INGUINAL HERNIA is a particular kind of ABDOMINAL HERNIA. By the term ERNIA is meant the outbreak of an abdominal bowel (fat, intestine, bladder) from its usual site through a more weak muscular wall area or anatomic canal located in the groin.
INDEX:
1. The causes of the Inguinal Hernia
2. THE SYMPTOMS OF INGUINAL HERNIA
3. SURGICAL TECHNIQUES:
3.1. ERNIOPLASTIC WITH MESH
3.1.1. POSTOPERATIVE INFORMATION
3.2. LAPAROSCOPIC ERNIOPLASTIC
3.2.1. LAPAROSCOPIC ERNIOPLASTIC POSTOPERATORY INFORMATION
1. The causes of the Injury
In normal adult conditions, the abdominal viscera does not produce through these gates, but a number of phenomenas may determine such an event, namely:
• physical effort ( Cough, Evacuative effort)
• obesity
• quick slimming
• Muscle weakness.
Often, the cause of the onset of inguinal hernia is represented by the effort to evacuate, in fact it is most present in people with constipation or constipation.
2. THE SYMPTOMS OF INGUNAL HERNIA
The symptoms complained of by the subject generally consist of a swelling of the inguinal area that can range from a modest cord, to the huge hernia that also occupy the entire scrotum.
Such swelling generally disappears into a lying position and reappears in the standing position. This is accompanied by a sense of weight, inguinal or testicular burns, digestive disorders and sometimes alterations in the intestinal habits.
Often the patient that carries it for fear of surgery is neglecting that it can be encountered complications such as ernie's throat or strangulation, resulting in the development of a dramatic picture of "acute abdomen" (characterized by symptomatology quickly Progressive with intestinal blockage with impossibility of evacuating and gas release, acute pain and intractable abdomen) that could seriously jeopardize the patient's life unless promptly treated with urgent surgery.
3. SURGICAL TECHNIQUES:
The only treatment for inguinal hernia is surgical.
The intervention is called: ERNIOPLASTIC.
There are mainly 2 techniques for the treatment of inguinal hernia:
3.1 ERNIOPLASTIC WITH MESH
It is the most used technique for two reasons: give brilliant results and its easy in execution. One prerogative of this intervention is that it can, in most cases, be performed in LOCAL ANAESTESIA ( local anesthetic injections just above the groin).
Often the patient fears of these "bites" and the anesthetist helps with a slight sedation that avoids from experiencing the surgical event as a trauma.
Through a small oblique or horizontal incision over the groin of 3-5 cm, the vein is re-introduced into the abdominal cavity.
The next repair is currently carried out with a technique that contemplates the placement of a MESH of non-absorbable material (eg polypropylene) that induces a cicatrial reaction to create a barrier preventing further hernia formation.
The mesh is prepared in 2 pieces: one wrapped around itself in the shape of a cone that is threaded into the hernia, and one of rectangular shape rounded on a margin applied to the area and fixed with a point or glue.
The wound closure is performed with absorbable points (no visible spots on the skin) and waterproof trays.
The intervention usually takes 20-40 minutes.
After surgery, the patient can go home accompanied but needs a set of instructions on post-operative phases, whose understanding is essential to prevent the operation from being "abandoned" by the surgeon.
To this end, I have written a post-operative instruction sheet (I call it "Instructions for Use") that I give before sending the patient home and usully is after 1-2 hours from surgery.
3.1.1. POST-OPERATIONAL INFORMATION AFTER INTERVENTION OF ERNIOPLASTIC WITH DOTT FARINA
The operated part remains generally painless for many hours after the surgery thanks to the local anesthetic. Before discharge, she was given a pain reliever which allows her to be taken home by car. Returning home, remember to buy the prescribed medicines because they must be taken from the evening of the intervention. The elastic panty for inguinal hernia should also be worn immediately and kept day and night for 5 days, then only during the day for 30 days. You will notice that some drugs must necessarily be taken even if it does not have any discomfort, while others only in case of need.
