Recurrent inguinal hernia

　　First, the cause of onset

　　1. Etiological classification According to the occurrence process of recurrent hernia, it can be divided into 2 categories in clinical practice:

　　(1) True recurrent hernia: It refers to the recurrence of hernia at the site of the initial hernia operation. The recurrent hernia is the same in anatomical location and hernia type as the initial hernia operation.

　　(2) Pseudo-recurrent hernia: It contains 2 situations:

　　① Left hernia: During the initial hernia repair surgery, there may be a hernia in other areas that has not been discovered clinically, that is, a concurrent hernia. The operation did not conduct a thorough exploration, becoming a left hernia.

　　② New hernia: After a thorough exploration during the initial hernia repair surgery and the exclusion of concurrent hernia, and the success of the operation, a new hernia may occur due to the patient's own factors after some time.

　　From the aspects of anatomy, etiology, and onset time, the above three situations are not completely the same, and the analysis and treatment should also be distinguished. However, in clinical practice, it is difficult to determine the type of recurrent hernia before reoperation; and during surgery, due to the separation and scar formation from the previous surgery, the local anatomical levels are changed to varying degrees, making it difficult to distinguish the type of recurrent hernia.

　　2. The causes of true recurrent hernia are generally related to the following factors:

　　(1) Patient age: The incidence of recurrent hernia increases with age. This situation may be related to the gradual degeneration of abdominal wall muscle tissue in middle-aged and elderly people and the susceptibility to chronic diseases that can increase intraperitoneal pressure.

　　(2) Labor intensity: It was previously believed that heavy laborers had a higher possibility of hernia recurrence after surgery. However, recent data show that this is not the case. On the contrary, the recurrence rate of hernia is highest among sedentary workers, which may be related to the strength of abdominal muscles.

　　(3) Primary hernia type and size: The recurrence rate of primary inguinal direct hernia after surgery is higher than that of indirect hernia, and the recurrence rate is even higher for patients with combined hernia. The abdominal wall tissue of combined hernia is often significantly weak and diffuse due to congenital or acquired factors, so the recurrence rate of hernia after surgery is relatively high, up to 20%. On the other hand, the larger the primary hernia, the larger the abdominal wall defect at the site of hernia occurrence, so the recurrence rate after surgery will increase accordingly.

　　(4) Concurrent diseases: When patients have concurrent diseases such as chronic bronchitis, asthma, benign prostatic hyperplasia, and habitual constipation, the recurrence rate of hernia after surgery increases.

　　(5) Surgical method: The recurrence of hernia is related to the failure of surgical methods, approaches, and surgical techniques. The defects of surgical procedures such as Bassini, Halsted, Ferguson, and McVay, which represent traditional hernia repair methods, only pay attention to strengthening the anterior or posterior wall of the inguinal canal without repairing the transversalis fascia, especially the enlarged internal ring. From a modern perspective, traditional repair surgery replaces the original anatomical abnormality with a new one.

　　(6) Bleeding, infection, and nerve injury: Abdominal hernia surgery involves a wide incision, which is prone to bleeding. The soft tissue lacks supporting structures, and postoperative hematoma may occur, leading to secondary infection and surgical failure. In addition, injury to the ilioinguinal nerve can also lead to recurrence of hernia after surgery.

　　(7) Surgical failure: The recurrence rate of abdominal hernia repair after surgery varies greatly in literature reports. This difference indicates the significant impact of surgical procedures on treatment outcomes. The reasons for surgical failure (postoperative recurrence) are often: ① The surgeon is not familiar with local anatomy; ② The choice of surgical method is inappropriate; ③ The processing of key links during surgery does not meet the requirements.

　　II. Pathogenesis

　　Currently, there is no relevant content description.

　　1. Incarcerated hernia, the hernia mass cannot be reduced into the abdominal cavity, and the pain becomes significantly more severe, persistent, and tender. If the incarcerated hernia content is the intestine, abdominal colic, nausea, vomiting, constipation, and abdominal distension may occur as symptoms of intestinal obstruction.

