Inguinal hernia

　　There are many causes of inguinal hernia, mainly the reduction of abdominal strength and the increase of intra-abdominal pressure. In the elderly, muscle atrophy, weak abdominal wall, and the inguinal region is even more weak, in addition to the passage of blood vessels, spermatic cord, or round ligament of the uterus, which provides a passage for the formation of hernia. In addition, the elderly often have diseases such as cough and asthma, constipation, and difficulty in urination due to benign prostatic hyperplasia, which lead to increased abdominal pressure, providing momentum for the formation of hernia. If a reducible mass appears in the inguinal region, which appears when standing, walking, coughing, or working and disappears when lying flat and resting, it should be considered as a possible inguinal hernia.

　　Postoperative complications of inguinal hernia may include conditions such as scrotal hematoma. The cause is usually rough operation during surgery, extensive stripping surface, especially when removing large and adherent hernia sacs, incomplete hemostasis, etc. To prevent hematoma, the operation should be gentle, and the stripping surface must be thoroughly hemostasized, even for small bleeding points, which should be ligated and hemostasized one by one. For larger or adherent hernia sacs, it is not necessary to strip and excise them, as long as the proximal part is separated, high ligation is performed, and the distal end is thoroughly hemostasized. Open drainage does not affect the efficacy.

　　The clinical symptoms of reducible hernia can vary due to the size of the sac or the presence of complications. The basic symptom is the appearance of a reducible mass in the inguinal region. Initially, the mass is small and only appears when the patient is standing, working, walking, running, coughing violently, or when an infant cries. The mass can be pushed back into place and disappear when lying flat or with the hand. Generally, there is no special discomfort, only occasional local distension and referred pain. As the disease progresses, the mass can gradually increase in size, descending from the inguinal region to the scrotum or large labium, which can cause difficulty in walking and affect labor. The mass is pear-shaped with a pedicle, narrow at the top, and wide at the bottom. The main characteristic of an irreducible indirect hernia, in addition to slightly more severe distension and pain, is that the mass cannot be completely reduced.

　　Incisional hernia often occurs during intense labor or defecation when intra-abdominal pressure suddenly increases, and it is usually an indirect hernia. Clinically, it often manifests as an abrupt increase in the size of the hernia mass, accompanied by marked pain. The mass cannot be pushed back into place by lying flat or with the hand. The mass is tense and hard, and there is significant tenderness. The contents of the incisional hernia are the omentum, and local pain is usually mild; if it is a loop of the intestine, not only is there significant local pain, but also symptoms such as intermittent abdominal colic, nausea, vomiting, constipation, and abdominal distension may occur, which are characteristic of mechanical intestinal obstruction. Once a hernia becomes incarcerated, the chance of spontaneous reduction is small; most patients' symptoms gradually worsen, and if not treated in time, it may become strangulated hernia. Incisional hernia is often overlooked when the local mass is not obvious and there is no definite sign of intestinal obstruction.

　　The prevention of inguinal hernia should first strengthen physical exercise, exercise the abdominal muscles, and make the abdominal muscles more robust, which can reduce the incidence and recurrence rate of inguinal hernia to a certain extent. For patients with prostatic diseases, oral medication can reduce the difficulty of urination, which can prevent it. Another is that for ordinary people, do not lift heavy objects, just like the patients with lumbar disc herniation, the action that should be avoided is bending over and lifting heavy objects, and then coming up too abruptly, which may cause the intervertebral disc to bulge. For hernia patients, it is also possible to have a hernia after such an effort. Another one is self-protection during intense exercise. Because for many athletes, they may also have hernia, especially football players, many in foreign countries also have hernia, so self-protection during intense exercise is also an aspect. Therefore, for the prevention of this disease, it is mainly to improve the body's ability to resist diseases, avoid catching a cold, coughing, and keeping the bowels smooth, do not strain during defecation. Appropriate physical exercise should be done to enhance the body's immune ability, avoid heavy physical labor, maintain an optimistic and cheerful mood, which can prevent the occurrence of inguinal hernia to a certain extent.

