Indirect hernia

　　Indirect hernia is mainly related to the decreased strength of the abdominal wall and the increased intra-abdominal pressure. Due to the increased intra-abdominal pressure, abdominal viscera can form an abdominal wall hernia through the vulnerable part of the abdominal wall. The appearance of a reducible mass at the external ring of the inguinal canal is the most important clinical manifestation.

　　If an indirect hernia cannot be reduced, it can lead to incarcerated hernia, causing intestinal obstruction, even intestinal necrosis, perforation, and even death.

　　1. Intestinal incarceration

　　Under normal circumstances, the contents of the hernia (usually the intestines) can pass through the hernia ring under the action of intra-abdominal pressure and enter the hernia sac, and can be returned to the abdominal cavity by itself (or by external force). When various reasons (such as friction, adhesion, etc.) cause the contents of a reducible hernia to suddenly not be able to be returned, and the local mass increases, it indicates that complications such as intestinal incarceration have occurred, and this is called an incarcerated hernia. After intestinal incarceration, the main clinical manifestations are those of intestinal obstruction.

　　2. Intestinal strangulation

　　If an incarcerated hernia persists and is not treated in a timely manner, the contents of the hernia (mainly the intestines) may experience circulatory disorders, leading to intestinal obstruction, intestinal necrosis, and even intestinal perforation and other serious consequences, then complications such as strangulated hernia occur.

　　The appearance of a reducible mass at the external ring of the inguinal canal is the most important clinical manifestation. Initially, when an indirect inguinal hernia occurs during long-standing, walking, or coughing, the mass protrudes outward along the inguinal canal; the mass gradually increases and extends into the scrotum. The upper end of the mass is narrow, the lower end is wide, and the shape is similar to a pear, with a handle-like extension into the inguinal canal. There is a feeling of descent or mild soreness when the mass protrudes.

　　There is still a certain recurrence rate after indirect hernia surgery, about 2% - 5%. Especially after surgery, children are prone to recurrent hernia due to increased intra-abdominal pressure caused by common cold, severe coughing, frequent crying, constipation, etc. Therefore, after surgery, attention should be paid to keeping the child warm, preventing colds, and if there is a habit of constipation, it is necessary to use a suppository every day or every other day to relieve constipation. Large indirect hernias after surgery are also prone to hematoma or recurrence, because the hernia sac is large, the剥离 area is large, and it is easy to damage small blood vessels and cause hematoma. The larger the hernia sac, the larger the hernia ring, and this area is still a weak link after surgery, so it is easy to recur. Therefore, it is better to have surgery as soon as possible for children diagnosed with a hernia after 6 months.

　　Most indirect hernias can be diagnosed based on the patient's clinical symptoms and physical examination. If the hernia is small and the symptoms are atypical, it can generally be diagnosed by an ultrasound examination. The appearance of a reducible mass at the external ring of the inguinal canal is the most important clinical manifestation.

　　In addition to general treatment, patients with indirect hernia after surgery can also relieve symptoms through dietary therapy.

　　1. Jujube Brown Sugar Stewed Pumpkin

　　Ingredients: 500g of fresh pumpkin, 20g of jujube, and an appropriate amount of brown sugar.

　　Preparation: Peel the pumpkin, cut it into small cubes, add jujube and brown sugar, and cook with water until done.

　　Usage: Eat with meals, and it is better to eat on an empty stomach.

　　Applicable: Suitable for patients with deficiency of Qi and blood after surgery and those with weak physique.

　　2. Black Sesame Bean Milk

　　Ingredients: 30g of black sesame seeds, 40g of soybean powder.

　　Preparation: Roast black sesame seeds with low heat until they are cooked, grind them into fine powder for later use. Put soybean powder in a pot, add an appropriate amount of water, stir to form a thin paste, soak for 30 minutes, cook over low heat until boiling, filter the soy milk with cheesecloth, return it to the pot, cook over low heat until boiling again, add black sesame powder, stir evenly and it is ready.

　　Usage: Take in the morning and evening, and sugar can be added as desired when taking.

　　Applicable: Suitable for patients with deficiency of Qi and blood after surgery, especially those with insufficient liver blood.

　　3. Astragalus Perch Soup

　　Formula: Perch 1 (200g), Astragalus 30g,山药 30g, Tangerine peel 6g, ginger 4 slices.

　　Preparation: Remove impurities from the perch, clean it, and cut it into pieces. Clean Astragalus,山药, and Tangerine peel, put all the ingredients in a pot, add an appropriate amount of water, boil over high heat, then simmer over low heat for 1 hour.

　　Usage: Drink soup and eat meat.

　　Indications: Invigorating the spleen and Qi, soothing the stomach and middle energizer, especially suitable for patients recovering from surgery.

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

　　First, Non-surgical Treatment

　　Conservative treatment includes hernia belts, hernia supports, traditional Chinese medicine and herbs, etc. 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 1 year old, the elderly, the weak, or those with serious diseases who cannot tolerate surgery.

　　Second, Surgical Treatment

　　The most effective treatment for indirect inguinal hernia is surgical repair. E易于复发性疝可以进行择期手术治疗，难复性疝应限制在短期内手术，嵌顿性疝和绞窄性疝必须采取急诊手术治疗，以免造成严重后果。手术方法可以归纳为以下三种。

　　1. Traditional Hernia Repair: The basic principle of surgery is high ligation of the hernia sac, reinforcement or repair of the inguinal canal wall. The abdominal muscles of infants and young children can gradually become strong during development, which can strengthen the abdominal wall. High ligation of the hernia sac can often achieve satisfactory efficacy without the need for hernia repair. Strangulated hernia due to intestinal necrosis and local severe infection usually only adopts high ligation of the hernia sac.

　　2. Tension-free Hernia Repair: Traditional hernia repair has the disadvantages of large suture tension, pulling and pain at the surgical site after surgery, and tension-free hernia repair has the characteristics of mild postoperative pain, rapid recovery, and low recurrence rate. Its main popular surgical methods include Lichtenstein surgery, Rutkow surgery, and Stoppa surgery.

　　3. Laparoscopic Inguinal Hernia Repair: In recent years, laparoscopic surgery has made significant progress, and its main methods mainly include four types, namely pre-peritoneal approach (TAPA), complete extraperitoneal approach (TEA), intraperitoneal approach (IPOM), and simple hernia ring suture method.