recurrent inguinal hernia
Introduction
Introduction to recurrent inguinal hernia In recent years, most scholars believe that the recurrence rate of inguinal hernia is about 4% to 10%. The most recurrence time was within 6 to 12 months after surgery. The recurrence of inguinal hernia was 4 times that of the oblique hernia. The recurrence rate was higher after recurrent hernia repair. According to the occurrence process of recurrent hernia, it can be divided into residual sputum, new hair lice and true recurrent sputum. basic knowledge The proportion of illness: 0.14% Susceptible people: no special people Mode of infection: non-infectious Complications: peritonitis constipation abdominal distension intestinal obstruction
Cause
Cause of recurrent inguinal hernia
(1) Causes of the disease
1. Classification of causes According to the occurrence process of recurrent hernia, it can be divided into two categories in clinical practice:
(1) True recurrence refers to recurrence of sputum at the site of the initial sputum operation, recurrence in the anatomical site and sputum type, the same as the sputum of the initial operation.
(2) False recurrence: There are 2 cases:
1Remaining sputum: During the initial sacral repair operation, there were still clinically undetectable sputum in other parts, that is, accompanied by sputum, and no thorough exploration was performed during the operation, which became a residual sputum.
2 new hairpin: the first sputum repair surgery was thoroughly explored and excluded with the sputum, and the operation was successful, but due to the patient's own factors, new sputum occurred after a certain time of surgery.
From the aspects of anatomy, etiology and onset time, the above three conditions are not identical, and the analysis and treatment should be different. However, in clinical practice, it is difficult to determine the type of recurrent hernia before reoperation; and surgery Among them, due to the separation of the previous surgery, scar formation, and local anatomical levels have been changed to varying degrees, it is difficult to distinguish the type of recurrent hernia.
2. The cause of true recurrence is generally related to the following factors:
(1) Age of patients: The occurrence of recurrent sputum increases with age. This condition may be related to the degeneration of abdominal muscle tissue in middle-aged and elderly people and the chronic diseases that may increase the intra-abdominal pressure.
(2) Labor intensity: In the past, heavy physical workers had a high possibility of recurrence after surgery. However, recent data indicate that this is not the case. On the contrary, mental workers have the highest recurrence rate, which may be related to abdominal muscle strength. .
(3) Type of primary sputum, size: The recurrence rate of primary inguinal hernia is higher than that of sputum, and the primary sputum is combined with sputum. The recurrence rate is higher. The abdominal wall of the sputum is often congenital or The acquired factors are obviously diffusely weak, so the recurrence rate of sputum after surgery is high, up to 20%. On the other hand, the larger the primary sputum, the larger the abdominal wall defect at the site of sputum, so the recurrence rate after surgery Will increase accordingly.
(4) Concomitant disease: When the patient has chronic bronchitis, asthma, prostatic hypertrophy, habitual constipation and other accompanying diseases, the recurrence rate of sputum after surgery increases.
(5) Surgical methods: the recurrence of hernia is related to the surgical methods, the mistakes of the approach and surgical technique, and the surgical defects such as Bassini, Halsted, Ferguson and Mc Vay represent the traditional hernia repair, only pay attention to strengthening the inguinal canal The wall or the posterior wall, without repairing the abdomen, especially the enlarged inner ring, from a modern point of view, the traditional repair surgery replaces the original anatomic abnormality with a new anatomical abnormality.
(6) bleeding, infection and nerve injury: inguinal hernia surgery, extensive wounds, easy to ooze, soft tissue and lack of support structure, hematoma can occur after surgery, secondary infection causes surgery failure, in addition, injury of the inguinal nerve, It can also cause recurrence after surgery.
(7) Surgical failure: The recurrence rate after repair of abdominal hernia surgery is very different in the literature report. This difference indicates the significant impact of surgical operation on the treatment effect. The reasons for surgical failure (postoperative recurrence) are often: 1 The surgeon is unfamiliar with the local anatomy; 2 The surgical procedure is not properly selected; 3 The processing of the key links in the operation does not meet the requirements.
