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

2. 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

3. 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.

4. 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

5. 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%

6. Frequency of finding out of the different types of the hernias

7. 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

8. 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

9. 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)

10. 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)

11. 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

12. 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

13. 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.

14. 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

15. 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

16. Access at the inguinal hernias

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

18. Separation of the hernia’s bag

19. Extension of the hernia’s gates

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

21. Liquidation of the hernia’s bag

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

23. Plastic of the hernia’s gates

24. Likhtenshteyn’s operation

25. Laparoscopic herniotomy

30. 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.