudden entry of a large amount of the viscera of the abdominal cavity into the hernial sac through the narrow hernial orifice. This can happen with a sharp increase in intra-abdominal pressure (for example, with a sharp physical exertion). Fecal infringement occurs as a result of overflow with the contents of the intestinal loop, which is located in the hernial sac. Infringement of the inguinal hernia is manifested by a sharp severe pain in the abdomen. The protrusion, which previously could be adjusted without effort, becomes irreducible and tense. Often this condition is accompanied by fever, nausea, vomiting and stool retention.

In case of infringement of the inguinal hernia, emergency surgical intervention is necessary.

Complications

The main complications of an inguinal hernia are: strangulation, coprostasis, irreducibility, inflammation, and damage to the hernia. More rarely, neoplasms and foreign bodies of a hernia occur.

The irreducibility of a hernia occurs as a result of the development in the hernial sac of adhesions of the internal organs between themselves and with the hernial sac, which is due to the traumatization of the hernial contents. Irreducibility can be partial (when part of the contents of the hernia can be reduced into the abdominal cavity, and the other part is not) or complete (the entire contents of the hernia is not reduced into the abdominal cavity).
Coprostasis (stagnation of feces) develops in cases where the contents of the hernial sac is the large intestine, as a result of a disorder in the motor function of the intestine. Contributes to the development of coprostasis irreducible hernia, plentiful food intake and a sedentary lifestyle. It is more common in older patients with increased body weight. Manifested by intractable constipation, abdominal pain and nausea, rarely vomiting. Coprostasis can lead to fecal incarceration of the hernia. Inflammation of a hernia develops when the hernial sac becomes infected, which is possible with acute inflammation appendicitis (appendicitis) or Meckel's diverticulum, trapped in the hernial sac, with peritoneal tuberculosis. At the same time, the general condition of patients suffers, the body temperature rises, chills occur, vomiting appears, stool retention and difficulty in passing gases. The size of the hernia increases, each reddens above it.
Hernia injuries can lead to rupture of the intestine in the hernial sac and occur with a sharp increase in intra-abdominal pressure, with direct trauma to the hernia, or due to bruising of the abdominal wall away from the hernia.
Neoplasms of a hernia are very rare; they can originate from the contents of the hernia, the hernial sac, or surrounding tissues and organs. The most common are lipomas (wen) of the hernial sac.

Foreign bodies in the hernial sac can be objects swallowed by the patient, worms, bladder stones.

Diagnostics

Primary diagnosis is carried out at the reception of a surgeon. It consists in collecting an anamnesis and complaints, visual and palpation examination of the patient. The location of the hernia, its size and degree of reducibility are determined. After that, additional diagnostic methods are assigned.

Laboratory diagnostic methods

Laboratory examination includes the determination of the following parameters.

A general blood test with the formula - an increase in ESR and an increase in the number of leukocytes indicates the beginning of the development of the inflammatory process.
Biochemical blood test - allows you to determine the violation of the abdominal organs, including the urinary system.
Tests to determine the patient's blood type, coagulogram, HIV and hepatitis (in preparation for surgery).

To obtain a complete picture, instrumental diagnostics are prescribed.

Instrumental research methods

Depending on the localization of the hernial formation, certain types of examination are prescribed.

Ultrasound of the abdominal organs - the presence of displacement of organs and their actual location is determined.
Ultrasound of the bladder - reveals the degree of involvement of the bladder in the overall process and signs of acute urinary retention.
Ultrasound of the pelvic organs - allows you to determine the location of the organs of the genitourinary system and the presence of pathological abnormalities.
Irrigoscopy - is prescribed for suspected pinching of the loop of the large intestine. Also, with its help, you can see the presence of cicatricial changes in the walls, tumor formations and other pathologies.

Treatment of inguinal hernia in men

Completely and permanently get rid of the inguinal hernia can only be surgically. Many authors at different stages of the development of medical science have proposed various methods of hernia treatment. Many methods are currently practically not used due to the fact that after them a relapse is likely to occur, and are only of historical significance.

The surgeon deals with the treatment of inguinal hernias. In the absence of complications and contraindications, the patient undergoes a planned surgery in the hospital. The operation can be performed under general anesthesia or local anesthesia. The hernial sac is excised, if there are abdominal organs in it, the surgeon sets them back. After this, the anterior abdominal wall is strengthened. To do this, plasty is performed by surrounding tissues or by sewing in a mesh graft.

