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Treating an inguinal hernia is less efficient. The operation is recommended to be carried out every 6 months. As a rule, surgery for groin hernia is either a “classic”, open-look with a linear incision in the groin hernia or laparoscopic. The advantage of the laparoscopic method is the ability, during one surgical procedure, to reveal and repair a groin hernia on the protracted side, which has not previously manifested itself, but could otherwise manifest itself in the future.

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Duhamel II Technique of surgery for groin hernia in children with Duhamel II. It will take 5 - 6 rounds if the inguinal canal becomes larger and it is no longer possible to see the neck of the pouch behind the inguinal canal. The skin is spherically cut to the aponeurosis of the external oblique meatus, which is exposed at once from the external opening of the inguinal canal. Extending 1.5 cm distally from the new one, cut the aponeurosis (the edges are 1.5 - 2 cm), open the window in the anterior section of the inguinal canal. From this center of tissue, which fills the inguinal canal, we find the neck of the hernia sac and reinforce it with the elements of the cord. In some congenital hernias, the simian duct is located medially to the hernia sac, with elements of the cord “spread” on it. The hernia sac is cut open, its place is inspected, and the internal organs are straightened out. Pull the grizhov's bag tight, the docks won't show up. The proximal part of the neck is sutured, tied at the sides, and the distal part is not tied. The operation is completed by suturing the window in the anterior part of the inguinal canal at the end, and placing ball sutures on the wound.

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Presentation on the topic: The hernia is pinched

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A strangulated grizhia is called a gostre squash instead of a grizhov bag in a grizhovy gate. This difficulty is observed, according to various statistics, in 8-20% of patients with abdominal hernia. Patients with strangulated hernias account for an average of about 4-5% of all patients with a “hot stomach”. Grizhs occur 1.5 times more often in women than in men. The fungus is infringed on the sincer of the pacemen of the non-hooded intestines, to finish the denture of lethal-8-11%, the pre-stroke of the zbizhishas of the zbilhennyas of the clock of the UDS to the operations.

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Treatment without proper medical assistance can result in necrosis of part or all of the organ. Infringement may be as different as external hernias (as found in defects of the pelvic floor or abdominal walls) and internal hernias (as found in the walls of the diaphragm or in the intestines of the stomach). Strangulated hernias come in different types. Determine the location of the strangulated hernia or any other type of anatomical area. The first classification of strangulated mynias is external and internal mynias.

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Clinical picture. Pain in the abdomen in the area of ​​the hernia is the main sign of swelling; As a rule, it occurs acutely due to physical strain, severe cough, etc. Pain often arises, but gradually worsens, and guilt and illness are associated with severe constipation . In a number of seizures, the pain is so strong that patients cannot stand up to the noise and screams. It is important for the pain to be of a gradual nature. Particularly severe pain occurs when the intestines are compressed at the hernial gate, which leads to bleeding of the strangulated intestinal loops.

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Types of strangulated herniasStrangulated hernias are divided into anatomical areas. For us, stench is divided into internal and external. The diaphragmatic hernias are connected to the internal ones. The stench is created when some of the organs of the empty cervix “enter” the empty chest and are compressed by the flesh of the diaphragm. These hernias become narrowed infrequently and, as a rule, become injured even less often, since their signs appear much earlier. Most often, the following can succumb to the pressure: the Schulus, the lesser omentum (a thick tissue apron with a large amount of fatty tissue that covers the Schulla, the liver and other organs of the upper abdomen.) and the lower abdominal cavity. u. All other grizhi are external. Because it is based on the “exit” of part of the organs of the cerebral emptying through the anterior cerebral wall. There are stinks, right off the bat: groin braids and groin straights. This kind of foundation is directly on the side of the grizhovy vipinannya. The ventral or ridged white lines of the abdomen are the lines that divide life into two halves.

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Elasticity and stool infringement are separated. The elastic tension bends raptovically, under the influx of any tension (for example, the rise of heaviness, the importance of physical work). In this case, it is necessary to remove large parts of the stomach from the stomach, including several guts, such as intestinal loops, which will recreate the hernia sac. At the narrow place, at the hernia gate, there is constriction, and first of all, thin-walled veins are compressed, as blood continues to lie behind the arteries for many hours. Venous stagnation develops and sweating begins in the middle of the veins in the empty hernia bag; Without exception, the intestinal wall becomes permeable to bacteria and the hernia region becomes infected. After about an hour, the intestinal loops become dead. The loop of intestine, which is located in the hernial pouch, affects the loop of intestine, which leads to loss of life. The burning of the earth develops, and then death occurs.

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The fecal cyst develops gradually, step by step. There will be a sound when there are great pains in the sick, who are suffering from consolidation. On the right here, the one who has shrunk his intestine, which is in the herb bag, cannot patch up the crossing - the peregin of the outer part of the intestine at the herb gate. Step by step, more loops of intestines are squeezed into the bag and the bridge is compressed, as with an elastic squeeze. However, this form of degeneration is readily available and can be experienced in severe hernias in people of advanced age who suffer from constipation.

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In case of the described most common infringement, in case of small ones, especially with stagnative and umbilical hernias, it may be called infringement of the walls. This is an elastic tension, but in the hernial gate it is not the bridge of the intestinal loop that is pinched, but the part of its wall. Making a diagnosis of wall cyst is often very important. The passage of the intestinal sac is not damaged, and the refilling of the sac is not possible. The patient will only experience severe pain in the hernia area, and even with proper investigation, it is possible to reveal a sharp illness at home in the hernia. The parietal ulcer is often the first sign of stagnation hernia.

The other main type of strangulated hernia is phlegmon of the hernia sac, which develops as a result of purulent melting of the strangulated tissues. Towards the end of a strangulated hernia, signs of inflammation appear: fever, hyperemia of the skin under the hernia, etc. Stage of Grekov's operation for strangulated umbilical hernia, congested hernia sac with phlegmon.

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Basic complications In the first place, the insecurity of a strangulated hernia results in the appearance of necrosis (deadness) of tissue that succumbs to compression. And also those parts that are located between the empty parts. If after about an hour the hernia becomes crushed (reverse process of pinching), a piece of dead tissue appears in the lower cavity. Toxins almost immediately begin to enter the bloodstream. And bring the immune system to the point of necrosis, which causes aseptic inflammation. After a few years, the intestinal flora penetrates beyond the border and peritonitis develops. And this country, due to the current development of medicine, is experiencing high mortality.

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Likuvannya. Treatment of injured hernias is no longer effective. The life of the sick person lies in the hour that passes from the moment of exchange to the operation. There is no contraindication for the operation of a strangulated hernia. If there is a suspicion of a hernia or self-reduction of the hernia, hospitalization in the surgical department is necessary. In cases of severe illness with flared up peritonitis or intestinal obstruction, infusion therapy is indicated during transportation.

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Reduction of the strangulated hernia is strictly opposed, because in this case the strangulated intestine can easily rupture. This will cause the development of peritonitis. It happens that when a patient is shifted or transported, the strangulated hernia can be self-reduced. Such patients still need to be hospitalized for care, since the loop of intestine, which often recovers, becomes permanent.

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External abdominal hernias are the escape of the internal organs of the abdominal cavity through defects of the myomatous-aponeurotic wall of the abdomen and pelvis simultaneously from the parietal layer of the abdominal cavity. Internal hernia is the penetration of the organs of the cervical region into the normally normal or pathologically formed cervical sac (hernias of the omental bursa, diaphragmatic hernias, hernias of the duodenum-small intestinal fossa ( fossa of Treits), retroduodenal abdomen and breech) The following concepts can be distinguished: Eventeration - exit of the intestines from the abdominal cavity , which is due to damage to the cervical wall (injury, rupture). The parietal leaf of the cherevina is at this age. The organ-filling parts are inserted into any area and are not covered with a cerebral leaf (neither visceral nor parietal). For example: the rectum, uterus, or secundum.

They occur most often - up to 75% of dry hernias are either straight or congenital and are either one or two-sided. The mother may be suffering from hydrocele of the nasal cord, testicle, or cryptorchidism. Up to 5% there are thickening hernias that cover the cecum, sechovy mikhur, nirka, sechovod, uterus, sigmoid colon. When these organs are injured during surgery, the mortality rate is 27%.

The ridges that are located in the jugular lacuna are most often the typical (or medial) staghorn ridges that pass through the stagnoid canal, then. medial to the stegnoid vein. However, they may be so called lateral vasculo-lacunar hernias, if the hernial sac is located in the stegova artery, and the middle vaso-lacunar hernia, if the hernial sac grows It is located under the pubertal ligament above the stegnoid artery and artery. The ridges that extend into the area of ​​the lamina lacunae - sag rarely, grow under the inguinal ligament in front of the club flesh, the lateral stegnoid artery. , occur among old wives for the obviousness of a wide lacunar.

Stegnova's ridges are more often narrowed in female women, and are infringed in 30-60%. In this case, squeezing the hernial ligament along the edge of the lacunar ligament can quickly lead to necrosis. Therefore, stegnovy hernias require a first-rate planned surgical treatment, so there is no need for cut hernias, then. The severity of the disease corona mortis is minimal, which is 10-15% when a.obturatoria is treated with a.epigastrica inferior or directly with a.ileaca externa.