For the first two days, he will rest between the bed and the armchair, eating light food and placing ice on the groin three times a day for an hour. From the third day I advise you to walk, also leaving the house, because this favors a faster disappearance of the troubles in the operated area. Discomfort occurs especially during position changes from lying to sitting and from this to a standing position. Once you have taken the desired position, you will feel better. Obviously all the disorders are greater for patients operated on for bilateral or inguinoscotal hernias.
The surgical incision is closed with intradermal or internal points that reabsorb themselves (there are no visible points on the skin) and is protected by some white waterproof patches (steristrips) above which there is a gauze.
The patient must take a shower after 3 days from the surgery with all the dressing, being careful to replace only the gauze leaving the steristrips that will be removed during the post-operative dressings or will fall during the showers within 15 days. After the shower, replace the external patch or gauze simply by drying the part. There is no need for disinfectants or waterproof plasters.
The mesh used for this operation makes the repair extremely strong and solid immediately. Sports activity will be gradually resumed at the end of the first month after the intervention.
You should avoid too heavy food, drink at least two liters of liquids - non-sparkling water, tea, fruit juices, broth, etc. - for the first few days, in order to promote intestinal functions and avoid efforts to evacuate. Eventually you can use a glycerin suppository or a mild laxative after the second day. sachet in the evening)
It is recommended to avoid driving the machine for 5 days. After the intervention, and in the following days, the patient could observe a series of possible situations:
• Pain in the groin region, on the side and towards the genitals: of varying intensity and controllable with analgesics;
• Ecchymosis (blue-blackish coloring) on the skin of the pubic region, on the side, on the scrotum, on the genital organ: it tends to disappear in a couple of weeks;
• Swelling, sometimes very evident, in the same regions: regresses after 1 - 2 weeks (ice pack useful).
• A few drops of blood on the dressing;
• Often there may be heartburn, small pangs and lack of sensitivity: these effects will subside until they disappear within a few weeks or months.
Sometimes the resumption of motor activity can coincide with the appearance of groin pain, which subside and disappear in about 10 days. They are caused by settling of the net on the contracting muscle and can also occur long after surgery.
• Fever (without tremors and / or chills of cold): it is the normal reaction of the organism to operative stress.
In the affected groin region, within a week a hard relief will form in the shape of a "sausage": this is due to the normal cicatricial reaction of the tissues. It will tend to disappear completely within a few months. Such events are absolutely normal and expected. Therefore, they must not generate any concern if present in the form described.
If some of these situations take on considerable dimensions (fever at 39 ° C with chills of cold and / or tremors, intense and unbearable pain, abnormal swelling, frank bleeding) the patient must promptly notify the surgical team.
For any further information or in case of need we remain available at our contact details, it being understood that in the first three days of the intervention you must necessarily send an SMS between 19.00 and 20.00 to one of the surgeons of your operating team to report on your state
3.2. LAPAROSCOPIC INGUINAL HERNIA REPAIR
I practice this technique mainly in cases of bilateral or recurrent inguinal hernias.
The intervention is to repair the hernia defect with a mesh inserted in the inside of the ernia instead of the outside as in the traditional hinge.
The repair is carried out laparoscopically by inserting the instruments and the net through three small holes of 0.5 cm, blowing gas into the abdomen.
The technique from a functional point of view has its rational:
It's like fixing a hole in a tire: usually you place a "patch" outside the hole (traditional ernioplasty with mesh) but if we could place the "patch" from the inside to close the hole than the repair would be much more durable.
The disadvantages compared to traditional technique are represented by the need for general anesthesia and longer operating times. So the comparison with the traditional technique is in favor of the latter for single hernias, while it is certainly more beneficial to repair a bilateral hernia with three mini-cuts instead of two inguinal incisions of 3-5 cm.
A separate discourse deserves the RECURRENT HERNIA repair. This is an intervention that requires some experience as the area to be repaired is full of adherence especially if a mesh has previously been positioned.
Reincluding externally is in fact very difficult, while performing the surgery from the inside in a laparoscopic way allows it to work in an even virgin area.
