1. Complications of the hernias of the abdomen The department of faculty and hospital surgery of the medical faculty of the Tashkent medical academy

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

3. In 1804, Cooper published a two-volume work "The Anatomy and surgical treatment of abdominal hernias." He described the transverse fascia, the inguinal canal and some other entities. Paying attention to the pubic ligament, which now bears his name, Cooper had no idea how important it is for the modern treatment of hernias. Austin Cooper (1759-1830), father of Rev Austin Cooper (1804-1871), grandfather of Austin Damer Cooper (1831-1900) and great grandfather of Austin Nathaniel Cooper (1853-1898)

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

5. Complications of the hernias of the abdomen Strangulation Not replacable Inflammation Coprostasis Complications at 10-15% of patients with hernia

6. Types of the strangulation of the hernias Excrement strangulation Elastic strangulation

7. Retrograd strangulation

8. Near-wall (Richter’s) strangulation

9. Clinic of the strangulated hernia Sharp begining Pain in the area of hernia Unreplacement of the earlier setting hernia Sharp pain, compaction, effort of the hernia The symptom of «cough pushing» is negative

10. Stages of the operation for the strangulated hernia 1. Tightly section of the tissues to the aponeurosis and stripping of the hernia’s sac 2. Opening of the hernia’s sac, liquidation of the hernia’s water, keeping strangulated organ 3. Section of the strangulative ring 4. Identification of the vitality of the strangulated organs 5. Resection of the not viable organs 6. Plastic of the hernia’s gates

11. Signs of not viable intestine Absence of the peristaltic Absence of the pulsation of the mesenterial vessels Blue-black color Absence of the brilliance of the peritoneum

12. Tests to indentify the vitality of the intestine Novocain test Mechanical test Test with the «hot compress»

13. Separation of the hernia’s sac Opening of the hernia’s gate

14. Section of the strangulative ring

15. Resection of not viable part of the intestine

16. Intraintestinal anastomosis “side-by-side” Nasoenteral probe Intubation of the small intestine

17. Independent or forcible setting of the strangulated hernia It is impossible to define the state of the strangulated organ Possibility of setting with the strangulative ring Possibility of defeat of the strangulated organ

18. Complications of the forcible setting of the hernia

19. Inflammation of the hernia Sources of the infection of the hernia’s sac From the inside From the outside Strangulation of the intestine Acute appendicitis Diverticulitis Terminal ileitis Typhoid fever’s ulcers Perforation of the small intestine Inflammatory processes of skin Defeats of the skin epydedimitis, orchitis lymphadenitis

20. Unreplacement The complication of the hernias, connected with the formation of the soldering among hernia’s bag and hernia’s content as a result of their trauma or aseptic inflammation

21. Unreplacement

22. Hernia and loose-hanging abdomen

23. Coprostasis - stasis of the excrements in the intestine - stasis of the excrements in the intestine The development of the coprostasis promote : Unreplacement of the hernia Less activity of the life Rich feeding Coprostasis more frequently occurs: At fat patients of elder age At men at the inguinal hernias At women at umbilical hernias

24. Treatment of the coprostasis It is necessary to reach the evacuation of the content of the intestine It is necessary to reach the evacuation of the content of the intestine At setting hernias it is necessary to try to keep the hernia at set state At setting hernias it is necessary to try to keep the hernia at set state Use small enemas with the hypertonic solution, glycerin Use small enemas with the hypertonic solution, glycerin The using of the purgatives is contraindicated! The using of the purgatives is contraindicated!

25. Prevention of the complications of the hernias The surgical treatment of all the patients with the hernias in planned regime

26. DUTIES of the general practitioners Carrying out sanitary - educational work on education of the population, promote healthy lifestyles, prevent disease development. Implementation of preventive work aimed at identifying early and latent forms of the disease and risk factors. Implementation of dynamic monitoring of the health of patients with carrying out the necessary examination and improvement. Emergency assistance in emergency and acute conditions. Timely consultation and hospitalization of patients in the prescribed manner. Conducting medical and rehabilitation activities in the amount corresponding to the requirements of qualifying characteristics. Examination of temporary disability of patients in accordance with the Regulations "On the procedure of issuing sick leave" and the direction of VTEK. Organization of health - social and household assistance in conjunction with social protection agencies and services of charity alone, the elderly, the disabled, the chronically ill. The main responsibility is to provide primary health care - social assistance, in accordance with the requirements of the qualification characteristics and obtain a certificate.