Femoral hernia: symptoms, diagnosis, treatment, laparoscopy

A femoral hernia is the passage of preperitoneal fat or peritoneally covered abdominal organs through the femoral canal medially from the femoral vein into the area of ​​the femoral triangle.

This type of hernia is dangerous due to the high probability of strangulation, so if symptoms are detected, you must contact a surgeon for treatment.

Femoral hernias are more common in women than in men. As a rule, the problem occurs in women after 40 years of age, due to a decrease in the elasticity of connective tissue.

Femoral triangle and hernia

Between the inguinal ligament and the pelvic bones there is a space that is divided by the iliopectineal fascia into two lacunae - muscular and vascular. The muscular lacuna contains the iliopsoas muscle and the femoral nerve, and the vascular lacuna contains the femoral artery and femoral vein. Between the femoral vein and the lacunar ligament there is a gap filled with fibrous connective tissue and the Pirogov-Rosenmüller lymph node. And this gap is called the femoral ring, through which the femoral hernia emerges.

Femoral hernias can occur:

• inside the femoral canal (C),
• medially (M),
• lateral (L) from it,
• prevascular (P),
• retrovascular (R).

Femoral hernia: features of manifestation

Worried about discomfort and pain between the groin and thigh?
Have you noticed a painful swelling on your thigh that appears with any load? All this may indicate a femoral hernia, so be sure to consult a doctor. The main danger of a hernia is the high risk of strangulation of the hernial sac. Compression of tissues, blood vessels and nerves is accompanied not only by pain, but also by disruption of their functioning, with further necrosis of the strangulated area, peritonitis and even sepsis. Timely surgery will help avoid complications and get rid of the hernia forever.

Prevention

Nonspecific preventive measures to reduce the risk of developing a femoral hernia include: maintaining the muscles of the lower abdomen in proper shape (training the abdominal muscles), wearing bandages during significant physical activity/pregnancy, balanced nutrition, timely/adequate treatment of diseases of the genitourinary tract/intestines, refusal smoking to prevent chronic cough.

Prevention of Baker's cyst comes down to:

• Timely/adequate treatment of knee joint diseases.
• Monitoring body weight and correcting it if necessary.
• Controlling the load on the knee joint.
• Regular exercises for joints.

Types of femoral hernias

Based on location, unilateral and bilateral femoral hernias are distinguished. According to clinical signs they are divided into:

• Reducible - which can be easily adjusted in a lying position with gentle pressure on the protrusion with your hand.
• Irreducible - partially reducible or not completely reducible.
• Strangulated - sharp compression of the hernial sac, dangerous for the development of intestinal obstruction, with stagnation of feces, gangrene with tissue necrosis, sepsis.

There are the following stages of pathology development:

• Primary – the formation does not protrude beyond the femoral ring and does not manifest itself in any way.
• Canal (incomplete) – the protrusion is located in the femoral canal, but does not protrude beyond its boundaries.
• Complete - the hernial sac protrudes from beyond the boundaries of the femoral canal under the skin in the area of ​​the inguinal fold on the thigh.

More often, the disease is detected in the advanced (complete) stage.

General information

In this article, we will look at a hernia of the inguinal-femoral zone, namely, a femoral hernia and hernias of other parts of the body that are relatively rare, in particular the knee joint - Baker's hernia (cyst), muscle hernia and coccyx hernia.

Femoral hernia

Femoral hernia in men and women accounts for 5-8% of all abdominal hernias. Significantly more common in females, predominantly mature/elderly (80%), less common in young multiparous women. The female/male sex ratio in various studies varies from 1.8:1 in the USA/European countries to 4:1 (in the Russian Federation), which is due to the greater width of the female pelvis, which is the cause of the relative weakness of the Pupart ligament and the greater severity of the vascular/muscular lacunae. Femoral hernias in women are prone to more frequent parietal strangulation than other hernias (umbilical/inguinal).

A femoral hernia is a protrusion located in the lower abdomen, caused by the exit of internal organs through the femoral canal beyond the abdominal wall.

Anatomically, the femoral canal is normally absent and is formed only during the formation of a hernial protrusion. The weakest point is the area located directly under the inguinal ligament (between the pelvic bones and the inguinal ligament). This space is divided by the iliopectineal fascia into muscular/vascular lacunae. The muscular lacuna contains the femoral nerve/iliopsoas muscle, and the vascular lacuna contains the femoral vein/artery. The space between the lacunar ligament and the femoral vein is filled with fibrous connective tissue and a lymph node . It is through this gap that the femoral hernia emerges and is called the femoral ring . That is, in most cases, a hernia is formed in the area of ​​the vascular lacuna. A strand of the omentum and part of the small/large intestine most often enter the hernial sac. In women, the fallopian tube, bladder and ovary may additionally enter the hernial sac. The formation of protrusions in the anatomical region of the muscle lacuna occurs extremely rarely, since it is limited by a strong fascial layer. The external opening of the femoral canal is the fossa oval, which is located on the lata fascia of the thigh.