3.2.1. POST-OPERATING INFORMATION AFTER THE INTERVENTION OF LAPAROSCOPIC ERNIOPLASTIC OF Dr CARLO FARINA
The surgery was performed under general anesthesia, practicing 3 or 4 micro-incisions of 0.5 or 1 cm in the abdomen, one of which at the navel level.
Generally the hospitalization is 12 - 24 hours after which you can go home, accompanied.
To drive we recommend waiting 4-5 days (important for medico-legal aspects in case of road disputes for insurance reimbursement!)
Returning home, remember to buy the prescribed medicines because they must be taken from the evening of surgery. The elastic panty for inguinal hernia should also be worn immediately and kept day and night for 5 days, then only during the day for 30 days. He will note that some medications must necessarily be taken even if he does not have any discomfort, while others only in case of need.
For the first two days, he will rest between the bed and the armchair, eating light food and placing ice on the groin two to three times a day for an hour. From the third day I advise you to walk, also leaving the house, because this favors a faster disappearance of the troubles in the operated area. Discomfort occurs especially during position changes from lying down to sitting and from this to a standing position. Once you have taken the desired position, you will feel better. Obviously all the disorders are greater for patients operated on for bilateral or inguinoscotal hernias.
The surgical incisions are closed with intradermal or internal points that reabsorb themselves (there are no visible points on the skin) and are protected by some white waterproof patches (steristrips) above which there is a gauze.
The patient must take a shower after 3 days from the surgery with all the dressing, being careful to replace only the gauze leaving the steristrips that will be removed during the post-operative dressings or will fall during the showers within 15 days. After the shower, replace the external patches or gauzes simply by drying the part. There is no need for disinfectants or waterproof plasters.
The mesh used for this operation makes the repair extremely strong and solid immediately. Sports activity will be gradually resumed at the end of the first month after the intervention.
You should avoid too heavy food, drink at least two liters of liquids - non-sparkling water, tea, fruit juices, broth, etc. - for the first few days, in order to promote intestinal functions and avoid efforts to evacuate. Eventually you can use a glycerin suppository or a mild laxative after the second day. sachet in the evening)
After the intervention, and in the following days, the patient could observe a series of possible situations:
• Pain, of modest entity at the level of the wounds, especially the umbilical one. They decrease in intensity and disappear in about seven days; tolerance and pain threshold vary significantly from patient to patient, so we still administer a base of painkillers at fixed doses and times that make the postoperative period as normal as possible.
• Pain of varying intensity at the level of the shoulders, especially the right one, which are reduced by lying down and accentuated with the changes of position, with a feeling of not being able to perform too deep breaths.
It is a reflection from distension of the diaphragm, typical of laparoscopic interventions. It appears in about 15% of cases and can be very intense for the first few days, then it will decrease until it disappears in 5-7 days and needs a higher dose of painkillers.
• In the affected groin region, a relief will form within a week, a sometimes soft, sometimes hard “bump”. No fright, Hernia has not returned.
It is the so-called "seroma" caused by the filling of serum and blood in the space previously occupied by the hernia.
It is controlled by the elastic pant which compresses prevents excessive swelling. It can last up to a few months after surgery and only in rare cases is it necessary to empty it with the syringe.
• A few drops of blood on the dressings.
• Fever: up to 38 ° C without tremors or chills. It is the normal reaction of the organism to operating stress, and disappears in 3-5 days.
• Sometimes the recovery of motor activity can coincide with the appearance of groin pain, which subside and disappear in about 10 days. They are caused by settling of the network on the contracting muscle and can also occur long after surgery.
• Fever (without tremors and / or chills of cold): it is the normal reaction of the organism to operative stress. It generally does not occur if you follow the therapy indicated in the discharge letter.
Such events are absolutely normal and expected. Therefore, they must not cause any concern if they are present in the form described.
Should some of these situations take on considerable dimensions (fever at 39 ° C with chills of cold and / or tremors, intense and unbearable pain, abnormal swelling, frank bleeding from one of the wounds), the patient must promptly notify the surgical team.
For any further information or in case of need we remain available at our contact details, it being understood that in the first three days of the intervention you must necessarily send an SMS between 19.00 and 20.00 to one of the surgeons of your operating team to report on your state.