　　2. Incarcerated hernia that has not been treated in time can lead to severe ischemia of the herniated contents, which may cause intestinal perforation, peritonitis; water, electrolyte, and acid-base imbalance, and even toxic shock.

　　3. Intractable hernia, the abdominal organs are adherent to the hernia sac, which is very likely to form an intractable hernia.

　　According to the location of the herniated abdominal organs, clinical symptoms and signs of indirect or direct hernia may be present.

　　The clinical characteristics are the appearance of a reducible mass in the inguinal region. Initially, the mass is small and only appears when the patient stands, works, walks, runs, or has a severe cough. The mass can be spontaneously reduced and disappear when lying flat or pressing with the hand. Generally, there is no special discomfort, only occasional local swelling and referred pain. The recurrence rate of hernia repair is higher after surgery. Common postoperative complications include atrophy of the testicles, sexual dysfunction, ischemic orchitis, chronic pain in the inguinal region, wound infection, etc.

　　1. Develop good living habits, quit smoking and limit alcohol. Smoking, the World Health Organization predicts, if people stop smoking, within 5 years, cancer in the world will decrease by 1/3; secondly, do not overindulge in alcohol. Cigarettes and alcohol are highly acidic substances, and those who smoke and drink for a long time are prone to acidosis.

　　2. Do not eat too much salty and spicy food, do not eat overheated, cold, expired, or deteriorated food; for the elderly, the weak, or those with certain genetic predisposition to diseases, eat some anti-cancer foods and alkaline foods with high alkalinity in moderation to maintain a good mental state.

　　Hernia imaging examination can accurately identify residual hernia, newly developed hernia, and true recurrent hernia through the accumulation of contrast agent, which has guiding significance for reoperation and can effectively reduce the occurrence of residual hernia.

　　I. Dietetic recipe for recurrent inguinal hernia

　　1. Boil pumpkin with red dates and brown sugar

　　[Ingredients] Fresh pumpkin 500g, red dates 20g, and appropriate amount of brown sugar.

　　[Preparation] Peel the pumpkin, cut it into small cubes, add red dates and brown sugar, and boil it with clean water until it is cooked.

　　[Usage] For dining, it is better to eat on an empty stomach.

　　[Applicable] Suitable for those with deficiency of Qi and blood after surgery and weak physique.

　　2. Black sesame bean milk

　　[Formula] 30g of black sesame seeds, 40g of soybean powder.

　　[Preparation] Roast black sesame seeds over low heat until they are done, grind them into fine powder and set aside. Put soybean powder in a pot, add an appropriate amount of water, mix it into a thin paste, soak for 30 minutes, then simmer over low heat until it boils. Filter the soy milk with a cloth, add it back to the pot, and simmer over low heat until it boils again. Add the black sesame powder and mix well.

　　[Usage] Take in the morning and evening, and you can add a little brown sugar as needed.

　　[Applicable] Especially suitable for those with deficiency of Qi and blood after surgery and insufficient liver blood.

　　3. Astragalus perch soup

　　[Formula] 1 perch (200g), 30g of Astragalus, 30g of Chinese yam, 6g of tangerine peel, 4 slices of ginger.

　　[Preparation] Remove the impurities and clean the perch, cut it into pieces. Clean the Astragalus, Chinese yam, and tangerine peel, put all the ingredients in a pot, add an appropriate amount of water, bring it to a boil over high heat, then simmer over low heat for 1 hour.

　　[Usage] Drink the soup and eat the meat.

　　[Applicable] Strengthen the spleen and Qi, regulate the stomach and harmonize the middle, especially suitable for the recovery of physical fitness after surgery.

　　4. Braised rabbit meat with red dates

　　[Formula] 60g of red dates, 250g of rabbit meat.