Anatomically, a femoral hernia does not differ from other abdominal hernias and includes the hernial orifice, hernial sac, hernial membranes and hernial contents. The development of a femoral hernia includes several stages:

• Initial stage - the hernial protrusion does not protrude beyond the femoral ring and is not clinically manifested.
• Canal stage - the protrusion is already located in the femoral canal, but does not protrude beyond its boundaries.
• Full stage - the hernial sac visually protrudes under the skin from the femoral canal in the area of ​​the inguinal fold of the thigh.

As a rule, a hip hernia is diagnosed in the full stage.

Baker's hernia

According to their shape, cysts are classified as crescent-shaped, grape-shaped, slit-shaped, oval and horseshoe-shaped cysts.

Becker's hernia (below the knee)

Baker's hernia (synonyms - Baker's cyst, popliteal hernia, popliteal bursitis, synovial cyst of the popliteal region) is an elastic protrusion (formation) in the area of ​​the popliteal fossa, formed as a result of the inflammatory process in the knee joint (photo below).

The incidence of synovial cysts among pathologies of the knee joint varies from 3.4% to 20.8% and are most often found in rheumatic diseases , as well as in patients with gonarthrosis at various stages of the degenerative-dystrophic process. Popliteal hernia is much more common in women, accounting for 68.9% of cases. It can exist either for a short period of time due to the resorption of fluid with its reverse development until it completely disappears, or it can be chronic for life in cases of the development of persistent synovitis of the joint .

The size of Baker's cysts varies significantly: in most patients (68.5%) the cyst volume is up to 10 ml; in 25% of cases their volume exceeds 50 ml. As a rule, Baker's cyst is single-chamber; multi-chamber cysts are extremely rare.

Essentially, a Baker's cyst (BC) is a synovial bursa of the popliteal fossa, distended with fluid, which is localized in the medial part of the popliteal fossa between the semimembranosus and the inner head of the gastrocnemius muscle, communicating through the anastomosis with the knee joint.

The number/size of bursae communicating with the cavity of the knee joint varies significantly, of which the most constant are:

• Bursa of the semimembranosus muscle (located in the area of ​​the medial femoral condyle between the medial head of the gastrocnemius and the tendon of the semimembranosus muscle).
• The medial bursa of the gastrocnemius muscle (localized between the capsule of the knee joint and the beginning of the medial head of the gastrocnemius muscle.
• The popliteus muscle bursa is always located at the level of the inferolateral inversion, between the tendon of the femoral muscle and the posterior wall of the inversion.
• The density of the joint capsule of the knee joint is not the same in a number of places, and the space between the ligaments of the posterior part of the joint is especially weakened, which becomes the most common place for a hernia of the synovial membrane of the joint. As cysts grow, they can compress the anatomical formations located in it (neurovascular bundle), causing various neurovascular disorders in the distal parts of the legs.
• Baker's cysts can significantly limit the functions of the knee joint, compress the neurovascular bundle in this area, and less often, their dissection or rupture is observed.

Muscle hernia

It occurs due to a rupture of the muscle fascia, mainly as a result of injuries (sharp jerk, strong blow, dislocation, falling of a heavy object). When it ruptures, muscle fibers protrude into the resulting opening, that is, a muscle hernia is formed, which can have very different localizations. The main manifestation of this type of hernia is a protrusion, which can appear when the muscle is tense or be permanent. Swelling is characteristic at the site of the protrusion and in the immediate area, which can compress the nerve fibers/surrounding tissues.

Patients are concerned about pain in the area of ​​injury, decreased mobility, numbness and tingling in the damaged muscle. For serious fascial tears, surgical treatment is performed; for minor injuries, painkillers, anti-inflammatory drugs are prescribed, and specially selected compression stockings/bandages are worn, which reduce the load on the muscles and adjacent tissues and allow the muscle to take a physiologically normal position.

Coccyx hernia

The coccyx area often becomes a target for the formation of hernial pathology of the spine, the peculiarity of which is that it is formed not due to protrusion of the disc nucleus, as hernias form in other parts of the spinal column, but due to a tear in the fibrous membrane. It manifests itself as pain when sitting on a hard surface, pressing on the tailbone area, during childbirth. The pain may radiate to the groin, anus, or thighs (coccydynia). Diarrhea , constipation , difficulty urinating, cramps in the thighs and calf muscles, and numbness of the legs may also appear Treatment is predominantly conservative, in severe cases - surgical intervention.

Why surgery is needed

• A conservative approach to the treatment of femoral hernias is not effective.
• The hernial sac that slips through the femoral ring enlarges over time and ceases to be reduced.
• Even the smallest protrusion is often complicated by pinching.