Umbilical hernias account for 2-5% of all hernias. In 85% of cases, females are caught. The peculiarity of these hernias in children is that: stinks appear in the first years of life (with improperly grown or weak umbilical ring), or up to 3 fatalities (against the background of constipation, coughing, crying), there are small sizes (up to 1- 2 cm) , They are rarely discriminated against. The white line of the abdomen becomes thicker in 90-95% of people. The greatest dilation is epigastric (82%), followed by mesogastric (~15%) and hypogastric in 0.3% of cases. The size of the white line hernia is usually up to 10 cm, most often around the greater omentum. Another common occurrence in a group of abdominal hernias is post-operative hernias. Among them, it is necessary to see a group of post-operative hernias - 3% of all “clean” laparotomies involving any illness, 10% of operations that festered, and 10% of inflammatory wounds of the cervical cavity. It is also necessary to see a group of recurrent hernias that occurred after the previous hernia. From 18 to 78%, depending on the type and localization of the hernia, the site of its relapse may occur. This is particularly evident in the destruction of the topographic-anatomical interaction of tissues, the presence of scar-change structures of encapsulated “ligature granulomas”, “deep infections” in scars, and sometimes the appearance is not normal.

Crotch ridges - can expand to the front of the interstitial line, starting from the fur-uterine recess in women, and back to this line, starting in men Iv from utero-rectal, and in women from uterorectal loss of the pelvic line. Ulcerative abdominal hernias - resolve along the course of spigelia and straight abdominal ulcers.

They become sharp with a wide jamming channel. When the surface of the hernia is formed, it appears on the inner surface of the stitch under the flesh. Most often, the mygia is not clear, the clinical picture of them in its unconscious, can be recognized at the time of the operation when squeezing.

Obligatory investigations – investigations that may be carried out on a skin patient: 1) clinical closure; 2) laboratory investigations: CBC, BAM, blood group, Rh factor, blood throat time, prothrombin index, glucose, blood volume; 3) ECG (in patients over 50 years old or in patients who are planning an operation under general anesthesia); 4) consultation with a therapist (for the remaining group of patients); 5) fluorogram of OGK during planned entry.

Recommended investigations are investigations whose significance has been demonstrated in their presence for most patients: 1) electrolyte blood storage (Na+, K+, CL-); 2) blood biochemistry (bilirubin, creatine); 3) coagulogram; 4) acid-base balance and normal blood storage; 5) cystoscopy (cystography) if there is a suspicion of the presence of sechomyura in a hernia; 6) consultation with a urologist, dichotomy tests (if planned). Additional investigations include further investigations of different categories of patients and will lead to a more detailed assessment of disruption of homeostasis. 1) visual radiography of the empty casing; 2) Ultrasound of the ventral emptying.

I. Conservative treatment is carried out only in 2 cases: in children up to 2 years of life (applying plastic bandages to the appearance of shingles with umbilical hernias). Indications before surgery include enlargement of the hernia, irregularity and tension. In adult patients, it is obviously contraindicated before planned surgical treatment, then. become sick and become ill, which causes hernia to become unsafe for life or the cause of hernia (decompensated heart disease, heart failure, uncorrected coagulopathy, active tuberculosis, malignant swellings and urethral strictures, and prostate disease, pustular lesions of the skin, etc.). Wearing a bandage, which gives only a symptomatic effect - closes the hernia gate and does not allow the hernia to go out into the hernia bag. It is not possible to recommend wearing a bandage for patients who may be contraindicated before surgery, because The final wear of the bandage reduces the expansion of the hernia opening (as a result of the pressure on the fabric) and reduces the gap between the internal organs and the hernia bag.

4 years), especially with extensive rich-chamber ventral hernias" with large rich-chamber ventral hernias" class="link_thumb"> 14!} Strangulated hernias require emergency surgical treatment. There is no contraindication before surgery. In patients with a severe condition with a long-term hernia pressure (> 4 years), especially with wide rich-chamber ventral hernias, with clinical signs of endotoxicosis and disruption of homeostasis, as well as with high anesthetic the risk of carrying out an emergency short-term intervention. body weight of the patient directly on the operating table. The main important aspect of surgical assistance in case of strangulated hernia (as opposed to a non-folded hernia) is the need to first open the hernia bag for fixation. I look around at the pinched organs and at the distant growth of the pinched ring. 4 years), especially with large rich-chamber ventral hernias >> 4 years), especially with large rich-chamber ventral hernias, with the presence of clinical signs of endotoxicosis and disruption of homeostasis, as well as with a high anesthetic risk emergency short-term preoperative ml/kg body weight of the patient directly on the operating table. The main principle of the usefulness of surgical assistance for strangulated hernias (as opposed to unfolded ones) is the need to open the hernial sac for fixation and inspection of the strangulated organs and further growth of the injury Yuchy ring. with extensive rich-chamber ventral hernias""> title="Strangulated hernias require emergency surgical treatment. It cannot be contraindicated before surgery. In severely ill patients with many years of herniation together (> 4 years), especially with great rich-chamber ventral grizhah"> !}!}

In cases of intestinal circumcision, signs of vitality include the following (as shown in the operation protocol): 1. renewal of the erysipelas color of the serous curve; 2. renewal of peristalsis; 3. renewal of the pulsation of the vessels of the chest. In doubtful cases, the recommended approach is the use of current instrumental methods: laser Doppler flowmetry and intraoperative biomicroscopy. If intestinal necrosis is evident, it is necessary to undergo resection and decompressive nasointestinal intubation of the intestine in accordance with the standards adopted for the treatment of acute intestinal obstruction. If it is impossible to carry out intestinal intubation in cases of severe overdistension of the intestinal loops with herniolaparotomic access, the remaining one is either expanded (for p/o and umbilical hernias), or the additional middle laparotomy access is removed (for stegnovye, groin ovikh grizh).

In case of necrosis of the wall of the mikhur, the strangulated part of the mikhur is resected, an epicystostomy is applied, a urethral catheter is inserted, and the flushing system is improved. In case of infringed fungus, the meckel diverticulum is incredibly, I will become yogo Zhittatatnosti, Vikoristovoi sub-acidic resort (analogue Apendektoy), and the wedge-by-lifting of the rejoin of the intestine, include the basis of the sabotage. In case of necrosis of the wall of the cecum, it is necessary to undergo a right-sided hemicolectomy with ileotransverse anastomosis. As soon as the differential diagnosis was started and during the hour of operation with the drive of the strangulated stegnovaya hernia, it was revealed not a hernia, but an increase in inflammation of lymphovuzol - Pirogov, then it is not possible to remove this trace through the possibility of development trival lymphorrhea and terminal lymphostasis. The operation will end with the application of rare sutures to the wound with drainage to the inflamed lymph node.

A quick reduction of the strangulated hernia If the correction was completed before hospitalization or in a state of complete calm, then the patient is obliged to undergo hospitalization until the surgical department for diagnostic careful. In case of spontaneous reduction of the hernia, after a painful period (>4-6 years), emergency laparoscopy is necessary. If, with prolonged periods of time, the patient develops abdominal pain, positive symptoms of gastrointestinal tract infection, increasing toxicosis, or a clinical picture of intestinal obstruction, it is necessary to undergo a midline laparotomy, It is also possible to identify the cause of obstruction and to perform resection of the injured organ if indicated. If the spontaneous reduction of the hernia occurred during the hour of “introduction to anesthesia” or the beginning of local anesthesia, then it may be necessary to resize the hernia bag with an audit of adjacent organs to identify the organ that recognizes the pressure and assessment yogo zhitezdatnostі. If the sounds of the injured organ are difficult, it is necessary to perform laparoscopy through the throat of the hernial sac. If the waist is stretched as far as possible after the herniation is corrected, there is no pain, then the patient, after necessary fastening, can be operated on as planned. 4-6 years), emergency laparoscopy is necessary. If, after a follow-up period of 24-48 years, the patient exhibits abdominal pain, positive symptoms of gastrointestinal tract infection, increasing toxicosis, or a clinical picture of intestinal obstruction, then it is necessary to remove the median laparotomy ii, revision and identification of the cause of obstruction and resection of the infringement. If the spontaneous reduction of the hernia occurred during the hour of “introduction to anesthesia” or the beginning of local anesthesia, then it may be necessary to resize the hernia bag with an audit of adjacent organs to identify the organ that recognizes the pressure and assessment yogo zhitezdatnostі. If the sounds of the injured organ are difficult, it is necessary to perform laparoscopy through the throat of the hernial sac. If the waist is stretched to the nearest point after the hernia has been corrected, there is no pain, then the patient, after the necessary fastening, can be operated on as planned.">

Phlegmon of the hernia sac The operation begins with a central laparotomy. If the intestinal loop is strangulated, then it is resected in cm and in cm from the intestine to be inserted. The ends of the strangulated part of the intestine are ligated, and the permeability of the intestine is replaced by an anastomosis “end to end” or, moreover, due to the obvious disparity of intestinal diameters – “side by side”. At this stage of the operation, the isolation of the empty chute from the empty grease bag will begin. For this purpose, around the throat of the pouch, cut the parietal cord and separate it to the sides by 2 cm, re-tie the ends of the strangulated section of the intestine, tie up the white of the hernia and sew over them a separated plot of the parietal line. Sew the middle wound tightly, ball-by-ball. Next, after completing the herniotomy, open the bottom of the hernia sac, then open the ring that is pinching, so that the organ can be retracted and the pinched organ removed. A mushroom bag with too much tissue cannot be seen. It is stitched at the neck with a new tampon, where the delivery is completed. Hernioplasty for purulent infections is categorically contraindicated not only because it is doomed to failure, but also because it can lead to the development of important phlegmon of the cerebral wall. For phlegmon of the umbilical hernia, it is possible to use the circular cut method according to Grekov.