　　[Preparation] Clean the rabbit meat, blanch it in a pot of boiling water, remove it and cut it into small pieces, then put it in a pot with red dates. Add an appropriate amount of water, bring it to a boil over high heat, add cooking wine, then turn to low heat and simmer for 40 minutes. After the rabbit meat is cooked, add scallion, ginger, salt, monosodium glutamate, and five-spice powder, mix well, bring it to a boil again, and add sesame oil before serving.

　　[Usage] Take as a dish with meals, and eat at will.

　　[Applicable] Tonify both Qi and blood, recover physical and mental strength after surgery.

　　II. Foods that are good for recurrent inguinal hernia

　　1. Generally, patients can start with fluid foods such as congee, rice porridge, vegetable juice, and fruit juice 6 to 12 hours after surgery. On the second day, soft food or regular food can be eaten, such as soft rice, noodles, egg cake, chopped and cooked vegetables and meat, with a focus on nutritious, easy-to-digest, and light diet.

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

　　3. Maintain smooth defecation, and you can use jellyfish, bitter melon, sweet potatoes, etc.

　　III. Foods that should be avoided for recurrent inguinal hernia

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

　　2. Avoid smoking, alcohol, greasy, fried, moldy, and salted foods.

　　3. Abstain from spicy foods such as garlic and radish.

　   I. Prevention

　  Some scholars have proven that sutured the transversalis fascia arch or 'combined tendon' with the inguinal ligament, most patients experience separation after 6 months of surgery. If the deep transversalis fascia is repaired, although the two have separated, there is no clinical recurrence of hernia. There is evidence that the recurrence rate is only 1.96% after simple and correct repair of the transversalis fascia. In the repair of inguinal hernia, excessive tension often leads to tissue tearing and is prone to recurrence. Recently, according to the experience of Shouldice Hospital, it has been proven that the use of non-absorbable sutures for continuous suture, so that the tension at a certain point is evenly distributed to several suture points, reduces tissue damage, and is one of the effective measures to prevent recurrence.

　　Some scholars believe that nearly 1/3 of recurrent hernias occur 5 to 10 years after surgery, and this long-term recurrence rate is usually stable at a certain percentage. This clinical reality suggests that recurrent hernias seem to have no close relationship with the first surgery technique, but are related to the patient's own disease. The internal ring of patients with indirect hernia, and the断裂 and lack of elastic tissue fibers in the transversalis fascia of patients with direct hernia, these evidence all indicate that there are still some unknown factors affecting the recurrence of inguinal hernia after surgery.

　　Secondly,Regarding medical technology

　　To prevent true recurrence of hernia, the following points should be noted:

　　1. Strict control of surgical indications The occurrence of inguinal hernia is caused by not only local anatomical defects in the inguinal area but also increased abdominal pressure factors, which are also important causes of recurrence. For patients with frequent increased abdominal pressure, such as chronic cough, constipation, difficulty in urination, and patients with ascites, hernia repair surgery should not be performed before the accompanying diseases are controlled or cured.

　　2. Thorough exploration The purpose of exploration during surgery: ① To confirm the preoperative diagnosis; ② To assess the degree of abdominal wall weakness and defects, and determine the surgical method; ③ To exclude the possibility of concurrent hernia.

　　3. Standardized surgical operation The recurrence of hernia within 2 weeks after surgery is all related to improper treatment of the sac, including not identifying the sac during surgery and performing a 'high ligation' on other structures, or the ligation of the sac not at the neck (extraperitoneal fat plane), or the suture distance being too large during ligation, causing abdominal organs (such as omentum) to slip out through the suture gap, or treating sliding hernia in general methods, etc.

　　4. Appropriate selection of surgical methods: The principle of surgical methods for primary inguinal hernia should be determined according to the patient's age, the cause of the disease (congenital or acquired, whether there are triggering factors), and the degree and scope of local tissue defects. Therefore, it is generally determined after the evaluation of the surrounding tissues during surgery. Regardless of the type of surgery used, tension-free repair is an important condition for the success of the operation. In recent years, the introduction of tension-free hernia repair has greatly reduced the recurrence rate of inguinal hernia.