At the GMS Hospital Hernia Treatment Center, treatment of femoral hernias is carried out using hernioplasty, which provides the following advantages:

• The use of microsurgical techniques and modern mesh devices allows minimizing trauma to the patient’s tissues.
• Stay in the hospital for no more than 1-3 days (depending on the scope of the intervention).
• Full recovery after surgery takes only 3-6 weeks.

Consequences and complications

Femoral hernia

The main complications of a femoral hernia include: inflammation of the serous/purulent type, coprostasis and strangulation of the hernia. The inflammatory process most often begins with the contents of the hernial sac (part of the intestine, appendix, uterine appendages, etc.), much less often the inflammatory process passes to the hernial sac directly from the skin. skin hyperemia occurs , the inflamed hernia becomes swollen, pain appears/intensifies, and body temperature may rise. An extremely dangerous complication is the development of peritonitis .

In cases of strangulation of the femoral hernia, an acute disruption of the innervation/blood supply to the organs/tissues of the hernial contents develops extremely quickly. The hernia sharply increases in size, becomes dense, unreducible, and sharply painful on palpation. Severe pain occurs in the pinched area, and there is retention of stool and gases. With prolonged strangulation there is a high risk of developing intestinal obstruction .

Baker's hernia

Baker's cyst, in the absence of timely/adequate treatment, can provoke:

• compression of the neurovascular bundle (tibial nerve, lymphatic/blood vessels, which appears as numbness, muscle weakness in the knee joint, swelling/pain of the lower leg;
• deep vein thrombosis and thrombophlebitis of the vessels of the leg , the development of varicose veins of the saphenous veins of the leg;
• rupture of the cyst, caused by high pressure as the tumor increases, with the contents of the cyst spilling into the intermuscular space of the upper third of the leg, which is manifested by swelling, pain, redness and increased temperature.

Causes of femoral hernia formation

The prerequisites for the development of a femoral hernia in men and women are weakness of the peritoneal muscles (rectus and oblique abdominal muscles). Sometimes it is congenital (in babies under one year old), but more often the defect occurs due to a regular increase in intra-abdominal pressure, due to:

• Rapid weight change
• Pregnancy
• Difficult birth
• Physical overexertion
• Abdominal wall injuries
• Severe, prolonged cough
• Regular constipation

Due to the specificity of the anatomy, hernial protrusion on the thigh is more often diagnosed in women and children.

Classification

Femoral hernia

Based on the location of the exit gate, several types of femoral hernia are distinguished:

• Typical femoral hernia (exits through the inner part of the vascular lacuna, which turns into the femoral canal).
• Femoral lacunar ligament hernia (exits directly through a defect in the lacunar ligament).
• Femoral-total hernia of the vascular lacuna (the protrusion occupies the entire vascular lacuna).
• Femoro-intravaginal hernia of the vascular lacuna (exits in the area of ​​the vagina itself).
• Femoral-lateral hernia of the vascular lacuna (exits between the artery of the iliac and pectineal ligament on the lateral side).
• Hesselbach's hernia (femoral hernia of the muscle lacuna) is formed in the area of ​​the femoral nerve.

Based on the location of hernial protrusions, they are divided into:

• unilateral femoral hernias, 60% of which are hernias on the right and 30% on the left;
• bilateral femoral hernias account for about 10%.

Taking into account the clinic, the following are distinguished:

• reducible (retracts into place at rest on its own);
• irreducible (does not disappear when changing body position);
• disadvantaged.

Becker's hernia

Highlight:

• Primary Baker cysts, the formation of which occurs in the absence of any intra-articular pathology (found in children/adolescents).
• Secondary Baker cysts (formed due to damage to intra-articular structures).

According to their shape, cysts are classified as slit-shaped, crescent-shaped, oval, grape-shaped and horseshoe-shaped cysts.

Cost of treatment for femoral hernia

The prices indicated in the price list may differ from the actual prices. Please check the current cost by calling +7 495 104 8605 (24 hours a day) or at the GMS Hospital clinic at the address: Moscow, st. Kalanchevskaya, 45.

Dear Clients! Each case is individual and the final cost of your treatment can only be found out after an in-person visit to a GMS Hospital doctor. Prices for the most popular services are indicated with a 30% discount, which is valid when paying in cash or by credit card. You can be served under a VHI policy, pay separately for each visit, sign an agreement for an annual medical program, or make a deposit and receive services at a discount. On weekends and holidays, the clinic reserves the right to charge additional payments according to the current price list. Services are provided on the basis of a concluded contract.

Plastic cards MasterCard, VISA, Maestro, MIR are accepted for payment. Contactless payment with Apple Pay, Google Pay and Android Pay cards is also available.

