Incisional hernia

　　First, the etiology

　　The etiology of incisional hernia caused by the hernial sac of an indirect inguinal hernia protruding into the interlayers of the abdominal wall is not yet clear. According to the comprehensive literature, it may be related to the following factors.

　　1. Narrowing or obstruction of the normal hernia channel:The narrowing or obstruction of the normal hernia channel is more common in patients with incomplete descent of the testicle. Incomplete descent of the testicle, in addition to being related to abnormal testicular pedicle, underdeveloped testicle, and other factors, anatomical abnormalities, mechanical obstruction, fascial covering of the scrotal orifice, and the processus vaginalis not entering the inguinal canal are also the main factors leading to its occurrence. Due to the fact that incomplete descent of the testicle is often accompanied by an unsealed processus vaginalis and therefore concurrent indirect inguinal hernia, during the progression of the hernia, due to the narrowing of the inguinal canal and external ring, as well as the presence of hard tissues and other obstacles, the normal hernia channel becomes obstructed, the hernia mass cannot pass through the narrowing or be covered by hard tissues in the inguinal canal, and can be pushed into the interstitial tissue of the abdominal wall, forming an incisional hernia. Some scholars also believe that when abdominal pressure suddenly increases, the abdominal viscera forcibly expand the hernial sac neck, causing a large amount of hernial contents to protrude. When the hernial sac neck retracts, the hernial contents cannot be retracted, and the sudden increase in hernial contents strongly stimulates and causes the contraction and closure of the internal oblique, transverse abdominal, and transversalis fascia, preventing the hernial contents from entering the normal channel and entering between the peritoneum and the muscle, or forming an anterior peritoneal incisional hernia.

　　2. Inappropriate pressure from the hernia belt:If the hernia belt is not pressed at the internal ring orifice but below it, when the intra-abdominal pressure increases, the hernia mass can protrude but cannot pass through the normal hernia channel into the inguinal canal and scrotum, but instead protrudes into the interstitial tissue of the abdominal wall.

　　3. Improper reduction techniques:During the reduction of an indirect inguinal hernia by manual manipulation, improper reduction techniques may force the hernial contents to be forcibly pushed through the internal ring, failing to fully return to the abdominal cavity and becoming incarcerated at the neck of the hernial sac, forming an anterior peritoneal space hernia. Moreover, frequent and improper reduction techniques can cause the hernial sac wall and the surrounding tissue around the abdominal ring to become weak and relaxed, which is also prone to incisional hernia.

　　二、发病机制

　　Secondly, pathogenesis

　　1. Pre-peritoneal interval hernia:According to the route of the hernia sac, interabdominal hernias are divided into 3 types:

　　2. Interval hernia:The sac is located between the layers of muscles, which can be between the transversus abdominis and the internal oblique muscle, or between the internal oblique muscle and the aponeurosis of the external oblique muscle, accounting for about 60%.

　　3. Hernia outside the aponeurosis of the external oblique muscle:The sac is located between the pre-peritoneum and the transversus abdominis muscle, where the bowel is incarcerated at the neck of the sac. The sac is bulging towards the peritoneum of the abdominal cavity, and the peritoneum and muscle are separated. This type of interabdominal hernia accounts for about 20%.

　　During physical examination, due to the incarcerated or strangulated segment of the intestine, symptoms of intestinal obstruction are presented, and local tenderness and mass may be present.

　　1. Pre-peritoneal interval hernia:The sac is located between the pre-peritoneum and the transversus abdominis muscle, where the bowel is incarcerated at the neck of the sac. The sac is bulging towards the peritoneum of the abdominal cavity, and the peritoneum and muscle are separated. This type of interabdominal hernia accounts for about 20%.

　　2. Interval hernia:The sac is located between the layers of muscles, which can be between the transversus abdominis and the internal oblique muscle, or between the internal oblique muscle and the aponeurosis of the external oblique muscle, accounting for about 60%.

　　3. Hernia outside the aponeurosis of the external oblique muscle:The sac is located outside the aponeurosis of the external oblique muscle, accounting for about 20% of the interval hernia. The position of the sac of a few interabdominal hernias can be between the transversalis fascia and the external oblique muscle, between the external oblique muscle and the internal oblique muscle, or between the internal oblique muscle and the aponeurosis of the external oblique muscle. A few interabdominal hernias may coexist with indirect inguinal hernia (having two hernia rings or double hernias).

