The cathedra of the faculty and hospital surgery of the treatment faculty of the Tashkent medical academy Hernias of the abdomen

Hernias of the abdomen – coming out of the internal organs from the natural or pathologic aperture at the anterior abdominal wall into the hypoderm or other cavities, covered with parietal peritoneum Hypoderm Intestine Parietal peritoneum Aperture

Sliding hernias - are the hernias, at which one of the walls of the hernia’s bag is the organ, partial covered with the peritoneum (urine bladder, ascending and descending intestines) 1 - peritoneum; 2 - fascia transversalis; 3 – hernia’s bag; 4 – wall of the caecum.

Elements of the hernia 4 3 2 1 1 – hernia’s gates 2 – hernia’s content 3 – hernia’s bag 4 – hernia’s shells 1 4 3 2

Frequency of finding out of the hernias depend on age 30-40 years 60 and elder to 1 year Death after planned operations – till 1%, after urgent – till 4%

Frequency of finding out of the different types of the hernias

Factors of the origin of the hernias local general Particularities of the anatomic construction of the area of the coming out of the hernias: Inguinal channel, White line of the abdomen and other. Producing Promoting

Promoting factors of formation of the hernias of the abdomen Heredity Age (children, elders) Gender (pelvis at women, inguinal channel at men) Particularities of constitution (fast loss of weight) Frequently births Traumas of the anterior abdominal wall Paralysis of nerves

Producing of formation of the hernias of the abdomen Factors, increasing intraabdominal pressure Constipations Lasting cough Hard physical work Hard birth Complicated urine evacuation (urethra’s stricture, adenoma of prostate)

Classification of hernias Internal External By the origin innate gained By the anatomic localization Inguinal Femoral Of white line umbilical By the clinic currency complicated (unsetting, coprostasis, strangulation, inflammation) Not complicated (setting)

Complaints of the patients with the hernias of the abdomen Presence of the formation in the area of the hernia, appearing at the vertical state or physical effort and disappearing at the horisontal positoin Pain or sense of dyscomfort in the area of hernia Seldom: sickness, constipation, ballooned abdomen

Special methods of research Symptom of cough pushing – At the coughing the finger of researcher have a sense of pushing of coming out peritoneum and nearest organs

Treatment of hernias Surgical Conservative - Wear bandage At small children At the contraindications to the surgical treatment Contraindications: Hard additional diseases 1804 Cooper - “anatomy and surgical treatment of the abdominal hernias” E.Bassini – 1884 г. – created united conception in the surgical treatment of the inguinal hernia Offered Lequen (1663) and further improved by Camper (1785) with the special metallic spring.

Negative moments of wearing bandage Atrophy of the tissues of the abdominal wall Formation of the soldering between hernia’s gate and its content Increasing of the sizes of the hernia’s gates Maceration of the skin Dyscomphort

Stages of the operation at the setting hernias Access Separation of the hernia’s bag Opening of the hernia’s gates Opening of the hernia’s bag Herniotomy Plastic of the hernia’s gates

Access at the inguinal hernias

Access at the umbilical hernias 1- by Sapejko 2- by Meyo 3- by Lexer

Separation of the hernia’s bag

Extension of the hernia’s gates

Opening of the hernia’s bag and setting of the hernia’s content

Liquidation of the hernia’s bag

Sliding hernia Danger at the sliding hernia – risk of defeat of the internal organs at the opening of the hernia’s bag

Plastic of the hernia’s gates

Likhtenshteyn’s operation

Laparoscopic herniotomy

Prevention of the hernias Observance of the hygiene of small children. Constant physical effort and sport. Fight with the obesity and cachexy Adequate choose of workers depend on their state of health. Earlier finding out people with the hernias of abdomen.