Western standards of treatment (evidence-based medicine)

Continuous staff development

Regular interaction with leading Russian and foreign medical institutions

Modern medical equipment and advanced diagnostic and treatment methods

Unified standard of service

We work around the clock 24/7/365

Make an appointment We will be happy to answer any questions Coordinator Oksana

Types of dorsal hernias

Depending on where the protrusion of the nucleus pulposus is directed, the following types of dorsal hernias are distinguished:

• paramedian - the hernia is located on the left or right side of the spinal canal;
• median - a protrusion forms in the center of the spinal canal (most often, median dorsal hernia L4–L5, L5–S1 is diagnosed);
• foraminal - grows into narrow foraminal openings formed by vertebral bodies, discs and facet joints;
• diffuse - a herniated intervertebral disc tends to gradually occupy the entire space of the spinal canal, since the protrusion extends to the entire posterior surface of the disc.

A complication of each of them can be sequestration of the formation. That is, during degenerative processes, the part of the nucleus pulposus that has gone beyond the fibrous ring can “come off” and be able to move freely along the spinal canal. In such cases, sequestered hernias are diagnosed, which is an indication for emergency surgery, as it is fraught with dangerous complications.

Signs and symptoms

In the first stages, the pathology has no visible clinical symptoms.
Occasionally, discomfort and pain in the inguinal-femoral fold may occur, aggravated by coughing, walking or other physical activity. The clinical picture of the full stage of the disease is expressed by the following symptoms:

• Visible protrusion in the inguinal-femoral fold.
• Disorder of urination (if parts of the bladder get into the hernial sac).
• Pain in the groin or lower abdomen.
• Flatulence, constipation, nausea, vomiting (if the hernia is formed by an intestinal loop).

If you have at least one of the above signs, do not delay your visit to the surgeon. The problem will not go away on its own, traditional and conservative methods will not help, the only solution is surgery.

Symptoms

Symptoms of a femoral hernia

The symptoms of a femoral hernia in men and the symptoms of a femoral hernia in women are identical. Symptoms are determined by the stage of development of the hernia, size, reducibility of the protrusion, the presence of complications and the nature of the prolapsed tissues/organs. The main symptom of a complete femoral hernia in men and women is a small hemispherical protrusion located in the femoral-inguinal flexion area (inward of the femoral vessels under the inguinal ligament). Hernial protrusion is clearly visible visually when the body is in an upright position, and especially when straining (photo below).

In uncomplicated cases, it disappears upon self-reduction, sometimes with rumbling. Percussion over the protrusion - a tympanic sound, a characteristic positive symptom is a cough impulse, dysuria . The occurrence of pain is usually associated with partial short-term strangulation of the contents of the hernia.

Baker's hernia

With a small size of Baker's cyst, it is not visually detectable, painless, palpation is difficult, and against the background of symptoms of diseases of the knee joint, the specific clinical picture of KB is practically absent. As it reaches a larger size, it is clearly visually defined and palpated in the form of an oblong-ovoid, densely elastic tumor-like formation, localized mainly in the medial parts of the popliteal region (up to 90% of cases).

Due to the presence of a mechanical obstacle to the function of flexion in the knee joint, patients complain of discomfort, pain during physical activity along the posterior surface of the joint and the presence of a tumor-like formation in the popliteal fossa. The main symptoms, besides pain, are:

• feeling of pressure in the popliteal fossa;
• presence of swelling;
• difficulty moving in the knee joint, less commonly - periodic blockades of the joint.

Also, the symptom complex may additionally include pain in the calf muscles and impaired sensitivity of the back of the lower leg, which manifests itself more often after going up and down stairs/long walking. Symptoms can be either isolated or combined with symptoms of diseases of the knee joint or intra-articular pathology (damage to intra-articular structures, rheumatoid arthritis , osteoarthritis ).

Diagnostics

A muscle hernia on the thigh is differentiated from diseases that have similar symptoms (inguinal hernia, chronic lymphadenitis, varicose veins of the femoral vein, etc.). Diagnostics include:

• Collecting a detailed medical history.
• Surgical examination with palpation.
• Ultrasound of the protrusion and its contents.
• X-ray of the intestines.
• Ultrasound of the bladder and pelvis.
• Lab tests.
• Irrigoscopy.

The modern diagnostic base of GMS Hospital allows us to identify pathology at the initial stage, long before the appearance of pronounced symptoms.

You have questions? We will be happy to answer any questions Coordinator Tatyana

Tests and diagnostics

Femoral hernia

Early forms of femoral hernias present difficulties for their diagnosis, but diagnosing a complete hernia based on patient complaints and physical examination data does not cause significant difficulties. Of the instrumental methods, the most informative and mandatory is ultrasound, which makes it possible to identify their contents.