Prevention
Recurrent inguinal hernia prevention
Some scholars have proved that the abdominal diaphragmatic arch or "combined fistula" is sutured with the inguinal ligament. Most patients are separated after 6 months. If the deep transverse fascia is repaired, although the two have been isolated, there is no clinical evidence. Recurrence, data show that the simple and correct abdomen transverse fascia repair, the recurrence rate is only 1.96%, in the inguinal hernia repair, excessive tension often leads to tissue tear and easy to relapse, according to the recent experience of Shouldice Hospital, application The suture is not absorbed for continuous suturing, so that the tension at a certain point is evenly distributed to several suture points, which reduces the damage to the tissue and is one of the measures for effectively preventing recurrence.
Some scholars believe that nearly one-third of recurrent hernias occur 5 to 10 years after surgery, and this long-term recurrence rate is stable at a certain percentage. This clinical reality shows that recurrent hernia seems to be in close contact with the first surgical technique. The relationship, which is related to the body's own disease, the inner ring of the paralyzed patient, and the rupture and lack of fibrotic tissue fibers in the transverse fascia of the patient, suggest that there are still some unknown factors affecting the recurrence of the inguinal hernia.
As far as medical technology is concerned, the following points should be noted in the prevention of true recurrence:
1. Strictly grasp the occurrence of surgical indications for inguinal hernia. In addition to the local anatomical defects in the inguinal region, the increase in abdominal pressure is also an important cause of recurrence. For patients with frequent abdominal pressure, such as chronic cough, constipation, urination Difficulties and patients with ascites should not be repaired until the disease is controlled or cured.
2. The purpose of exploration in careful exploration:
1 confirm the preoperative diagnosis;
2 to assess the extent of weakness and defects in the abdominal wall, and determine the surgical approach;
3 Exclude the possibility of accompanying hairpins.
3. Standardize the recurrence of sputum within 2 weeks after surgery. All of them are related to the improper treatment of the sac, including the failure to identify the sac in the operation and the "high ligation" on other structures, or the ligation of the sac is not in the neck. (the extraperitoneal fat plane), or the distance of the suture needle during ligation, generally causes the intra-abdominal organs (such as the greater omentum) to escape through the suture gap, or the sliding sputum is treated according to a general method.
4. Proper selection of surgical procedures: primary abdominal hernia surgery should be based on the patient's age, the cause of the disease (congenital or acquired, with or without predisposing factors), and the extent and extent of local tissue defects, so generally It is necessary to evaluate the tissue around the ankle during the operation. No matter what type of surgery is used, tension-free repair is an important condition for successful operation. In recent years, the introduction of tension-free hernia repair has greatly reduced the abdominal hernia. Recurrence rate.
Complication
Recurrent inguinal hernia Complications, peritonitis, constipation, abdominal distension, intestinal obstruction
1. Incarceration
The sacral mass can not be returned to the abdominal cavity, the pain is obviously aggravated, and it is persistent and tender. If the incarcerated sputum content is intestinal tube, abdominal cramps, nausea, vomiting, constipation, abdominal distension and other symptoms of intestinal obstruction may occur.
2. Strangulation
Incarcerated sputum was not treated in time, causing severe ischemia of the contents, intestinal perforation, peritonitis; water, electrolytes and acid-base disorders and even toxic shock.
3. difficult to relapse
The abdominal organs adhere to the sac, which is easy to form recurrent recurrent sputum.
Symptom
Recurrent inguinal hernia symptoms common symptoms, pain, nausea and bloating
According to the site of the abdominal organ, there are clinical signs and symptoms of inguinal hernia or straight sputum.
The clinical feature is that there is a reversible mass in the inguinal region. The initial mass is small. It only appears when the patient is standing, working, walking, running, and coughing. When lying down or pressing by hand, the mass can be returned and disappeared. Generally no special discomfort, only occasionally with local pain and pain. The recurrence rate was higher after recurrent hernia repair. Common testicular atrophy, ejaculation disorder, ischemic orchitis, chronic pain in the groin area, wound infection, etc.
Examine
Examination of recurrent inguinal hernia
Diagnosis
Diagnosis and diagnosis of recurrent inguinal hernia
The medical history and symptoms and signs of the inguinal region are the main basis for the diagnosis of recurrent inguinal hernia. There are only fuzzy symptoms in the inguinal region. No signs can be found by sputum angiography. The positive rate can reach 40%. There are groin areas. Among patients with symptoms and no signs, 88.6% of patients after sputum angiography can be diagnosed. Recent data indicate that the local residual symptoms after inguinal hernia surgery, or the symptoms are reproduced without signs, the positive rate of sputum angiography is 60%.