If the patient currently has contraindications to surgical treatment, it is possible to perform temporary conservative treatment - wearing a bandage.

Treatment without surgery

The bandage helps to alleviate the condition and is not a 100% method of treating an inguinal hernia without surgery. It is worn at home, as well as outdoors under clothing. The bandage helps to keep the hernia in its original position, thereby preventing it from falling out and causing discomfort.

After elimination of contraindications, surgical treatment is performed. After the surgical treatment, the patient stays in the hospital for several days for observation and processing of sutures. The stitches are removed after 7-10 days.

Wearing a bandage for inguinal hernia

Performing a surgical intervention

Methods of surgical operations:

Laparoscopy - suturing a hernia with an endoscope through a puncture of the abdominal wall using a mini-camera, micro-endoscopic instruments and with the installation of a mesh;
Operative hernia repair. Various methods of surgical treatment of inguinal hernia are used (Bassini, Matrynova, Ruggi, etc.)

The patient is discharged from the hospital a few days after the treatment. Pain at the same time in the area of punctures in the postoperative period is insignificant. Full recovery after removal of an inguinal hernia occurs after 3-6 months. During this period, heavy physical labor should be avoided. Meals should be easily digestible food so that the patient does not experience constipation.

With the development of a strangulated inguinal hernia, emergency surgical treatment is performed. At the beginning, the surgeon opens the hernial sac and assesses the state of the organs contained in it. Since if the intestinal tissues in the hernial sac are dead, they are excised. And then the hernial sac is excised and the anterior abdominal wall is strengthened. After the modern methods treatment of inguinal hernias, their recurrence is extremely rare, provided that all recommendations are followed in the postoperative period.

Postoperative period

After performing the operation of hernioplasty of the inguinal hernia in a planned manner, the patient should adhere to bed rest for about a day. After spinal anesthesia, the patient will not feel the lower body for approximately 4-6 hours. When the sensitivity returns, you can turn on your side. The first meal and water can be done after 12-24 hours, you should start with the usual soup, jelly, sweet tea or simple mineral water. Further, the diet expands and it is allowed to eat the usual food for the patient.

It is allowed to get out of bed the next day after the operation, preferably with the help of strangers. Further, strength will gradually appear and it is allowed to walk independently.

Medical therapy:

painkillers are administered during the first 3-4 days;
antibiotics (depending on the duration and course of the operation) for 1 to 3 days;
anticoagulants (drugs that significantly reduce blood clotting) daily for 7 days, if there are concomitant
diseases, age after 40 years, obesity, diseases of the veins of the lower extremities.

For 1-2 months, it is strictly forbidden to engage in heavy physical work, you need to lead a sparing lifestyle, after the 2nd month you need to gradually increase the load.

Large inguinal-scrotal hernia in an adult male.

Can a recurrence occur after surgery?

After surgery, inguinal hernias recur in 2-10% of patients.

Possible reasons for relapse:

not quite correctly chosen surgical tactics, errors during the operation;
intense physical activity after surgery;
concomitant diseases accompanied by severe cough;
constipation;
suppuration at the site of operation;
prostate adenoma, which was not cured before surgery;
non-compliance by the patient with the appointments and recommendations of the doctor in the postoperative period.

The only effective way to treat postoperative inguinal hernia is surgery. The operation is quite complicated due to the fact that after the previous intervention, the anatomical relationships in the inguinal region have been changed, there is a scar.

Other possible complications after surgery for inguinal hernia:

suppuration in the area of sutures - treatment in the department of purulent surgery, opening of the abscess, a course of antibiotics is necessary;
bleeding - stop with medication or in the operating room;
severe pain - various painkillers are used.

Prevention

To prevent the formation of an inguinal hernia, it is necessary to exclude factors that increase intra-abdominal pressure: weight lifting, chronic constipation, excessive strength sports training.

If a man wants to start bodybuilding, then he needs to first strengthen his back and abdominal muscles for several months. Loads must be increased gradually. Exercises to strengthen the press can be used as an effective prevention of the appearance of inguinal hernias, but in the absence of a risk of hernial protrusion.

Congenital hernia cannot be prevented in any way. Parents should carefully monitor the child, especially if he was born with undescended testicles. If you have any doubts, it is recommended to contact a pediatric surgeon.