If necessary, the following may be prescribed: cystography , colonoscopy , cystoscopy , irrigography , CT . Differential diagnosis includes inguinal hernia , femoral artery aneurysm , abscess / tumor , thrombophlebitis .

Baker's hernia

The diagnosis is made on the basis of complaints, visual examination and palpation of the knee joint. Ultrasound/MRI are used as instrumental methods.

Surgeries for femoral hernias

The essence of the intervention is that the surgeon excises the hernial sac, returns the displaced organs to their normal anatomical position and closes the hernial orifice. Femoral canal plastic surgery is performed using two techniques:

• The defect is sutured with a special material using the patient’s own tissue.
• The femoral canal is closed with a mesh implant (tension-free hernioplasty).

Specialists at the GMS Hospital Hernia Treatment Center prefer a low-traumatic, gentle surgical technology, which is tension-free hernioplasty.

Symptoms

A femoral hernia is located under the inguinal ligament and manifests itself as a characteristic protrusion (of varying sizes) in the area between the groin and thigh. The patient may complain of discomfort and pain, which intensifies with physical activity and walking.

Due to anatomical features, the female pelvis is wider than the male pelvis, there are more weak points under the inguinal ligament and the strength of the connective tissue is less. Therefore, this pathology occurs much more often in women than in men. In the full stage of a femoral hernia in women, it often protrudes directly into the labia.

A typical symptom complex in this case is manifested by pain:

• in the pelvis;
• at the site of the hernia;
• during sexual intercourse;
• during defecation;
• in the thigh;
• in the ovarian area;
• in the vagina.

The main reason for the appearance of protrusions in the thigh area in men is heavy physical work. Clinically, such a hernia manifests itself:

• severe pain in the hip;
• the appearance of small protrusions similar to a tumor;
• lowering the hernial sac into the scrotum in some cases.

The most dangerous complication of the pathology is a strangulated femoral hernia, which manifests itself as sudden compression at the hernial orifice. This condition can cause intestinal gangrene, peritonitis, intestinal obstruction, and necrosis.

The following signs indicate it:

• vomit;
• acute pain in the groin, scrotum, labia;
• absence of bowel movements;
• irreducible hernia;
• bloody stool.

Stagnation of feces in the colon (coprostasis) or inflammation of the hernia itself may also develop.

Femoral hernia repair with mesh

The operation is carried out in two ways:

• Open hernioplasty is performed through a small incision in the inguinal-femoral fold. The surgeon opens the inguinal canal, isolates and drains the defect, and then strengthens the canal with a mesh endoprosthesis.
• Laparoscopic hernioplasty - the intervention is carried out using endoscopic equipment through small punctures into which surgical instruments are inserted.

The surgeon determines the method of intervention after examination. How the operation will be performed depends on the stage of the disease, the size of the hernial sac, the severity of clinical symptoms, the presence of complications and other factors.

Hernia of the anterior abdominal wall

Inguinal hernia

• What is an anterior abdominal wall hernia
• Inguinal hernia
• Femoral hernia
• Umbilical hernia
• Hernia of the white line
• Postoperative hernia
• Hernia treatment

What is an anterior abdominal wall hernia

A hernia of the anterior abdominal wall is the protrusion of the viscera, covered with the parietal layer of the peritoneum, through a defect in the muscle layer of the abdominal wall under the skin.
The main components of a hernia: 1 - the shell of the hernial sac; 2 - hernial sac; 3 - hernial orifice; 4 - contents of the hernial sac

There are external and internal hernias. An external hernia is a disease in which the abdominal organs come out along with the peritoneum through “weak spots” of the abdominal wall. Internal hernias are the exit of abdominal organs through natural or acquired openings of the diaphragm (the muscle that separates the chest and abdominal cavities) into the chest cavity.

Abdominal hernias are the most common pathology requiring surgical intervention. Up to 50 people per 10,000 population suffer from this disease. Abdominal hernias are observed at any age, but most often in preschool children and people over 50 years of age. Men develop abdominal hernias more often than women. The most common types of hernias are inguinal hernias (75-80%), followed by postoperative hernias (8-10%) and umbilical hernias (3-8%).

Predisposing factors for hernia formation

Predisposing factors are divided into local and general.

Local include :

• congenital defects of the abdominal wall, in which from birth there is a hole in the abdominal wall through which the hernia emerges;
• expansion of the abdominal wall openings;
• thinning and loss of tissue elasticity due to aging or exhaustion or congenital abnormalities of connective tissue;
• injuries or wounds, including postoperative ones, which lead to degenerative changes in the area of ​​damage; the risk of hernia formation increases significantly when the wound suppurates;
• an increase in intra-abdominal pressure directly leads to the release of the viscera in the presence of the above factors.

Classification
General - gender, age, heredity, body type, increased intra-abdominal pressure with ascites, obesity, pregnancy, intestinal dyskinesia .

