[Popular Science Time] 3.7 China Hernia Day, hernia is not a good thing, don’t ignore it just because it’s small

March 7th is "China Hernia Day". Although hernia is not rare, it is often ignored. Scientific knowledge and timely intervention are the key. On the morning of that day, the Department of Surgery of our hospital held a large-scale free clinic on Hernia Day, and the medical team provided on-site consultation for the general public.

【01What is hernia? 】

Hernia refers to the protrusion of an organ or tissue of the human body through a weak or defective part of the abdominal wall. The most common sites are the groin, navel, waist, and postoperative incisions.

According to different classification criteria, inguinal hernias can be classified into many different categories. Clinically, they are often classified according to the location of the hernia and the situation of the hernia contents entering the hernia sac. According to the situation of the hernia contents entering the hernia sac, they are divided into:

1. Reducible hernia: The hernia contents can be easily returned to the abdominal cavity. A lump will appear when standing or moving, and can be returned to the abdominal cavity by lying down or pushing with hands.

2. Irreducible hernia: The hernia contents cannot be completely reduced or cannot be completely returned to the abdominal cavity, but do not cause serious symptoms.

3. Incarcerated hernia: The hernia contents forcefully expand the hernia sac neck and enter the hernia sac. The hernia sac neck elastically contracts and traps the hernia contents. The hernia contents are then stuck in the defect or gap and are compressed, which may be accompanied by symptoms such as pain and intestinal obstruction, but ischemic necrosis does not occur.

4. Strangulated hernia: If the intestinal incarceration is not relieved in time, the intestinal wall and its mesentery will continue to be under pressure, which may reduce arterial blood flow and eventually lead to complete blockage. The hernia contents will suffer from ischemia and necrosis, leading to complications such as intestinal perforation and peritonitis, which may be life-threatening in severe cases.

【02 Causes of hernia】

1. Congenital factors

The abdominal wall is born underdeveloped, with weaker areas forming hernias.

2. Acquired factors

① Long-term high abdominal pressure: such as chronic constipation, difficulty urinating, long-term coughing, sudden heavy physical labor, etc., increase abdominal pressure and induce hernia.

② Obesity: Obese patients have increased abdominal wall fat, and reduced abdominal wall strength and toughness.

③Age: As age increases, the elasticity of the abdominal wall muscles and tissues weakens, inducing hernia.

【03 Common symptoms of hernia】

The main symptom of inguinal hernia is a lump in the groin area that protrudes from the body surface, which is usually more obvious when exerting force, coughing or standing. Some patients experience a sense of pressure, pain or discomfort. As the disease progresses, the lump may progressively increase in size and the pain may intensify. Intestinal obstruction or incarceration may even occur, manifesting as severe abdominal pain that is difficult to relieve, and emergency surgical treatment is required. Therefore, hernia must be taken seriously in the early stages of the disease and appropriate treatment should be selected as soon as possible.

[04Diagnosis of hernia]

1. Clinical examination

The initial diagnosis can be made mainly through history inquiry and palpation. If a lump appears in the groin area after standing or running, or even in the scrotum, and disappears slowly after lying down or sleeping, it is professionally called a "reducible lump". During palpation, a protruding lump is detected, which can be moved by coughing or exerting force on the abdomen. This can be used to differentiate it from lymphadenopathy or malignant masses.

2. Auxiliary examination

Ultrasound: Ultrasound can help confirm the presence and location of a hernia, especially when the mass is not obvious or difficult to feel.

CT: In complex cases or when intestinal obstruction is suspected, a CT scan can provide more detailed information to help doctors assess the extent of the hernia and possible complications.

【05 How to treat hernia? 】

Non-surgical treatment: Wearing a hernia belt can relieve symptoms and delay the progression of the disease, but it cannot cure hernia and is only suitable for patients who cannot tolerate surgery at all. It should be noted that long-term use of a hernia belt may cause skin abrasions and rashes or adhesions of the hernia sac, increasing the difficulty of surgery.

Surgical treatment: It is the most effective way to treat hernia. It inserts a patch, repairs without tension, and repairs the abdominal wall defect more firmly. Common surgical procedures include:

1. Open surgery

Cut the skin and muscles to directly repair the abdominal wall defect. It is suitable for most hernias and patients with poor general conditions who are not suitable for minimally invasive surgery under general anesthesia.

Advantages: easy operation and wide application range; for larger or complex hernias, open surgery can directly observe the entire hernia sac and repair site, making it easier to handle; no pneumoperitoneum is required, avoiding the risks associated with pneumoperitoneum in laparoscopic surgery.

Disadvantages: The trauma is slightly increased, and a longer abdominal wall skin incision is required, resulting in a longer recovery time; the postoperative pain is stronger, the incision is larger, and the postoperative pain and recovery period are longer; the complications increase, such as incision infection, hernia recurrence, etc.

The most commonly used open hernia surgery (Lijenstein repair): The patch strengthens the posterior wall of the inguinal canal, reducing tissue tension and recurrence.

2. Laparoscopic surgery (minimally invasive surgery)

The main surgical procedures are total extraperitoneal patch repair (TEP) and transperitoneal tension-free repair (TAPP), which are suitable for most hernia patients.

Advantages: ① Small trauma, mild pain, and less infection: patients can walk normally one day after surgery and resume daily activities within a few days, with less infection than open surgery. ② Better vision and access: Especially TEP surgery, which does not enter the abdominal cavity, relies on the natural space before the peritoneum to reduce damage to abdominal organs and postoperative pain caused by adhesions. ③ Short hospital stay: Most patients can be discharged one day after surgery, shortening hospital stay and reducing hospitalization costs. ④ Especially suitable for bilateral inguinal hernias.

· Postoperative precautions ·

After surgery, patients need to pay attention to the following:

You can get out of bed and go to the toilet on the day after the operation, and mainly move around in bed.

Keep the wound clean and dry, avoid getting it wet, and change the dressing regularly to avoid infection.

Pay special attention to the prevention and treatment of diseases that cause increased intra-abdominal pressure, such as prostate hyperplasia, long-term chronic cough and constipation.

Avoid lifting heavy objects or doing strenuous exercise that may significantly increase abdominal pressure within 3 months after surgery.

[06 Common misunderstandings about hernia]

Myth 1: “Hernia can only be treated surgically”

Answer: Although surgery is the most effective treatment, not all hernias require surgery. It is mainly for elderly patients with other serious diseases who can still use hernia belts for conservative treatment, but this treatment will not cure the hernia.

Myth 2: “Only old people get hernias”

Answer: Hernia not only occurs in the elderly, but also in young people and even infants, especially inguinal hernia, which is particularly common in men.

Myth 3: “Hernia will heal on its own”

Answer: Many people mistakenly believe that hernia can heal on its own, but in fact, hernia will not heal on its own. Instead, it may worsen over time and may even cause incarceration or strangulation, which may be life-threatening.

Early detection and early treatment! If you have related symptoms, it is recommended that you seek medical attention as soon as possible.