The current concept of grizhotvoreniya shodo inguinal grizh zagalom is no longer the subject of scientific research. The basis for this was formed by the secret understanding of the inability of the tissue structures of the posterior wall of the inguinal canal. It is clear that the main pathogenetic principle of the treatment of inguinal hernias lies in the new posterior wall of the inguinal canal and the given necessary mechanical function, and the methods of hernioplasty are to blame for the main criterion: whether this meta operation reaches or not. For over 100 years, operations against inguinal hernias have been based in Russia on the principle founded by Bassin in 1884. Bassini's operation became the basis for many other methods of hernioplasty.

Author Method of plastic surgery Relapse rate Nesterenko Yu.A. Bassini, 2% Salov Yu.B. Kukudzhanova 19828.9% Mitasov I.G. Postemski 19856.0% Tran V. et al. Bassini, 0% Panos R. et al .Shouldice19927.0% Nyhus L.Nyhus19936.0%

The main reason for the unsatisfactory results of treatment with traditional methods of inguinal canal plastic surgery is the proximity of heterogeneous tissues under tension, which is in accordance with the basic principles of surgery. The flesh that is stitched to the inguinal ligament is susceptible to degeneration, atrophy and cicatricial degeneration, and the tension leads to ischemic necrosis of the tissue along the suture line, their cutting and further relapse. The designated furnishings have been developed and developed in detail the new technology of lichenectomy – tension-free hernioplasty. In case of plastic surgery of hernias of the white line of the abdomen, umbilical, small ventral postoperative hernias, due to the lack of tissue tension, the use of traditional surgical methods is appropriate. In case of strangulated giant ventral hernias, it is necessary to include a larger part instead of the cervical sac, especially in the elderly with severe concomitant pathology, as it is impossible to achieve tension-free hernia repair through the presence of an allograft And, the Grizh's collar should not be sutured, but on the skin.

The basis of tension-free plastic surgery is to eliminate the causes of relapses characteristic of traditional types of hernia repair: 1. Stitching of scar-change tissues 2. Stitching of heterogeneous tissues (for inguinal hernias) 3. Ischemia of tissues due to tension and compression by sutures With non-tensioned plastic. The alomaterial, which closes the hernia gate, removes tissue in a fixed position, stimulates the creation of mature healthy tissue, at the same time or overrides the importance of the aponeurosis.

1. Elasticity, so as not to cause pressure sores in the tissues 2. Resistance to infection 3. Not to cause inflammatory, allergic reactions 4. Porosity for the penetration of macrophages, fibroblasts, blood vessels and collagen fibers 5. mothers of carcinogenic power

Polygloctin-910 (Vicryl) and polyglycolic acid (Dexon) will be removed. Stinks will be removed the day after surgery. The main manufacturers of sieve are “Ethicon”, “B. Braun”, “USSC USA”, “Ecoflon”. Polyester (Mersilene), which cannot be dissected polypropylene (Surgipro, Marlex, Prolene, Atrium), polytetrafluorothelene (Tetlon, Gjre - Tex, Ekoflon) - maximum inert, can be dissipated intraperitoneally without the risk of adhesive process, because With a very low surface tension, it is important for the fiberglass to attach to the surface of this plate

It occurs in 70-80% of cases of groin hernias in America and Europe. Its main principle is the replacement of the posterior wall of the inguinal canal with a similar material. Since that hour, since 1989. Liechtenstein, having presented the results of more than 6,000 operations, this technique is widely admired around the world, possibly producing almost the same results as those achieved in the USA at the Liechtenstein Institute. It is a given fact: initiation and creation are the greatest advantage of any technique.

Author Number of operations in patients Relapse rate Lichtenstein L ,1% Horeyseck J ,25% Kux M ,9% Egiev V.N.,9% Friis M ,9% Advantages of hernioplasty in Liechtenstein: 1. Significantly reduced relapse rate (from 6 to 14 % to 1%): 2. Reduced invasiveness of the operation, which reduces the severity of pain syndrome and allows patients to be discharged for 3-4 additional days.

Suppuration of the post-operative wound (in which there is no need to remove the endoprosthesis) The endoprosthesis feels like a foreign body. There is a publication that informs about the possibility of the appearance of unacceptable symptoms during coitus in people up to 25 years old, in connection with which it is necessary to avoid the persistence of this technique in this contingent of patients . Seroma Hematoma

Basic principles of endoprosthetic implantation: It is important to avoid contact of the alkali material with the subcutaneous tissue to prevent the development of rash. After fixation to the tissue, the endoprosthesis must lie without tension.

1. Anterior cervical implantation - the mesh is placed in the anterior space, behind the aponeurosis, which eliminates the problem of creating the cervical tissue, reduces the risk of infection and eliminates the displacement of the prosthesis during displaced internal cervical vice.

3. Supraneurotic implantation – the mesh is removed from the subcutaneous fat ball, fixed above the aponeurosis and meats. In the “tension” option, plastic surgery of the hernia stitches is carried out in front, and the mesh is placed on top of the seams. With the “non-tension” method, the mesh is laid and fixed without tension up to the aponeurosis around the perimeter with U-like sutures.

1. Laparoscopic anterior prosthetic hernioplasty: In the area of ​​pneumoperitoneum, the vernix is ​​cut with scissors in a U-like or arcuate manner, leaving the lateral and medial groin fossa of the animal. Then the suture is separated to the pubic cyst. The hernia sac is reinforced with a blunt ridge against the elements of the vernal cord and transverse fascia. To close all three pits (the stagiform, lateral and medial groin) - potential areas, a herg should be used with a mesh of at least 6 x 11 cm in size. The mesh can be applied without a cut (for straight groin), or with a front cover for the underside elements of the cord. Fixation of the prosthesis is carried out with a herniostapler and tantalum clips (10 pieces) to remove any damage to the club, lower epigaiteral, testicular vessels, the septal duct, and the mikhur.

Under endotracheal anesthesia, due to the strained carboxyperitoneum, instead of the hernial sac, the hernial sac is removed into the cauterus, the sac itself can be resected. A polytetrafluoroethylene implant is inserted at the crown, which exceeds the size of the hernia defect by at least 1 cm beyond the perimeter. The prosthesis is fixed on top of the frame using an additional stapler with staples tightened to 4.8 mm around the perimeter. The absolute absolute contraindications are: vaginalness; concomitant illnesses and conditions for which general anesthesia and planned surgical treatment are contraindicated. Obvious contraindications include fatty stage 3-4, adhesive process in the lower part of the body. If a spike process is suspected, the possibility of performing an operation may be determined after diagnostic laparoscopy. The presence of additional special possession allows you to carry out operations in the mind of the adhesive process, preventing the development of intraoperative complications in your child. II The following contraindications include: strangulated hernia; forging; illegal; Giant odorless hernias associated with hydrocele of the nasal cord and hydrocele of the membranes of the testicle. Nowadays, endovideosurgical herneoplasty is becoming a possible procedure for patients with complicated forms of inguinal hernias.

The problem arises from insufficient closure of the hernia vortex due to displacement of the implant due to insufficiently reliable fixation, as well as insufficient dimensions of the prosthesis. The stench begins to persist for the first three days after the operation. In the later period, relapses of rare diseases occur, because Having penetrated the germs with suitable tissue, the prosthesis is securely fixed at the hernia gate.

Donetsk National Medical University named after M. Gorky
Department of Faculty Surgery named after. K.T.Hovnatanyan
Assoc. Gredzhev F.A.
Donetsk 2008

Abdominal hernia (hernia abdominalis) is called

recovery of encased internal organs
through natural or artificial cervical openings
walls, pelvic floor, diaphragms under the external curves
body or otherwise empty.
The oblique components of true hernia are:
1) grizhov’s gate; 2) hernia sac with parietal
ocherevini; 3) grizhovy vmіshka - organi
empty stomach.
The recovery of internal organs is called through defects
parietal line (those not covered with line)
called prolapse (prolapse), or eventration.

Grizhov Gate

natural or pathological opening in the meat-aponeurotic ball of the vernal wall or fascial
cases, through which the grizhov vypinannya comes out.

Grizhov's bag

is part of the parietal lining,
kicks through the grizh gate. They are separated from each other
girlo - cob part of the bag, shyu - narrow wedge
the bag that is in the canal (in the same cervical walls),
body - the largest part that is found beyond the boundaries
the grizhov's vortex, and the bottom - the distal part of the sac.
The mushroom bag can be one and a lot empty.

Grizhovy vmіst

internal organs found in an empty hernia sac.
Any organ of the cerebrum may be empty in the hernia sac.
Most often someone has good crumbly organs: great
omentum, small intestine, sigmoid colon, appendix. Grizhov
Instead, you can easily slide into the empty chuck (right
hernias), to be reduced too often, not to be reduced (incorrect hernias)
or you will appear infringed at the grizh gate (infringed grizhi).
It is especially important to remove injured hernias from wrong-footed, splintered
tightening threatens the development of acute intestinal obstruction,
necrosis and gangrene of the intestine, peritonitis. As most of the internal
organs spent three hours in a burlap bag, then
Such hernias are called giant hernias (hernia pennagna). Stink forcibly
corrected at the time of surgery due to changes in duty
empty space and wasting space previously occupied by them.

External abdominal hernias

External abdominal hernias become narrower in 3-4% of people
population The natives are separated for their activities
Grizhi are swelling. The rest is divided into grizhi from zusillya
(as a result of a sharp displacement of the internal cervical pressure),
hernias due to weakness due to muscle atrophy, changes
tone and elasticity of the cerebral wall (in summer
weakened spirits). In addition, they separate
postoperative and traumatic hernias. IN
The anatomical growth is carefully separated
hernias of the inguinal, stegnos, umbilical, transverse, sedular, posterior, perineal.

