Inguinal sliding hernia

　　I. Etiology

　　Under normal circumstances, part of the ascending colon, descending colon, bladder, fallopian tubes, and other organs are covered by the peritoneum, while the other parts are not covered by the peritoneum. Due to congenital developmental abnormalities or acquired factors such as aging, ligament relaxation, emaciation, and visceral prolapse, the mobility of the organ is increased, and it is pathogenic due to the aforementioned factors of hernia formation.

　　II. Pathogenesis

　　The pathological classification of inguinal sliding hernia mainly has two methods:

　　1. Classification according to the position of the hernia sac and the protruding organ:

　　(1) Para-hernia sac (pulling type): This type is more common, with the protruding organ being the colon and forming the posterior wall of the hernia sac. The hernia sac formed by the peritoneum is located in front of the mass.

　　(2) Intra-abdominal hernia sac: This type is not different from general hernias, but attention should be paid to extraperitoneal organs during surgery.

　　(3) External hernia sac (pushing type): This type is rare, with the protruding organ constituting most of the hernia. A part of the peritoneum is located higher, and it is easy to damage the protruding organ when looking for the hernia sac during surgery if not careful.

　　2. Categorized by the content of the protruded organ:

　　(1) Bladder sliding hernia.

　　(2) Intestinal sliding hernia.

　　(3) Mixed sliding hernia.

　　During the sliding process of abdominal organs, due to repeated friction, it is easy to cause adhesion between the organs and the hernia sac, thus forming a reducible hernia. Inguinal sliding hernia is almost always an indirect hernia, occasionally a direct hernia extrudes from the Hesselbach triangle, and its symptoms are similar to those of general indirect hernia. In some cases, there may be special clinical manifestations that help diagnose sliding hernia.

　　Hernia sac extrusion type (pushing): This type is rare, and the protruding organ constitutes most of the hernia. Part of the peritoneum is located higher, and it is easy to damage the protruding organ when searching for the hernia sac during surgery if not careful.

　　Inguinal sliding hernia is almost always an indirect hernia, occasionally a direct hernia extrudes from the Hesselbach triangle, and its symptoms are similar to those of general indirect hernia. In some cases, there may be special clinical manifestations that help diagnose sliding hernia.

　　1. After the hernia is reduced, if the content of the hernia is the descending colon or sigmoid colon, the patient cannot defecate, and can only defecate after the hernia is reduced.

　　2. The phenomenon of 'two urinations' refers to the pain in the hernia during urination, after the first urination, the hernia shrinks, and there is soon a desire to urinate again, forming the phenomenon of urinating twice. This phenomenon is often seen in bladder hernias that are large and protruding.

　　3. The phenomenon of pulling the testicle, which is the hernia reduction in elderly sliding hernia.

　　First, change bad living habits and cultivate a healthy lifestyle

　　1. Quit smoking:Smoking not only causes chronic cough and increases intraperitoneal pressure, but also inhibits the synthesis of collagen fibers and promotes degenerative changes in the abdominal muscles, which is one of the important factors causing inguinal hernia in the elderly. Therefore, the elderly are best not to smoke or reduce the amount of smoking.

　　2. Maintain smooth bowel movements:Constipation is one of the important causes of increased abdominal pressure, therefore, maintaining smooth bowel movements is an effective method for preventing inguinal hernia. The elderly should eat more vegetables and fruits, drink water in fixed amounts, and develop the habit of defecating at regular times.

　　Second, take active preventive and treatment measures

　　Diseases that promote increased intraperitoneal pressure, such as chronic bronchitis, emphysema, and benign prostatic hyperplasia.

　　If there are the aforementioned symptoms or signs in clinical practice, in order to prevent organ damage during surgery, colonography, cystoscopy, or bladder urography can be performed before surgery.

　　1. Gastrointestinal contrast or barium enema can reveal the shadow of the intestinal loops in the inguinal area.

　　2. Renal venography or bladder urography can observe whether the hernia involves the urogenital system, and judge the relationship between the sliding hernia and the bladder.

　　1. Foods beneficial for inguinal sliding hernia:

　　Maintain smooth bowel movements: Constipation is one of the important causes of increased abdominal pressure, therefore, maintaining smooth bowel movements is an effective method for preventing inguinal hernia. The elderly should eat more vegetables and fruits, drink water in fixed amounts, and develop the habit of defecating at regular times.

　　2. Foods to avoid for inguinal sliding hernia:

　　Quitting smoking: smoking not only can cause chronic cough, increase intra-abdominal pressure, but also inhibit the synthesis of collagen fibers and promote the degeneration of abdominal muscles, which is one of the important triggering factors of elderly inguinal hernia. Therefore, the elderly should not smoke or reduce the amount of smoking.

　　(The above information is for reference only, please consult a doctor for details.)

　　I. Treatment

　　should be treated surgically. The key points of the operation are to first free and return the slipped organs, reconstitute a complete hernia sac, and then perform high ligation and hernia repair surgery.

　　1. Hernia sac formation and high ligation

　　(1) Bevan method: a commonly used surgical method, suitable for smaller sliding hernias, such as the cecum slipping out.

　　Operation steps: cut the peritoneum along the marginal 2 cm of the cecum in an arc, and the two ends of the incision must reach the neck of the hernia sac to ensure that a complete hernia sac can be formed for high ligation. Carefully free the cecum to the level of the internal ring, avoiding damage to the mesentery blood vessels and the spermatic cord blood vessels. Up to this point, the slipped cecum can be returned, and the two ends of the arc-shaped incision of the peritoneum are sutured together to form a complete hernia sac for high ligation.

　　(2) LaRoque method: suitable for larger sliding hernias, such as sigmoid colon sliding out.

　　Operation steps: cut the anterior wall of the hernia sac, free the posterior side of the intestine to the internal ring, and be careful not to damage the mesentery blood vessels during the dissection. Then separate the internal oblique muscle and the transversalis muscle in the direction of the muscle fibers 3 cm above the internal ring, and be careful not to damage the iliohypogastric nerve. Cut the peritoneum, and return the free slipped intestine through the internal ring.

　　(3) Ponka method: suitable for larger sliding hernias.

　　Operation steps: first separate the hernia sac and the slipped intestine from the deep surface of the internal ring, and pay attention not to damage the mesentery and the blood vessels of the spermatic cord. Cut the anterior wall of the hernia sac and cut along both sides of the intestine to the deep surface of the internal ring, then suture the two cut edges on the posterior surface of the intestine to form a complete internal ring, return the intestine, perform a high ligation of the hernia sac, and this operation does not require the peritonealization of the free surface behind the intestine.

　　2. Hernia Repair:The characteristics of sliding hernia are that the hernial ring is expanded, and the strength of the aponeurosis of the abdominal wall layers and the transversalis fascia is severely damaged, so it is more commonly used to repair the internal ring with the Bassini method after the internal ring is repaired, or a mesh repair is adopted.

　　II. Prognosis

　　There is no relevant content description at present.