Depending on the location, there are inguinal, femoral, umbilical, linea alba and others.

Inguinal hernia

It accounts for up to 66% of all hernias. The reason for its formation is the anatomical features of the groin area. Inguinal hernias are divided into oblique and direct. An indirect inguinal hernia is located under the skin, often descending into the scrotum (in men) or into the labia majora (in women).

Inguinal hernia

A direct inguinal hernia exits the abdominal cavity through the medial inguinal fossa, located opposite the superficial inguinal ring, and is often bilateral. An inguinal hernia in most cases is formed from the small intestine and omentum, occasionally the cecum, appendix, bladder, sigmoid colon, and internal female genital organs.

Femoral hernia

Femoral hernia occurs more often in women 40-60 years old. Its development is due to an increase in size and weakness of the femoral ring. A femoral hernia usually contains the small intestine and omentum, very rarely other abdominal organs (uterus, ureter, etc.). Patients complain of pain in the lower abdomen, groin and thigh, and nausea. Upon examination, a small oval-shaped protrusion (about the size of a hazelnut, the largest - about the size of a chicken egg) is noted below the inguinal ligament, in contrast to the inguinal hernia located above it.

Umbilical hernia

Umbilical hernia
An umbilical hernia is a disease characteristic of women, since it most often occurs as a result of multiple pregnancies and childbirths, which weaken the abdominal wall and umbilical ring. With such a hernia, as a rule, the small intestine and omentum come out, but the large intestine and stomach can also come out. The presence of a hernia often causes pain and nausea.

Hernia of the white line

A hernia of the linea alba forms through the gaps and openings between the tendon fibers that form the linea alba. It can be hidden when the hernial protrusion is located in the thickness of the white line, without violating its boundaries. Often multiple hernias occur, located one above the other. The hernial contents in the initial stage are preperitoneal fat, and later - tissue of the umbilical-hepatic ligament, omentum, and sometimes the small intestine. Usually these hernias are asymptomatic, but in some cases patients complain of pain in the epigastric region, worsening after eating, nausea and even vomiting. Often, a hernia of the white line accompanies the development of peptic ulcers, stomach cancer, and cholecystitis.

Postoperative hernia

A postoperative hernia appears in the area of ​​the surgical scar, as a rule, after various complications (suppuration, infiltration, etc.). Symptoms are pain, sometimes nausea, vomiting, constipation. Protrusion is determined during straining, coughing or when the patient is in an upright position.

Complications from hernias

The most serious complication of hernia is considered to be strangulation, caused by sudden compression of its contents in the hernial orifice, usually after heavy lifting or heavy straining. The cause of strangulation may be spastic contraction of the tissues surrounding the hernial orifice or scar constrictions in the hernial sac. More often, the small intestine is strangulated, at the site of compression a strangulation groove appears (sharp thinning of the intestinal wall), as a result of which blood circulation in the strangulated part of the intestine is disrupted. The second mechanism occurs when feces accumulate in the herniated intestine. When strangulation occurs, the blood supply to the organ or tissue contained in the hernial sac is disrupted. For example, when the intestine is strangulated, intestinal obstruction occurs, which is potentially life-threatening. Strangulated hernias are usually operated on under general anesthesia, which is also associated with many dangers.

Hernia treatment

Treatment of hernias is always surgical. There are no methods for treating hernias without the use of surgical techniques; the use of various types of bandages can only delay the development of pathology for a short time. It must be remembered that delaying the operation is extremely dangerous; at the first signs of hernia formation, you need to contact a medical institution, where the issue of the type of operation required can be decided.

Surgical intervention for hernias consists of removing the hernial sac, straightening the viscera into the abdominal cavity and strengthening the weak area of ​​the abdominal wall in the area of ​​the hernial orifice in one way or another. Currently, there are two methods for operating external hernias - local tissue and tension-free.

Treatment of inguinal hernias

The following techniques are currently used for the surgical treatment of inguinal hernias:

Plastic surgery according to Bassini and its varieties (plasty according to N.I. Kukudzhanov, plastic surgery according to, etc.)

Operation ILLichtenstein.

Plastic surgery using PHS (prolen hernia system)

Plug and patch technique

Endoscopic hernioplasty (JDCorbitt (1992)).

Plastic surgery according to Bassini

Plastic surgery according to Bassini
This method uses extraperitoneal access to the hernial sac. An incision 6–8 cm long is made just above the inguinal ligament. The spermatic cord is isolated, after which its membranes are dissected and the hernial sac is isolated.

After opening the hernial sac and immersing its contents back into the abdominal cavity. The neck of the hernial sac is sutured and the sac is cut off.

After this, plastic surgery of the posterior wall of the inguinal canal is performed. The edge of the rectus abdominis muscle is sutured to the inguinal ligament.