Internal abdominal hernias

guts to the right and to the left.

Etiology and pathogenesis

Most often, mynias occur in children up to 1 year of age
Roku. The number of sick people is gradually changing to 10
century, after which the new growth will increase to 30-40 years
reaches the maximum. For the summer and old people
This also indicates an increase in the number of patients with hernias.
The most common are hernias (75%),
stegnov (8%), navel (4%), as well as
postoperative (12%). All other forms of hernia
become close to 1%. People tend to have tighter groins
bristles, and in women - stencils and umbilicals.

Friendly factors

Favorable factors include depression,
century (for example, a weak cerebral wall in children of the first
fate of life, atrophy of the tissues of the cerebral wall in the elderly
people), forgery (peculiarities of the pelvis and great dimensions
stegnogo ring in women, weakness of the groin area
illumination of the inguinal canal in men), feet
old age (weight loss), injury to the cervical wall,
post-operative scars, nerve palsy,
what innervates the vernal wall. Qi factor
soothe the weakening of the cerebral wall.

Vibrating factors

Vibrating factors cause displacement
internal cerebral vice; they bear a heavy burden
physical exercise, important tasks, difficulty
rash, constipation, trivial cough. Zusillya,
relieves the displacement of the internal cervical pressure,
may be united and rapt (under severity)
or it recurs often (cough).

The reason for the development of congenital hernia is
underdevelopment of the cerebral wall during the intrauterine period:
fetal umbilical hernia, fetal hernia
(hernia of the umbilical cord), lack of growth of the umbilical cord
teenage girl. Grizhovs are formed on the back
gates and grizhovy bag, later as a result of physical
Thus, the internal organs penetrate the hernial sac.
When adding grizhov, the grizhov bag and internal
organs exit through the internal opening of the channel, then
through the external (stomach canal, inguinal canal).

(zagalni principles)

The main symptoms of illness are swelling and pain in the hernia area.
during stress, coughing, physical stress, walking, when the patient is in an upright position.
Vipinannaya knows or changes in a horizontal position or after manual
straightening
The swelling gradually increases in size and becomes oval or round in shape. With ridges,
acutely sick at the moment of sharp movement of the internal cerebral pressure, the ailment is felt
severe pain in the area of ​​the hernia, which is forming, a raptoine appearance of the protruding cervical wall
and in numerous fits of blood, bleeding into excessive tissue.
The sick person is examined in a vertical and horizontal position. Looking at the vertical
the position allows you to determine if there is a tense cough or a cough that was previously unbearable, and if
In large gristes, their maximum size is set. With percussion of the hernial vein
produce a tympanic sound, as if there is an intestine in the hernial sac that releases gases, and
dullness of percussion sound, as the great omentum or organ is located in the sac,
take revenge on the gas.
Upon palpation, the consistency of the hernial mass is determined (elastic consistency)
It has an intestinal loop, a lobe of soft consistency - the great omentum).
In a horizontal position of the patient, the right to place the hernia bag is indicated. IN
At the moment of reduction of the great hernia, there may be a slight rumbling of the intestines.
After adjusting the ridge with your finger, insert it at the ridge gate and specify
size, shape of the external opening of the grizhov gate. When a sick finger coughs
The following is a symptom
cough cough; It affects external abdominal hernia.
In case of great ridges, depending on the nature of the ridge, carry out
X-ray examination of the grass tract, sectum.

Likuvannya (zagalny principles)

Conservative treatment is carried out for umbilical hernias in children. Vono lies in
tightening of bandages with a pelot, which interferes with the exit of internal organs. U
adults wear different types of bandages. Wearing a bandage means
we have illnesses that cannot be operated on due to the fact that they have serious diseases
contraindication before surgery (chronic heart disease, diseases, diseases
stages of decompensation, liver cirrhosis, dermatitis, eczema, malignancies
new creation). The wearing bandage crosses the exit of the internal organs
at the grizhov's bag and closes the grizhov's collar for the time being.
Vikoristannya bandage mozhlive lishe with right-handed ridges. Trivale yoga
Wearing can lead to atrophy of the tissues of the cranial wall, healing
between the internal organs and the hernia sac, so that the development of the hernial
grizhi.
Surgical debridement is the main method of escaping such severe
deformation of the hernia, such as deformation, inflammation, etc.
When the grizhs are not folded, the fabrics over the grizhov's vipinanny are split,
Grizh's gate, one sees the Grizh's bag and opens it. Set
instead of the bag into the empty neck, stitch and bandage the neck
grizh bag. The bag is opened and the cutting wall in the area of ​​the hernia is crushed.
involves the use of plastic fabrics, sometimes aloplastic materials.
Grizhosіchenya should be carried out under the local or other diseases.
Prevention. The advanced development of hernias in children occurs in pre-natal
hygiene of infants: proper care of the navel, rational bathing,
regulation of intestinal function. As we grow up we need regular exercise
physical culture and sports to improve both the muscles and the body
zagalom.
Of great importance is the early detection of individuals who suffer from abdominal hernias, and
the operation was carried out until the development of complications. For whom is it necessary?
preventive examinations of the population, the care of schoolchildren and elderly people
century

Inguinal hernias

Inguinal hernias account for 75% of all hernias. Sered sick
With odorous hernias, the proportion of people falls 90-97%.
Inguinal hernias may be swollen and swollen at birth.

Embryological information

From the third month of intrauterine development of the human embryo
Now the process of lowering the cells begins. In the area
the internal inguinal ring is punctured
wall membrane - sprout of soil
cherevini. The month of intrauterine
The development is pushed away from the protruding diverticulum
cherevini into the inguinal canal. Until the end of the 7th month
begin to descend towards the scrotum. At the time of the people
The baby's egg is found in the scrotum, the sprout of the throat
The cherries are overgrown. When it is not overgrown, it is created
congenital inguinal hernia. In times of uneven growth
sow sprouts of cherry blossoms on adjacent plots
This is due to hydrocele of the spinal cord (funicocele).

Anatomy of the groin area

When looking at the anterior cerebral wall from the middle
Five folds can be added to the empty sides
cherevini and burials (pits), which are in places
vihojennya grizh. The external inguinal fossa is
internal opening of the inguinal canal, it is designed
approximately above the middle of the groin (pupart) ligament on
1.0-1.5 cm more for it. The normal inguinal canal is
wide expanse, filling the people of the present day
cord, in women – round ligaments of the uterus. Pachovius
the canal passes obliquely under the cutum to the inguinal ligament and white
people may dowzhin 4.0-4.5 div.

Inguinal canal and inguinal space

The walls of the inguinal canal are created: Anterior - by the aponeurosis of the external oblique
abdominal tissue, lower - inguinal ligament, posterior - transverse fascia
abdomen, upper - with the free edges of the internal oblique and transverse muscles
belly.
External (superficial) opening of the inguinal canal using the legs
aponeurosis of the external oblique abdominal muscle, one of them is attached to
pubic hump, otherwise - to the pubic ridge. The size of the external opening
inguinal canal rizna. The transverse diameter should be 1.2-3.0 cm,
late – 2.3-3.0 cm. In women, the external opening of the inguinal canal
something less, less among people.
The internal braid and the transverse flesh of the abdomen, growing at the philtrum
inguinal ligaments, approach the vernal cord and spread over it,
creating different shapes and sizes of the inguinal space. Cordoni inguinal
space: below - inguinal ligament, above - edges of the internal oblique
transverse abdominal muscle, from the medial side - the outer edge is straight
belly pulp. The groin area can cause a gap,
spindle-like or tricutaneous shape. Tricutaneous form of inguinal
The gap indicates the weakness of the groin area.
At the site of the internal opening of the inguinal canal there is a transverse fascia
lightly bends and switches to the cord, creating a fire
the vaginal membrane of the cord and the testicle.
Round ligament of the uterus on the level of the outer opening of the inguinal canal
is divided into fibers, some of which end on the pubic bone, and other
to be lost in the subcutaneous fatty tissue of the pubic area.

Congenital hernias

When the soil shoots are completely deprived
unclosed, its empty one is freely aware of
empty cherry. Further forming
congenital inguinal hernia, with any type of inguinal hernia
The sprout is a mushroom bag. Ingredients
Grizhs become the main mass of grizhs in children (90%).
However, adults also have congenital hernias.
(close to 10-12%).

Remove inguinal hernias

Remove the groin hernia. Cutting the braid
Pakhvinnu grizhu that directly. Braid inguinal ridge
pass through the outer groin hole, straight -
through the medial With a channel shape the bottom
the grizh bag reaches the outer opening
inguinal canal. With the cord form of hernia
exit through the external opening of the inguinal canal and
is expanded at different heights of the rope.
In the inguinal-scrotal form, the hernia descends into
scrotum, stretching її.

Crooked groin mushrooms

are created in the situation when one of the walls of the grizh
The sac is an organ, partially covered with lining,
for example, sechovy mikhur, blind intestine. Rarely grizhoviy
the bag is empty, and everything is done just now
these segments of a stiff organ, which is not
covered with lining.
Cowtail hernias account for 1.0-1.5% of all inguinal hernias.
grizh. The stench stems from mechanical compaction.
the periphery of the hernia sac of the segments adjacent to it
intestines or sechovogo mikhur, reduced serous curvature.
It is necessary to know the anatomical features of the leather
gryzh, so that during the hour of surgery do not open the place
the hernia sac, the intestinal wall or the wall of the sectum sac.

