Complications of the hernias

of the abdomen

The department of faculty and hospital surgery of the medical faculty of the Tashkent medical academy

  The first written mention of abdominal hernia refers to the time of Erbes papyrus in Egypt. Information about hernias was found in the works of Hippocrates (V century BC.), Celsus (I c. BC), Galen (II century AD.), Heliodorus (IV century AD.) . In particular, Celsus, gave the classical definition of hernia - protrusion of viscera through the acquired and congenital "gate", calling it a hernia.

The history of the doctrine of hernias

In 1804, Cooper published a two-volume work "The Anatomy and surgical treatment of abdominal hernias." He described the transverse fascia, the inguinal canal and some other entities. Paying attention to the pubic ligament, which now bears his name, Cooper had no idea how important it is for the modern treatment of hernias.

Austin Cooper (1759-1830), father of Rev Austin Cooper (1804-1871), grandfather of Austin Damer Cooper (1831-1900) and great grandfather of Austin Nathaniel Cooper (1853-1898)

Historic breakthrough in herniology Historic breakthrough in herniology associated with the name of the associated with the name of the Italian surgeon E.Bassini, to create Italian surgeon E.Bassini, to create a single concept in the surgical a single concept in the surgical treatment of inguinal hernia. In treatment of inguinal hernia. In 1884 Bassini first described the 1884 Bassini first described the technique of surgery for inguinal technique of surgery for inguinal hernias, and laid the foundations hernias, and laid the foundations for the modern understanding of for the modern understanding of the role of the posterior wall of the the role of the posterior wall of the inguinal canal in the herniation. He inguinal canal in the herniation. He developed the concept of developed the concept of reconstruction of the inguinal canal reconstruction of the inguinal canal has revolutionized the surgery of has revolutionized the surgery of inguinal hernias. Methods and inguinal hernias. Methods and principles of the plastic used principles of the plastic used Bassini, gradually occupied the Bassini, gradually occupied the leading position.leading position.

Complications of the Complications of the hernias of the abdomenhernias of the abdomen

Strangulation

Not replacable

Inflammation

Coprostasis

Complications at 10-15% of patients with hernia

Types of the strangulation of the hernias

Excrement strangulation

Elastic strangulation

Retrograd strangulation

Near-wall (Richter’s) strangulation

Clinic of the strangulated Clinic of the strangulated herniahernia

•Sharp begining•Pain in the area of hernia•Unreplacement of the earlier setting

hernia•Sharp pain, compaction, effort of

the hernia•The symptom of «cough pushing» is

negative

Stages of the operation for the Stages of the operation for the strangulated herniastrangulated hernia

1.1. Tightly section of the tissues to the Tightly section of the tissues to the aponeurosis and stripping of the aponeurosis and stripping of the hernia’s sachernia’s sac

2.2. Opening of the hernia’s sac, Opening of the hernia’s sac, liquidation of the hernia’s water, liquidation of the hernia’s water, keeping strangulated organkeeping strangulated organ

3.3. Section of the strangulative ringSection of the strangulative ring4.4. Identification of the vitality of the Identification of the vitality of the

strangulated organsstrangulated organs5.5. Resection of the not viable organsResection of the not viable organs6.6. Plastic of the hernia’s gatesPlastic of the hernia’s gates

Signs of not viable intestine

•Absence of the peristaltic

•Absence of the pulsation of the mesenterial vessels

•Blue-black color

•Absence of the brilliance of the peritoneum

Tests to indentify the vitality of the intestine

•Novocain test

•Mechanical test

•Test with the «hot compress»

Separation of the hernia’s sac

Opening of the hernia’s gate

Section of the strangulative ring

Resection of not viable part of the intestine

Intraintestinal anastomosis “side-by-side”

Nasoenteral probe

Intubation of the small intestine

Independent or forcible setting of the strangulated hernia

It is impossible to define the state of the strangulated organ

Possibility of setting with the strangulative ring

Possibility of defeat of the strangulated organ

Complications of the forcible setting of the hernia

Inflammation of the herniaInflammation of the hernia

Sources of the infection of the hernia’s sac

From the inside

From the outside

•Strangulation of the intestine•Acute appendicitis•DiverticulitisTerminal ileitis•Typhoid fever’s ulcers•Perforation of the small intestine

•Inflammatory processes of skinDefeats of the skinepydedimitis, orchitislymphadenitis

Unreplacement The complication of the hernias, connected with the The complication of the hernias, connected with the

formation of the soldering among hernia’s bag and formation of the soldering among hernia’s bag and hernia’s content as a result of their trauma or aseptic hernia’s content as a result of their trauma or aseptic

inflammationinflammation

Unreplacement

Hernia and loose-hanging abdomen

Coprostasis Coprostasis

- - stasis of the excrements in the intestinestasis of the excrements in the intestine

The development of the coprostasis promote:•Unreplacement of the hernia•Less activity of the life•Rich feeding

Coprostasis more frequently occurs:•At fat patients of elder age•At men at the inguinal hernias•At women at umbilical hernias

Treatment of the Treatment of the coprostasis coprostasis

• It is necessary to reach the It is necessary to reach the evacuation of the content of the evacuation of the content of the intestineintestine

• At setting hernias it is necessary to At setting hernias it is necessary to try to keep the hernia at set statetry to keep the hernia at set state

• Use small enemas with the hypertonic Use small enemas with the hypertonic solution, glycerinsolution, glycerin

• The using of the purgatives is The using of the purgatives is contraindicatedcontraindicated!!

Prevention of the Prevention of the complications of the complications of the

herniashernias

The surgical treatment of all the patients with the hernias in

planned regime

DUTIES of the general practitioners• Carrying out sanitary - educational work on education of the population, promote

healthy lifestyles, prevent disease development.

• Implementation of preventive work aimed at identifying early and latent forms of the disease and risk factors.

• Implementation of dynamic monitoring of the health of patients with carrying out the necessary examination and improvement.

• Emergency assistance in emergency and acute conditions.Timely consultation and hospitalization of patients in the prescribed manner.

• Conducting medical and rehabilitation activities in the amount corresponding to the requirements of qualifying characteristics.

• Examination of temporary disability of patients in accordance with the

• Regulations "On the procedure of issuing sick leave" and the direction of VTEK.

• Organization of health - social and household assistance in conjunction with social protection agencies and services of charity alone, the elderly, the disabled, the chronically ill.

The main responsibility is to provide primary health care - social assistance, in accordance with the requirements of the qualification characteristics and obtain a certificate.The main responsibility is to provide primary health care - social assistance, in accordance with the requirements of the qualification characteristics and obtain a certificate.