After this, the spermatic cord is placed on the formed posterior wall of the inguinal canal and the aponeurosis of the external oblique abdominal muscle, subcutaneous tissue and skin are sutured over it.

Kimbarovsky method

Used for indirect inguinal hernia. This method is very similar to the Bassini method in the first two stages of the operation. The differences begin at the stage of inguinal canal plastic surgery.

The internal flap of the dissected aponeurosis and the underlying muscles are sutured in such a way that when the thread is tightened, the edge of the internal flap of the aponeurosis is tucked under the edge of the muscles and brought into tight contact with the inguinal ligament (see figure). The outer flap is then sutured over the inner flap. As a result of all this, a fairly strong anterior wall of the inguinal canal is formed.

The Lichtinstein operation involves traditional access and plastic surgery of the posterior wall of the inguinal canal with a 2-dimensional polypropylene or Teflon mesh implant. Relapses are about 1%.

Non-tension methods of surgical treatment of hernias differ from conventional ones in that synthetic material is used for plastic surgery. Of the surgical non-tension methods for treating inguinal hernias, the Lichtenstein method should be considered as the most commonly used.

With this technique, a 6–8 cm long incision is made just above the inguinal ligament.

The spermatic cord is isolated, after which its membranes are dissected and the hernial sac is isolated.

After opening the hernial sac and immersing its contents back into the abdominal cavity. The neck of the hernial sac is sutured and the sac is cut off.

After this, the allograft (polypropylene mesh or perforated polytetrafluoroethylene plate) is cut to the shape of the posterior wall of the inguinal canal) and sutured to the posterior wall of the inguinal canal.

Plastic surgery using PHS : the method involves the use of a complex 3-dimensional prosthesis in non-tension hernioplasty, consisting of a suprafascial flap, a connector, and a subfascial flap. Traditional access to the inguinal canal is performed. The internal flap of the prosthesis is folded, inserted through the internal inguinal ring and expanded in the preperitoneal space under the transverse fascia. The outer flap is formed, ensuring the passage of the spermatic cord, and is fixed in a similar way to the Lichtenstein plasty.

The “plug and patch” or “cork and patch” technique can be considered a type of Lichtenstein operation. During this operation, typical access to the inguinal canal is performed. As a rule, during this operation the hernial sac is not opened, but is immersed with a “plug” obturator made of polypropylene mesh in the form of a shuttlecock.

The obturator with its apex is directed towards the hernial sac, and in the base area it is fixed with several sutures to the surrounding tissues. The posterior wall of the inguinal canal is strengthened with a mesh “patch” in the same way as is done with Lichtenstein plastic surgery.

Endoscopic hernioplasty forms the posterior wall of the inguinal canal according to the type of ILLichtenstein operation, but is carried out using a special hardware and instrumental complex through laparoscopic access.

Treatment of femoral hernias and white line hernias

Hernias of the white line of the abdomen and umbilical hernias can be operated on using both traditional and non-tension methods.

Traditional methods include the Mayo and Sapezhko methods; they involve plastic surgery of the hernial orifice with aponeurotic duplicatures. In some cases (especially in obese patients and in cases of genetic disorder of the connective tissue structure), when creating a duplication, a mesh implant can be used to reinforce the suture lines.

For large hernial orifices, it is more advisable to use synthetic prostheses, placing them above the aponeurosis or below the aponeurosis. In this case, the hernial defect is sutured in the transverse direction with a non-absorbable thread edge-to-edge. The synthetic prosthesis is fixed with a similar thread using a continuous wrapping suture when the prosthesis is located above the aponeurosis or with U-shaped through sutures with the mesh placed under the aponeurosis.

In case of giant hernias, when suturing the hernia defect is impossible or leads to severe respiratory insufficiency, repair is carried out without covering the defect with one’s own tissue. The implant is formed in such a way as to exceed the tissue defect by 5 cm, then it is sutured with two continuous sutures along the border of the hernial orifice and 3-4 cm away from the edge.

In addition, in some cases (for small umbilical hernias), endoscopic techniques can be used to strengthen the hernial orifice with an implant.

Treatment of postoperative hernias

Plastic surgery of postoperative hernias is carried out using the same techniques as umbilical hernias and the white line of the abdomen. The only difference is the excision of the old postoperative scar and the difficulty of isolating the aponeurosis and hernial sac from the surrounding tissue.

Currently, plastic techniques using allograft are used to treat postoperative ventral hernias.

Advantages of tension-free hernioplasty

Modern medicine has improved many surgical techniques for hernia repair, and one of the most minimally traumatic options is tension-free hernioplasty. This technique has undeniable advantages:

• Mild pain syndrome
• Fast rehabilitation (hospital stay is reduced to 1 day)
• No risk of relapse
• 2-3 weeks are enough for complete recovery

The entire operation lasts less than an hour and has an excellent cosmetic effect.