Clinical picture and diagnosis of inguinal hernias

It doesn’t matter if you recognize the groin hernia, which has formed. Typical
anamnesis: raptov's hernia at the moment of physical stress
or the progressive development of the grizh vipinannya, the appearance of vipinannaya with
strained, in a vertical position of the sick body and straightened - in
horizontal. Patients experience pain in the area of ​​the hernia, in the abdomen, almost
handlessness under an hour of walking.
Examination of a patient in a vertical position reveals evidence of asymmetry
groin areas. For obvious protrusion of the cervical wall, you can
determine your size and shape. Finger tracking of the external opening
the inguinal canal is vibrated in a horizontal position of the sick posture
repositioned instead of the ridge bag. Doctor with an impish finger,
Invaginates the skin of the scrotum, extends into the superficial inguinal opening
channel, splayed in the middle and a little higher than the pubic hump. Normal
The superficial opening of the inguinal canal in men allows the tip of the finger to pass through.
If the posterior wall of the inguinal canal is weakened, the tip can be firmly inserted
finger behind the horizontal lap of the pubic brush, so that it does not work when
well-defined posterior wall, formed by the transverse fascia of the abdomen.

Obviously, investigation of the organs of the scrotum (palpation of the scrotum.
funiculi, cell and appendage cells).

Looking around the sick man

Examination of the patient in a vertical position reveals
asymmetry of the inguinal areas For the presence of bulging of the cervical
The walls can be determined according to the size and shape.
Finger tracing of the external opening of the inguinal canal
vibrate in a horizontal position of the patient after repositioning
instead of a mushroom bag. Doctor with an impish finger,
Invaginates the skin of the scrotum, sinks into the surface hole
inguinal canal, expanded to the middle and a little higher than the pubic
hump. The norm is the superficial opening of the inguinal canal in men
misses the tip of the finger. With weakened posterior wall of the inguinal
channel, you can safely place the tip of your finger behind the horizontal thread
pubic bone, which cannot be developed with good posterior alignment
walls formed by the transverse fascia of the abdomen.
This is a symptom of cough cough. Observe the groin canals.
Obviously, examination of the scrotal organs (palpation
cords, cells and appendages).

Looking around the sick man

Diagnosis of inguinal hernias in women is based on
look and palpate, as the finger is inserted from the outside
The opening of the inguinal canal is practically impossible.
In women, the groin fungus differentiates from the brush
round ligament of the uterus, distended at the inguinal canal. IN
when changing from a gryzhia, it does not change its size when
horizontal position of illness, percussion sound
it is always dull, and above the hernia there is a powerful tympanic.

Differential diagnostics

The inguinal hernia should be differentiated from hydroceles, varicoceles, and also
Stegnova grizhi.
The hydrocele has a round or oval, not pear-shaped shape, a highly elastic consistency, and a smooth surface. Palpable light
It is not possible to interpose between the testicle and its appendage. Hydroceles of great dimensions,
reaching the outer opening of the inguinal canal, can be clearly visible
upon palpation. The percussion sound over the hydrocele is dull, over the hernia it can be
tympanic. An important method of differential diagnosis is
Diaphanoscopy (examination). They vibrate in a dark room for help
The lid is firmly placed on the surface of the scrotum. What is palpated?
created to take revenge on the homeland, then when enlightened there will be
mother red color. Intestinal loops, which are located in the herb bag,
The seal does not allow light passages to pass through.
Varicocele (varicose veins of the nasal cord), when
When the patient is in a vertical position, dull, widespread pain appears in
The scrotum is indicated as increasing in size. With palpation you can
reveal snake-like dilation of the veins of the cord. Enlarged veins
They easily fall off when pressure is applied to them or when the scrotum is lifted, they burn out.
The mother is aware that the varicocele may collapse under (the pressure of the testicle
vein the plump lower pole of the nirka.

Likuvannya

The main method is surgical debridement.
The main meta operation is plastic surgery of the inguinal canal.
The operation is carried out in stages. First stage -
molding access to the inguinal canal: at the inguinal
areas vibrate an oblique cut in parallel and more
inguinal ligament from the anterior superior spine of the club bone
to symphysis; grow the aponeurosis of the external oblique muscle
belly; the upper valve is reinforced with the inner oblique and
transverse muscle, lower - from the cord,
bare at the same time the gullet of the inguinal ligament to the pubic
hump.
The next step is to see and remove the mushroom bag;
The third step is to sew deep into the groin ring until
normal sizes (diameter 0.6-0.8 cm)
The fourth stage is plastic surgery of the inguinal canal.

Access for inguinal hernia

When choosing a method of plastic surgery of the inguinal canal
vrahovuvati, which is the main reason for the creation of the groin
Hernia is weakness of the posterior wall.
For straight ridges and folding forms of inguinal ridges
(braids with a straightened canal, braids, relapses)
buti Vikonana plastic surgery of the posterior wall of the inguinal
channel.
Implantation of the anterior wall with obstructive ligamentous suturings
deep ring to normal dimensions can be
stastovannogo in children and young people with small
slanting ridges.

Etapi grizhoperetina

Etapi grizhoperetina

Etapi grizhoperetina

Etapi grizhoperetina

Etapi grizhoperetina

Etapi grizhoperetina

Etapi grizhoperetina

Etapi grizhoperetina

Etapi grizhoperetina

Etapi grizhoperetina

Methods of plastic surgery of the inguinal canal

The Bobrov-Girard method ensures the strengthening of the anterior wall of the inguinal canal. Above
Sew the inner oblique and transverse edges of the kidney to the inguinal ligament using a cord.
abdominal muscles, and then with closed sutures - the upper valve of the aponeurosis of the external oblique muscle
belly. The lower part of the aponeurosis is fixed with sutures on the upper part of the aponeurosis, fixing it in this way
the rank of duplication of the aponeurosis of the external oblique abdominal muscle.
The Bassina method ensures the improvement of the posterior wall of the inguinal canal. After seeing you
of the hernia bag, the rope is inserted and the inner braid is hemmed under it
and transversely from the transverse fascia of the abdomen to the inguinal ligament. Nasal cord
place on the prepared meat wall. The application of deep sutures seals
renovation of the weakened posterior wall of the inguinal canal. The edges of the aponeurosis with an external oblique
The abdominal tissues sew edge to edge above the abdominal cord.
The Posttempsky method is used for complete liquidation of the inguinal canal, inguinal area and
the opening of the inguinal canal is completely new and straight. Edge of straight meat
the abdomen is sutured together from the connected tendons of the internal oblique and transverse muscle until
superior pubic ligament. Further, the upper valve of the aponeurosis is both from the internal oblique and the transverse
The abdominal meat is used to stitch up to the pubic club cord and to the inguinal ligament. The seams are torn until
Insert the vernal cord between them at the lateral side. Inferior valve of the external aponeurosis
oblique abdominal meat, carried out under the cord, fixed over the upper clamp
aponeurosis. The new creation of the “inguinal canal” from the anterior cord may pass through
the myo-aponeurotic ball is called obliquely, back to front and in the middle, so that
There were no internal or external openings on the other hand. Nasal cord
placed on the aponeurosis and the subcutaneous fatty tissue and skin are sutured over it.

Stegnov's grizhi

The stitches grow on the stitches in the area
quiltweed and become 5-8% of all
belly ridge.
Stegnovy hernias especially often occur in
wives, to explain with greater versatility
meat and ship lacunae and menshoi
the value of the aroma ligament.

Anatomy of Stegnov's ridges

Between the inguinal ligaments and the pelvic bones it is broken
space, which is divided by the club-comb
fascia into two lacunae - meat and vessel. IN
meat lacunae are found to be spiritual-transverse meat and
stegnov nerve. The judiciary's lacuna has retouched stitches
artery with stegnoid vein.
Between the stegnoid vein and the lacunar ligament
interlining, filling with fibrous fabric
and the Pirogov-Rosenmüller lymphatic node. Tsey
the gap is called a stitch ring, through yak
Stegnova grizha comes out.
Cordoni of the quilt ring: zverhu – inguinal ligament; below -
ridge of the pubis; zovni – stegnova vein; before
in the middle there is a lacunar (gibbernate) ligament.
In normal minds there is no stitch channel. Vin
is created when the quilt is molded. Ovalne
a hole on the wide fascia of the stina and the outer opening
stitch channel.

Clinical picture and diagnosis

The characteristic sign of the stitched hernia is
vipinannya in the area of ​​the stegnovo-inguinal region in
the appearance of a small, supraspherical creation
size, grown under aroma bonds
to the middle in front of the lashing vessels. Ridko Grizhove
The liquid rises to the point where it burns and dissolves
above the aroma of the vines.

Differential diagnostics

Stegnova's fungus is differentiated from aroma
grizhi. For Stegnova's illegal grizha they can buti
accepted by limes, which will grow at the top
widdle of the quilted tricut. Lipoma may
partly budova, not connected with the outside world
the opening of the quilt channel. Simulyuvati
Stegnova's hernia may cause increased lymphatic
wuzley in the area of ​​the tricutaneous
(chronic lymphadenitis, swelling metastases in lymphatic nodes).

Likuvannya stegnovykh grizh

Bassina method: cut the cut parallel to the groin ligament and
lower for her over Grizhov’s vipinannyam. Grizhov Gate
cover the suturing of the inguinal and upper pubic ligaments with a stitch.
Apply 3-4 stitches. Another row of seams between
the crescent-shaped edge of the lata fascia of the stigina and the pectineal fascia
The stagnation canal is sutured with fascia.
Rudzhi's method - Parlavechchio: cut the cut like a groin
grizhi. The aponeurosis of the external oblique abdominal muscle is opened.
Bare groin area. Cut through the transverse fascia
at the late date directly. Vіdsuvayuchi primordium
cellulose, you can see the neck of the mushroom bag. Grizhov's bag
remove from the stitching channel, open, stitch and
they see. Grizhov's gates are closed by the sewing road
internal oblique, transverse meat, upper edge
transverse fascia with superior pubic and inguinal ligaments.
Plastic surgery of the anterior wall of the inguinal canal is vibrated with a path
duplication of the aponeurosis of the external oblique abdominal muscle.