　　Some patients may have a history of indirect inguinal hernia and receive manual reduction treatment for this time's incarceration, after which the hernia mass 'disappears', but the symptoms of abdominal pain still exist and worsen progressively. Physical examination shows signs of intestinal obstruction, the position of the testicle on the side of the indirect hernia is elevated, and a mass with tenderness can be felt near the internal inguinal ring in the lower abdomen.

　　A few patients may experience paroxysmal abdominal pain, bloating, vomiting, and cessation of defecation and flatus after sudden straining or severe coughing, but there is no hernia prolapse. There is tenderness and a mass near the internal inguinal ring in the lower abdomen.

　　The clinical manifestations of this disease are not specific, and there may be no symptoms or vague symptoms, such as dull pain and acid discomfort in the lower abdomen, which are generally rarely seen in clinical consultation due to symptoms. Sometimes, the mass is small and located in the muscle layer, making it difficult to touch. In addition, the inguinal ring is empty, and it is rarely noticed by doctors and missed.

　　Most hernias cannot be prevented, but it is possible to reduce the recurrence of hernias. The following suggestions can help reduce the recurrence of hernias:

　　8. Maintain a healthy weight.

　　7. Persist in strengthening abdominal muscle exercises.

　　6. Actively prevent and control constipation and chronic cough.

　　5. Eat more high-fiber foods.

　　4. Avoid lifting, pushing, or pulling heavy objects; give up the bad habit of smoking.

　　At the time of diagnosis, in addition to relying on its clinical manifestations, auxiliary examinations are also needed.

      1. X-ray examination:X-ray透视 or abdominal X-ray film shows signs of intestinal obstruction.

　　2. Ultrasound:Indicate the echo of an abnormal intestinal tract of gas and fluid near the lower abdominal ring.

　　One, postoperative food therapy for intermuscular hernia, diet for helping the body recover vitality after surgery:

　　1. Take 4 grams of Jilin ginseng and 3 grams of American ginseng and simmer with lean meat.

　　2. Take 4-5 mushrooms and simmer with lean meat or chicken breast (drink the soup).

　　3. Take 15 grams of astragalus, 21 grams of codonopsis, 30 grams of dioscorea opposita, and 15 grams of lotus seed and simmer with lean meat.

　　4. Take 30 grams of rhizoma smilacis glabrae, 30 grams of Job's tears, and 3 pieces of glutinous rice and simmer with grass carp or water turtle.

　　5. Take 17 grams of codonopsis, 21 grams of semen coicis, 10 grams of fructus lycii, and 15 grams of Job's tears and simmer with lean meat or chicken.

　　6. Take 3 grams of notoginseng, 3 grams of ginseng (or red ginseng) and simmer with lean meat or chicken.

　　Two, what is good for the body to eat for intermuscular hernia

　　1. Generally, patients can start with liquid food such as congee, thin lotus root powder, vegetable juice, and fruit juice 6 to 12 hours after surgery. On the second day, eat soft food or regular food such as soft rice, noodles, egg cake, chopped and cooked vegetables and meat, etc., focusing on nutrition-rich, easy-to-digest, light diet.

　　2. In terms of diet, eat more nutritious foods. Eat more roughage foods such as leeks, celery, cabbage, coarse grains, beans, bamboo shoots, various fruits, etc.

　　3. Keep the bowels smooth, and you can use jellyfish, bitter melon, sweet potatoes, etc.

　　Three, what foods should not be eaten for intermuscular hernia

　　1. After surgery, avoid eating foods that can cause intestinal bloating, such as milk, soy milk, eggs, etc.

　　2. Avoid smoking, drinking, greasy, fried, moldy, and preserved foods.

　　3. Avoid eating spicy foods such as garlic and mustard.

　　4. Avoid eating excessively sour, spicy, and salty foods.

　　1. Indirect inguinal hernia should be diagnosed and treated early.

　　2. When treating indirect inguinal hernia, it should be avoided to apply inappropriate hernia belts or manual reduction. Improper manual reduction can cause the hernia contents to be forcibly pushed through the internal ring and not fully returned to the abdominal cavity, resulting in incarceration at the neck of the hernia sac, forming a pre-peritoneal space hernia. Moreover, frequent and improper manual reduction can cause the hernia sac wall and the surrounding tissue around the abdominal ring to become weak and relaxed, which is also prone to intermuscular hernia.