　　Inguinal hernia is a condition where a reversible mass appears in the inguinal region. Initially, the mass is small, only appearing when the patient stands, walks, coughs, or engages in strenuous exercise. Infants often experience it during crying. When lying flat or pressing with the hand, the mass can return to the abdominal cavity on its own. Generally, there are no special discomforts, but occasionally, there may be a local feeling of sagging. As the disease progresses, the mass can gradually increase, descending from the inguinal region to the scrotum or large labia, making walking difficult and affecting labor.

　　The routine examination for inguinal hernia is laboratory ultrasound. Regular hernia specialty hospitals use special hernia superconducting visual examination to diagnose the condition of hernia, including the type, size, and defect size of the hernia ring, and then the doctor will formulate a specific treatment plan.

　　The superconducting visual examination of hernia is a new method that uses Doppler high-frequency ultrasound to examine blood flow in the vascular cavity or cardiac cavity. It can measure the speed and direction of blood flow from outside the body, thereby determining the distribution of blood flow at the affected site, and can print the condition of the lesion as a high-definition color image, making it more intuitive.

　　Patients with inguinal hernia should eat more fresh vegetables and fruits and more protein-rich foods, which can increase the firmness of local muscle tissue. Eating more fiber-rich foods can alleviate constipation, thereby preventing the occurrence of hernia and reducing the chance of recurrence. Strengthening physical exercise, exercising the abdominal muscles, and making the abdominal muscles more robust can reduce the incidence and recurrence rate of inguinal hernia to a certain extent.

　　The treatment of inguinal hernia includes conservative treatment and surgical treatment. Once an inguinal hernia cannot be reduced and forms an incarceration, it can lead to intestinal obstruction, even intestinal necrosis, perforation, and even death.

　　1. Conservative Treatment

　　Conservative treatment includes hernia belts, hernia supports, traditional Chinese medicine, and other methods. These methods can alleviate symptoms or delay the progression of the disease, but cannot cure it. Some inappropriate conservative treatments may worsen the condition. This method is only suitable for infants under 2 years old, the elderly, the weak, or those with serious diseases. Commonly, a special hernia belt is used to press on the hernia ring to alleviate symptoms.

　　2. Surgical Treatment

　　Surgery is the only reliable method for treating adult inguinal hernias with less recurrence. Elective surgery can be performed for reducible hernias, while intractable hernias should be limited to short-term surgery. Incarcerated hernias and strangulated hernias must be treated with emergency surgery to avoid serious consequences. Surgical treatment is divided into traditional tension suture repair and tension-free hernia repair techniques. Currently, tension-free hernia repair techniques are universally recognized, including open procedures and laparoscopic procedures.

　　(1) Traditional surgery patients are prohibited from eating before and after surgery, and need to lie in bed for several days, receive intravenous fluids, and have a catheter inserted. Patients experience severe pain after surgery, have a slow recovery, and a high recurrence rate. Many patients with heart, lung, and cerebrovascular diseases cannot undergo surgery due to intolerance to general anesthesia or local anesthesia.

　　Open tension-free hernia repair, introduced from abroad, has been rapidly popularized. The operation can be performed under local anesthesia, with a low recurrence rate, less pain, and generally only requires hospitalization for 2 to 5 days, or even the operation can be completed on an outpatient basis, with quick postoperative recovery.

　　(2) Laparoscopic inguinal hernia repair has made significant progress in recent years. Laparoscopic total extraperitoneal repair (abbreviated as TEP) only requires two 0.5 cm and one 1 cm incisions, does not enter the abdominal cavity, pulls the hernia sac back into the abdominal cavity extraperitoneally, and then covers the hernia protrusion with a synthetic mesh. This method is suitable for the treatment of bilateral inguinal hernias and recurrent hernias, and has the advantages of small trauma, quick recovery, and low recurrence rate.