Umbilical ridges

The umbilical hernia is called the swelling of organs
vaccum through a defect in the cervical wall in
navel area. The greatest illness
Beware among children of early age and especially
We are almost 40 years old. Women have umbilical hernia
occurs twice as often, less in humans, which is associated with
stretching the umbilical ring for an hour
vagusness.

Treating umbilical ridges

Only surgical - autoplasty of the cervical wall
Sapezhka chi Mayo method.
Sapizhka method: with closed seams, snoring from one
side edge of the aponeurosis of the white line of the abdomen, and on the other
sides - posteromedial part of the flesh of the direct meat
abdomen, create duplication from the myo-aponeurotic
Klaptiv at the later date directly. When it’s so bad,
stitched on the top, hemmed to the bottom at the bottom
duplicates.
Mayo method: cut the skin with two transverse cuts
at once from the navel. After the vision and hanging of the grizhov
Mishka Grizhov's gates expand in the transverse direction
two cuts through the white line of the abdomen and the front wall
Fry the straight belly meats to the inner edges.
The lower part of the aponeurosis is sutured with U-like sutures
upper, which has a duplicating appearance with closed seams
hem to the bottom collar.

Access for umbilical hernias

Sapezhka method

Mayo method

White lines of the abdomen

The white lines of the abdomen may have
supra-umbilical, sub-umbilical and sub-umbilical.
The rest meet even rarely.
Umbilical hernias grow more often from the side
navels.
Characterized by the presence of pain in the epigastric region,
becomes stronger after walking, when moving
internal cerebral vice. It's time for fastening
sickness is typical for hernias
symptoms It is necessary to carry out further investigations for
illness accompanied by pain
in the epigastric region.

Treatment of the white line of the abdomen

The operation involves a closed opening in
aponeurosis with a purse-string suture or suturing
wuzlov stitches. With a concurrent hernia
separation of straight belly meats to congeal
Napalkov's method - to grow straight fruits
Abdominal ulcers are cut along the inner edge and sutured
the outer edges of the leaves, and then the outer edges of the leaves
dissected soils. To act in such a manner
subwart of the white line of the abdomen.

Rare types of abdominal hernia

Grimae of a sword-like teenager are approved for the presence of a defect in a new one. Through
open in a sword-like teenager can be pinned like a precursor
lipoma and hernias. The diagnosis is made based on the revealed
enlargement in the area of ​​the sword-like appendage, evidence of a defect in the new data
X-rays of the xiphoid appendix.
The hernia (the hernia along the menstrual line) comes out through the defect in this part
aponeurosis of the cervical wall, which grows between monthly
(spigelian) line (cordon between the meat and tendon parts
transverse abdominal meat) and the outer edge of the straight meat. Grizha pass
through the aponeurosis of the transverse and internal oblique abdominal muscles
grows under the aponeurosis of the external oblique abdominal muscle as
Interstitial hernia (between the pulps of the vernal wall). Often
complicate the injured. Diagnosis is important, followed by differentiation
swelling and illness of the internal organs.
Transverse hernias rarely close. In some places their exit is the upper one
lower transverse tricuputinea between the 12th rib and the ridge of the club
brushes along the lateral edge of the widest part of the back (m. latissimus dorsi).
Grizhi can be congenital and inflated; shilni until utisku. Ix
differentiate between abscesses and swelling.

Rare types of abdominal hernia

Zamikalna grizha (grizha of the blinking opener) come out at once
vascular-nervous bundle (vasa obturatoria, n. obturatorius) through the valve
the opening under the comb meat (m. pectineus) and appears on the internal
the surface of the upper part of the stitch. It is most common to be wary of old wives
resulting in weakening of the pelvic floor. Grizha zazvichai small
size, could easily be mistaken for Stegnova's face.
Crotch ridges (front and back). Anterior crotch hernia
exit through the mikhurovo-uterine burial (excavaflo vesicouterina) cherevina
at the great stately lip near the central part. Posterior crotch hernia
exit through the rectouterine obstruction (excavatfo rectouterina),
pass posteriorly from the intersciatic line through the fissures in the muscle that lifts
the anus, and comes out at the subcutaneous fat cell, expands
in front or behind the anal opening. Crotch ridges are more common
Women are careful. Instead of a grizh bag there is a sechovy one
mikhur, state organs. Anterior crotch in women
it is necessary to differentiate from inguinal hernia, which also occurs in
great statue lip. Finger tracking through
pіhvu; The piercing of the perineal ridge can be worn out
between the foliage and the seed brush.
Sednichny hernias can come out through large or small sednichnye
open Grizhov's vypinannaya was retouched under the Great Sidnichnaya
meat, sometimes coming out from under the bottom edge. Grizhove vipinannya
be in close contact with the sciatic nerve, therefore pain may
They irradiate along the course of the nerve. Sednichny hernias are more often guarded against
wife. Instead of the hernia there may be the small intestine, the great omentum.

Compression of external abdominal hernias

Strangulated hernia is the most common
unsafe arrangements that will require non-gay
surgical treatment.
The organs that came out into the grizhov’s bag give in
crushed (usually on the level of the neck of the mushroom bag
at the grizh gate).
The snatch of organs from the very grizh bear
Possibly in one of the chambers of the grizh bag, with
the presence of scar cords that press on organs during
grown them one by one and with a hernia sac
(For incorrect ridges).

The mechanism is divided into:

The elastic tension is created at the moment of rapt movement
internal cerebral pressure during physical exertion, cough,
tense When this occurs, there is an overextension of the grizhov’s collars,
As a result, the mushroom bag comes out larger, lower,
internal organs. Turning grizhovyh vorit u kolishne
the camp is brought to the exchange instead of grizhi. With elastic compression, the organs that have entered the hernia sac are compressed.
The call is being made.
Fecal strangulation most often occurs in people of advanced age.
As a result of the purchase of a large quantity of intestinal products
bring the loops of intestine that are in the hernial pouch, it is expected
press the loops of the intestine, the pressure of the hernias is on
instead of the gryzhi it will be forced until the fecal bite
becomes elastic. This is how the mixed form comes to blame
exchange.
Zmishane

Pathological picture

In the injured organ, blood flow, lymph circulation,
As a result of venous stasis, transudation occurs at the intestinal wall,
There is lumen and empty grizhov bag (grizh water).
The intestine swells with cyanotic stagnation, the grizhovaya water is deprived
insight. Necrotic changes in the intestinal section begin with
mucous membrane. The region faces the greatest losses
strangulation furrow at home crushing intestines strangulating
ring.
Pathomorphological changes progress over time,
gangrene of the strangulated intestine sets in. The intestine swells with a blue-black color, and multiple subserosal hemorrhages appear.
The intestine is limp, does not peristalt, and the muscles do not pulsate.
Grizhova water becomes calamutous, hemorrhagic with feces
smell. The intestinal wall may show perforation with development
fecal phlegmon and peritonitis.
Squeezing the intestines into a grizh bag with a typical butt
marginal intestinal obstruction

Clinical picture and diagnosis

Clinical manifestations of strangulated hernia lie
in the form of a squeeze, a strangulated organ,
an hour that has passed since the moment of exchange.
The main symptoms of strangulated hernia
there is pain in the hernia area and irregularity
It’s safe to recover before the hernia.

Clinical picture and diagnosis

The intensity of the pain varies, a sharp pain may
cause shock. With Mist signs
Squeezing a hernia means severe pain
with palpation, tightening, hernial tension
vipinannya. Symptom of cough cough
negative. When percussed it means
dullness in these seizures, if the grizhov’s bag
wash out the oil seal, sechovy mikhur, grizhova water.
As if there is a gut in the grizh bag,
to remove gas, then mean tympanic
percussion sound.

Clinical picture and diagnosis

Elastic ustic. Cob of folding knitting from movements
internal cerebral pressure (physical work, cough, defecation)
The intestinal squeeze shows signs of intestinal obstruction: on
background of persistent acute pain in the abdomen, developed (by the pressure of the vessel
of the nerves of the strangulated intestine, which is caused by transverse pain,
associated with increased peristalsis, indicating the retention of empty gases,
Mozhlive vomiting. Without terminological surgical treatment of the patient's body
The skin becomes swollen: there is swelling, hyperemia of the skin in the area
hernia infection, phlegmon develops.
Retrograde is not disadvantaged. Most often, the small intestine is strangulated retrogradely, if
the hernia sac has two intestinal loops separated, and the crotch
(successfully) the loop is empty. Gives in to the pressure
Most of the time, the intestinal loop is successful. Necrosis begins earlier
intestinal loop, retracted in the abdomen by pinching rings. In this
The intestinal loops found in the herniated bag may still be
live with them.
Parietal infringement occurs at the narrow ring, which infringes, if
Part of the intestinal wall, along the proximal line, is pinched
breeches attached. Beware more often in stitch and groin hernias,
rіdshe - at the umbilicals. Disorder of lymphatic system and blood circulation in the injured person
dilations of the intestine lead to the development of destructive changes, necrosis and
intestinal perforation.