Symptoms of a dorsal hernia

The nature of the clinical picture depends on many factors. First of all, this is in which part of the spine the hernia is located and its type. Size is not always the determining factor. Even small formations located in the foraminal openings, or with congenital narrowness of the spinal canal, can provoke severe pain and serious neurological disorders.

When a dorsal hernia is located in the cervical spine, nerves and blood vessels supplying blood to the brain can be compressed. Therefore, symptoms may include:

• headaches that tend to spread to the neck, shoulders, and arms over time;
• decreased sensitivity and numbness in different parts of the arms and hands;
• noise in ears;
• dizziness;
• weakness in the hand;
• pain radiating under the shoulder blade;
• lack of movement in the hand.

Classification of hernias depending on location
The thoracic spine is affected extremely rarely. At the same time, the formation of a hernia is difficult to recognize without the use of instrumental diagnostic methods, since the symptoms often resemble pathologies of the heart, lungs or gastrointestinal tract.

The formation of a hernia in the lumbar spine most often occurs at the level of L4–L5, much less often at the level of L3–L4. Very often, a dorsal hernia of the L5–S1 lumbosacral region is diagnosed. This is accompanied by:

• pain in the lumbar region, radiating to the buttocks, perineum, thighs, legs, knees and feet;
• increased pain during sudden movements, laughing, coughing or straining and a decrease in their intensity after taking a lying position;
• decreased sensitivity and gradual atrophy of the leg muscles;
• paresis and paralysis of one or both legs;
• decreased or loss of control over urination and bowel movements;
• decreased libido and deterioration of potency.

If at least one of these signs appears, you should contact a neurologist or vertebrologist.

Preparing for surgery

During the consultation, the surgeon will prescribe a set of necessary examinations:

• ECG.
• X-ray of the lungs or fluorography.
• Blood and urine tests - general, biochemical.
• Blood tests for hepatitis, HIV, syphilis, coagulation, blood group and Rh factor.

You should definitely tell your doctor about the medications you are taking; you may have to stop them for a while. Your doctor will tell you more about preparing for surgery during your consultation. You can undergo a comprehensive examination at GMS Clinic in 1 day.

Our surgeons

• Rudenko Alexander Viktorovich

  Cardiovascular surgeon, phlebologist, laser surgeon, surgeon, doctor of the highest category.

• Matveeva Marina Aleksandrovna

  Doctor - surgeon, vascular surgeon, phlebologist, mammologist

• Kostromin Roman Alekseevich

  Cardiovascular surgeon, phlebologist, laser surgeon, general surgeon

• Zasorin Alexander Alexandrovich

  Surgeon of the highest category, Doctor of Medical Sciences, proctologist

• Kornienko Andrey Sergeevich

  Surgeon of the highest category, proctologist

Treatment of femoral hernias at GMS Hospital

The minimally invasive surgery technologies used by surgeons at the Hernia Treatment Center at GMS Hospital will help quickly and safely eliminate the defect, eliminating the risk of postoperative complications. The use of mesh (including three-dimensional) endoprostheses from well-known manufacturers allows us to eliminate the risk of relapse of the disease, and the use of microsurgical techniques reduces the length of hospital stay to 1 day.

The rehabilitation period is easy, and full recovery takes only 3-6 weeks. You can learn more about the operation and the need for one or another diagnostic procedure at a consultation with a surgeon. You can make an appointment with a doctor by phone or by leaving an online application on the website.

Hernia treatment methods

You can’t delay treating a hernia. If signs of a hernia are detected, you should immediately consult a surgeon.

The only way to treat a hernia is surgery. This type of operation is called hernioplasty.

.
Terms such as hernia repair
and
hernia removal
. But hernioplasty is a more correct name, since in most cases the hernia is not removed, but reduced.

Hernia removal – laparoscopic hernioplasty

The hernial contents are immersed through the hernial orifice back into the abdominal cavity, after which plastic surgery of the hernial orifice is performed. At this stage, the problem of preventing the re-formation of a hernia is solved. The area of ​​the hernial orifice is strengthened either by the body’s own tissues or by implants (polymer meshes). Within a month, the mesh grows into body tissues. Such a frame reliably holds the organs in place. When using your own tissues, relapses may occur (in 25% of cases).

At Family Doctor, hernia removal (hernioplasty) is performed laparoscopically - through small punctures in the abdominal wall, which allows for faster healing and avoidance of conspicuous scars. Laparoscopic hernioplasty is performed in a surgical hospital, under local or spinal anesthesia. The use of polymer implants almost completely eliminates the possibility of re-formation of a hernia.

More information about the treatment method

Make an appointment Do not self-medicate. Contact our specialists who will correctly diagnose and prescribe treatment.

Rate how useful the material was

thank you for rating