Likuvannya infringed hernias

When a hernia is squeezed, emergency surgery is necessary. Її carry out
so, so as not to cut the ring that infringes, open the grizhov
bag, prevent licking of the injured organs from the cerebrum
empty. The operation is carried out in several stages.
The first stage - ball-by-ball dissection of tissues to the aponeurosis
the shank of the grizh bag.
The other stage is growing out the grizhov bag and removing the grizh water.
To advance the clamping of the empty pinches into the cherry
organs, the assistant surgeon removes them with additional gauze
servets. It is unacceptable to cut the ring that infringes, to the point of breaking
grizh bag.
The third stage is cutting the ring that infringes, under control
Be careful not to damage the organs that are soldered to the middle.
The fourth stage is the determination of the living standards of the disadvantaged
organs. This is the most advanced stage of the operation. Main
criteria for the vitality of the small intestine and renewal
normal color of the intestine, preserving the pulsation of the abdominal vessels,
presence of strangulation furrow and subserous hematomas,
renewal of peristaltic short-lived intestines
signs of intestinal dysfunction and dark discoloration,
dark serous membrane, flaccid wall, intensity of pulsation
blood vessels and intestinal peristalsis.

Likuvannya infringed hernias

Fifth stage – resection of the non-living loop
intestines. View of the serous curve visible from the side
the boundaries of necrosis are resected at least 30-40 cm
bring in a section of intestine and 10 cm bring in
video. Resection of the intestine is considered if any
at its station of strangulation furrow, subserosal
hematomas, swelling, infiltration and abdominal hematomas
intestines.
When squeezing a rusty herg, it is necessary
mean the vitality of a part of an organ,
covered with lining. If necrosis of the caeca is detected
intestines, resection of the right half of the colon
intestines with ileotransverse anastomosis. At
necrosis of the wall of the mesh fur requires resection
changed parts of the fur with overlays
epicystostomy.
Sixth stage – plastic surgery of the hernia vorit. When choosing
the method of plastic surgery gives priority
in the simplest way.

Forecast

Post-operative mortality rate is increasing worldwide
depending on the hour that has passed since the moment
exchange before surgery, and start first 6 hours -
1.1%, for a line from 6 to 24 years – 2.1%, after 24 years –
8.2%; after intestinal resection, mortality is still 16%,
with phlegmon hernia – 24%.

Compression of self-cut and forcibly reduced strangulated hernias

Illness with infringement spontaneously
corrected the grizha guilty buti
hospitalization to surgical department.
Mimovolі was cut before pinched
the intestine may become a jerelom peritonitis or
internal intestinal bleeding.

Irregularity

Obumovlena in the grizhova bag rosshchen
internal organs between themselves and the hernial sac,
what happened as a result of their traumatization and aseptic
ignited
Improperity can be partial, if one part
instead of the grizhia, it is directed into the casing empty, and the other
loses the right. The development of illegality is suppressed
Trivalle wearing a bandage.
The umbilicals, stagnations and
post-operative hernias. It is often wrong to finish drinking
Grizhi can be richly peaceful. Inherit the development
multiple adhesions and chambers in a hernia sac are illegal
The hernia often develops by pressing the organs into one of the chambers
hernial sac or development of adhesive obstruction
intestine.

Coprostasis

Coprostasis is stagnation of feces in the colon. Tse
folding the grizhia, with a grizh bag instead
It's a thick gut. Coprostasis develops as a result
disorders of the motor function of the intestine. Yogo rozvitku
hide the illegality of the grizhi, the weak image
life, bright life. Coprostasis occurs more often in smooth
illnesses of the last century, in people with groin hernias, in
women - at the umbilical.
The main symptoms are chronic constipation, pain in
stomach, tediousness, rarely vomiting. Grizhove vypinannya polno
The colonization of the colon with feces is increasing around the world
Masami, there may be no pain, little tension,
dough-like consistency, symptom of cough cough
positive. Zagalny camp of sick people of average severity.

Prevention of deformity

undergoes surgical treatment for all patients
with ridges in planned order to development
complicate The presence of hernia is indicated before
operations.

Internal abdominal hernias

Internal abdominal hernias are called displacement of organs
gastric emptyings in the stomach, clefts and openings of the parietal
cerebral or chest empty (diaphragmatic hernia). IN
the embryonic period of development as a result of the rotation of the primary
the intestines close to the axis of the superior ventral artery
duodenal destruction (recessus duodenalis superior - kishenya
Third). This place could be buried by the Grizhov gates
repairing the internal pinched hernia.
Recessus duodenalis inferior
called brizhov's grizhi. Loops of the small intestine
The debris can penetrate between the plates of the rim bridge.
guts to the right and to the left.
Most often, the grizh gates of internal grizhs and kischens
at the end of the cerebellum the place where the club gut enters the caecum (recessus)
ileocaecalis superior et inferior, recessus retrocecalis) or in the area
lower sigmoid colon (recessus intersigmoideus).
The reasons for the creation of grizhovyh collars may be not sewn into
the hour of surgery for a gap in the breeches, the greater omentum.
Symptoms of illness are the same as for acute obstruction
intestines for any illness and to operate.

Treating internal herbs

Establish the foreign principles of honoring the state
intestinal obstruction. At the hour of surgery
Carefully follow the walls of the grizhovy gates, on
the dot indicates the daily pulsation of the great
vessels (superior or inferior ventral artery).
Grizhov's gates grow on those without judgment
in the villages. After the protective measures
displacement of intestinal loops from the hernial sac
yogo sew in. PISSALOPERATIVES
VENTRAL GRIGES

Viznachennya

Postoperative hernia (there is a ventral hernia,
cicatricial hernia) - camp, with any organ of the cerebral
empty parts extend beyond the boundaries of the cervical wall in the area
scar that disappeared after surgery.
After all laparotomies, mynias improve by 3-5%.

Reasons for the appearance of post-operative hernia

Post-operative hernia is still earlier
Vikon's operational delivery.
The main reason is the separation of the myo-aponeuratic balls of the anterior cerebral wall in the area
post-operative scar
The primary reasons for this development are:
–
–
–
–
–
–
–
–
suppuration and disintegration of postoperative wounds
multiple relaparotomies
laparostomy
tamponade of the cerebral sac
peritonitis
incorrect online access
theft of surgical equipment
early physical development

Acceptable factors for the development of ventral ridges

Nadmirna massa tila
Summer and old age
Bronchitis, pneumonia after surgery
Vomit
Constipation
Flatulence (bloating)
Suppression of dry and regenerative
the body's capabilities

Most often after surgery
the operations become complicated,
carried out in emergency or
term order.
In this situation, surgeons, as a rule, do not have much time to
carrying out standard preoperative
preparations.
This should be done in the nearest post-operative period until
impaired intestinal function (bloat or passage
intestinal instead), which means before advancement
internal cerebral vice, destruction of the diaphragms
function, cough, which has a negative impact on the process
formation of postoperative scar.

Classification of post-operative myria

Egiev St. N., 2002:
- Mali (occupy 1 area of ​​the anterior coronary
walls)
- Middle (occupy 2 areas)
- Veliki (occupy 3 areas)
– Giant (occupy over 3 areas)
Yatsentyuk M. N., 1978:
–
–
–
–
–
Mali – up to 5 div.
Middle – 6 to 15 cm.
Large – length 16 to 25 cm.
Large – length 26 to 40 cm.
Giant - over 40 cm.

Classification
ventral
grizh

Classification ICD-10

K43.0
Hernia of the anterior celiac wall
without gangrene: wickedly
obstruction, infringed,
illegal, transgulatory
K43.1
Hernia of the anterior celiac wall with
gangrene, gangrenous hernia
anterior celiac wall
K43.9
Hernia of the anterior celiac wall
without obstruction or gangrene

The butt of a gryzhi with trophic changes

Trophic changes in tissues in the area
gigantic dimensions of post-operative hernia
anterior cerebral wall.

SWR classification

S (size) - localization of hernia
M
Medial retouching
L
Lateralne roztashuvannya
M.L.
Poєdnane roztashuvannya
W (windlas) - size of the grizhovyh vorit
W1
Up to 5 div.
W2
View 5 to 10 div.
W3
View 10 to 15 div.
W4
Ponad 15 div.
R (relapse) - relapse
R1
First relapse
R2
Another relapse too.
Butt forming diagnosis: Gangrenous hernia of the anterior
celiac wall with acute intestinal obstruction (2 relapses),
retouched medially-К43.1 MW4R2

A - Sickness P. The average post-operative hernia is great. B - Hvora M. Great post-operative hernia in the right airway

region.

A - Sickness C. Giant postoperative hernia in the right hypochondrium. B – sick K. Giant average after surgery

grizha.

A - Illness I. Great legal cross-sectional post-operative hernia. B - Hvora U. Great left-sided transverse

grizha.

A - Illness D. Average multiple postoperative hernias of the right hypochondrium and epigastric region. B - Illness Ya. Veliki

multiple post-operative procedures
hernia of the right constrictor, umbilical and left
zdukhvinnyh regions.
A
B

A - Sickness N. Gigantic post-operative hernia. B - Illness Ch. Giant post-operative hernia.

A - Hvory M. Great upper-middle post-operative hernia. B - Sickness O. The average post-operative hernia is large.

Symptoms of ventral hernias

Indicated as a premium in the area
post-operative scar, which increases with
strained and in a standing position, which changes
lying down.
For the evidence of the great underworld
kishenі, vypinannya mozhe buti
Keep away from the skin scar.

Compression of post-operative hernias

The main complications of postoperative
grizhi:
–
–
–
–
–
Destruction of the street
Intestinal obstruction
Strangulated hernia
Newly created grizhi
Flatulence too.
Ale navit for the importance of overinsurance
life is made easier for those who are careless,
Post-operative hernias are reduced
labor and physical activity, impairment
the joys of life!

Folding ridge

Utisk
–
–
–
–
Pakhovi – 57.3%
Stegnovi – 31%
Pupkovi – 6%
White line mushrooms – 3%
– Post-operative – 2.2%
- Other localizations - 0.5%
Ignition
Poshkodzhennya
New creation

Clinic of strangulated hernia

Strong white.
Irregularity.
Voltage and increased dimensions.
Negative symptom of “cough cough”.
Symptoms of GKN.
Leukocytosis, temple SHOE.
In the section - protein, erythrocytes,
cylinders (toxic jade).
8. Ultrasound and fluoroscopy data of the cervix.
empty
1.
2.
3.
4.
5.
6.
7.

Methods of bathing

Only surgically! (hernioplasty)
1. Removal of the hernia and plastic surgery of the hernia
with cotton fabrics - stretch plastic. (practically not
get stuck)
2. Removal of the hernia and plastic surgery of the hernia are common
grafts - tension-free plastic surgery (plasty according to
Liechtenstein).
Stagnation occurs in mature, elderly and elderly patients
century The most advanced method, since relapse
Let's let the literature become 0.1-1%.

Prompt treatment

Stage 1 Quick access:
Wide-cut openings with high hangers
post-operative scars, excess skin and pancreas.
Vibir access:
- Epigastric region - lower access
– Mesogastric – transverse sections
- Hypogastric region - transverse or similar (in case of obesity, the subcutaneous region appears
fat apron).
Finish with the latest views of the grizh bag and
edges of the hernial defect in the myo-aponeurotic
balls.

Online access

Shape
directly
skinny cuts
at
postoperative
grizhryznoi
localization.

Prompt treatment

Stage 2 - Re-creation of the mushroom bag and separation
organs of the cerebrum empty from its walls.
Operations for post-operative hernias should be
vibrate only in an internal way, so
allows you to look around and solder to the grit bag and
edges of the hernial defect of the coronal wall of the intestinal loop
and the oil seal, strengthen them or cut them partially,
changing the self-inflicted guilt of the early
postoperative adhesive obstruction.

Hanging of the grizh bag

During the great and gigantic post-operations
grizhov grizhov bag incompletely
I’ll hang it all over, just like my parts,
combinations with additional plastic
materials, can be used for plastics
hernia defect.
For small and medium-sized hernias, if hernias
The gates are small and their edges can be closed in
duplication without any tension, grizhovy
I'll sweep the bag all over each stake.

Mobilization and hanging of the edges of hernia collars

Grizh's gate rings for post-operative hernias
may be in the wrong shape and may be separated
thick scar tissue on the edge of the middle.
At the hour of surgery, all partitions are separated and
give Grizhov's gates a clear view of the oval.
Apparently, the scar tissue is growing even worse.
not growing at all, because she is poor in blood supply
vessels.
Vikoristanny of scar tissues for maje plastic surgery
will inevitably lead to a recurrence of hernia, so
scar tissue in the area of ​​plastic surgery
Possibility of hanging!

Suturing a postoperative wound

Vibrate after vigorous rinsing
antiseptic solution.
This allows you to remove your clothes so you can lie down comfortably.
fatty cells and blood clots. Vuzlovimi
Use seams to close the cellulose and skin.
Obov'yazkovim - drainage of the wound
gum mixtures for one dose or vacuum drainage.

Plastic surgery of the cervical wall

Autoplasty
Aloplasty
Among autoplastic surgical methods
care for post-operative myria as much as possible
the widening of the bulb is fascial-aponeurotic and myaso-aponeurotic
plastic surgery, mainly in the following ways:
1.
2.
3.
4.
5.
Martinova
Napalkova
Sapizhko
Mayo
Sabaneva-Monakova.

Autoplasty according to Martinov

Operation with N.I. Napalkova for the separation of direct abdominal ulcers.

The ventral hernia is strangulated. Plastic surgery according to Sapizhko.

A - P-like sutures are applied, and
the right leaf of the aponeurosis is brought under the left one.
B - another row of knotted sutures is applied
Illumination of duplication.

Hernioplasty follows the Sapezhko-Dyakonov method. Overlay of U-like seams

Hernioplasty depends on the method
Sapizhko-Dyakonova. Overlay of similar seams
Create duplication with
claptiv aponeurosis white
vertical abdominal line
straight way
sphincter patch 2-4
P-like seams, similar
so how to deal with
Mayo methods, s
for further submissions
knotted seams around the edge
free hand
aponeurosis to the anterior wall
straight meat soup
belly.

The method of hernioplasty for hernias of the anterior vernal wall using the Voronin-Smirnov method

Aloplastic methods of surgery

With the help of transplants
For postoperative ventral hernias
transfer to a specific skin condition
as much as possible vikoristannya
sick tissues (m'yazi,
aponeurosis, fascia, scar tissue, parts
mushroom bag).
The sprat is sleeping
methods of stagnation
transplants.

Method 1 (“Onlay technique”)

The value of the grizhov vorit to rob the hems
graft over autoplasty. The edges of the grizhovaya
the defect is sewn up with knotted seams until the
dotik or in duplication.
Then the anterior surface of the myaso-aponeurotic
the ball is reinforced with a stretch of 8-10
see the line of sutures in the offending side and suturing the graft,
strong lines of seams and weak areas of the cervical wall

Transplant
roztashovaniy
in front of the myo-aponeurotic
ball
1 - skin
podshkirna
cellulose
2 - m'yazovo-aponeurotic
ball
3 - core
4 – transplant.

Aloplasty of the cervical wall with ventral hernias. (“Onlay-technique”).

Method 2 ("Inlay technique")

To help the transplant take a wide range
area of ​​the cerebral wall in the middle, between
with a core and a fleshy ball.
After removing the hernia bag and hanging scars
the lining is spherical to the meat-aponeurotic ball
stretching 6-8 cm. The edges are sewn. Then over
the graft hangs around the edge, one edge of which
It is fixed with U-like sutures to the myo-aponeurotic ball in the middle.
Then we hem the other edge with such a gap, so that
after moving the edges of the hernial defect over
the transplant has made the plastic tissue lose its tension,
"didn't sail."

Aloplasty of the cervical wall with ventral hernias. "Inlay technique"

Posterior laceration graft
m'yazovo-aponeurotic ball
1 – skin and under skin
cellulose
2 – myco-aponeurotic ball
3 – core
4 – graft

Method 3 (“Sublay technique”)

This is a way to get rid of these types of seizures if you fix them with seams
the edges of the grizhovs are cumbersome and careless. Zi sten
the grizh bag is cut out by two flat clappers
6-8 cm wide and long, which is the same as in diameter
Grizhovih vorit.
For help from one of the clappers, the thick hemmings of his
edge to protilegny edge grizhovyh turns, closes
empty casing. Then to the edges of the hernia defect throughout
when the graft is sewn on,
on top of one fix and another layer of grizh
sack.

Aloplasty of the anterior cerebral wall “Sublay-technique”

The graft grows between the leaves
grizh bear:
1 - skin and PZhK
2 - m'yazovo-aponeurotic
ball
3 - core
4 - graft

Complicated postoperative period

Early postoperative period:
Suppuration of the wound
Pneumonia
Accumulation of serous weed
Thrombophlebitis of the lower ends
Late postoperative period:
Relapse
Fungi and other localizations

Clinical applications of hernioplasty

Sickness N. Gigantka postoperative hernia
belly. A – before surgery; B - 3 days after
operations.

Giant post-operative abdominal hernia. A – before surgery; B - 6 days after the operation.

Illness R. Gigantic postoperative abdominal hernia. A – before surgery; B - 2 days after the operation.

Giant post-operative abdominal hernia. A – before surgery; B - 1.5 days after the operation.

Great post-operative abdominal hernia. A – before surgery; B - 3 days after the operation.

Methods of plastic surgery for giant hernias with a defect of the cervical wall of more than 300-400 cm2

Method V.M. Yanova:
a – the first line of readings is dotted
middle option
pararectal incision;
b - dotted line readings other
middle option
pararectal incision;
in – without interruption lacing
autodermal smoothing of the edges
aponeurosis of the white line of the abdomen;
d – middle laparotomy
the wound is sutured, pararectal
laparotomy wounds are closed
subgenital autodermal
transplants.

Method V.M. Yanova
Autodermal cream
pass through the myo-aponeurotic edges
hernia defect on
stand 3-5 cm from the edge
Grizhovikh vorit shlyakhom її
woven into grizhov
the gate is near the seam
let's step on
justice
sewing okremikh
stibkiv smuzhka
with adaptable seams
molded frame
with autodermal
Smoochki vyglyada garat.

Method V.M. Yanova
Vidminniy tim,
what is autodermal
the husband is intertwined with
the edges of the grizhovyh vorіt
by type of lacing,
s carried out
dark girls in the middle
name

Laparoscopic hernioplasty

The method of laparoscopic hernia repair lies in
Carrying out operations using low-access networks
(The puncture appears to be approximately 2 cm in diameter).
The operation is planned for additional laparoscopic
technology.
This method is not unimportant among Wikoristans
from a smaller perspective, but from a smaller world
traumatization of the patient's tissues with less frequency
Difficulty during and after surgery. Not much
method is based on laparoscopic surgery
under general anesthesia.

Prevention

Wearing bandage after surgery on the cervix
empty
Better food
Normalization of the vagina
Physical restrictions
importance after surgery