Hernia Of The White Line Of The Abdomen - Symptoms, Treatment, Surgery

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Hernia of the white line of the abdomen

Content:

• Anatomical features of the abdominal wall
• What does a hernia of the white line of the abdomen mean?
• Causes of a hernia of the white line of the abdomen
• Symptoms of a hernia of the white line of the abdomen
• Complications of hernia of the white line of the abdomen
• Diagnostics of the hernia of the white line of the abdomen
• Surgery to remove a hernia of the white line of the abdomen

A hernia of the white line is a disorder in which crevices form between the muscles on the white line, through which fat and internal organs appear. A hernia manifests itself in the form of a painful formation, it is treated only by surgery. For any manifestations, you need to consult a surgeon.

Anatomical features of the abdominal wall

The abdominal wall is represented mainly by the abdominal muscles. The layers of the abdominal wall include:

• Peritoneum. It is a thin layer of connective tissue lining the inside of the abdominal cavity. It covers all the organs of the abdominal cavity.
• Fat layer (pre-peritoneal tissue).
• Transverse fascia. It is a compacted layer of connective tissue that strengthens the abdominal wall.
• Abdominal muscles. They cover almost the entire stomach. Located on the right and left, outside covered with fascia (a layer of connective tissue).
• Subcutaneous fatty tissue covered with skin.

There is a narrow area along the median line where the muscles contract. Here the fascia of the right and left muscle groups converges. This anatomical formation forms the white line.

The white line is not uniform in width. From above, it is wider and is up to three centimeters. It tapers below the navel. The likelihood of a hernia in the upper part is highest. Often, a defect forms under the sternum.

What does a hernia of the white line of the abdomen mean?

As practice shows, pathology is 3-10% more common in men under the age of 30. With this form of the disease, parts of the internal organs and fat begin to show through the holes between the muscles. The typical site of localization is the epigastric region.

Depending on the localization relative to the umbilical cavity, the following types of hernias are distinguished:

• Supra-umbilical (located above the navel);
• Paraumbilical (located near the umbilical cavity);
• Umbilical (localized below the umbilical cavity).

The location of a hernia of the white line near and under the navel is rare.

Modern methods of treatment make it easy to get rid of the disease, however, to identify it at the initial stage, you need to familiarize yourself with the causes of the development of pathology and the symptoms that accompany it. A hernia, like any other disease, is easier to treat at the initial stage of development.

At first glance, education does not cause significant discomfort, but the disease is still fraught with danger. The main threat lies in the pinching of organs trapped inside the hernial sac. In some cases, nerve compression occurs.

Causes of a hernia of the white line of the abdomen

A hernia is formed due to congenital or acquired weakness of the connective tissue of the white line. As a result of this, the tissue becomes thinner and expands, crevices form in the white line, and diastasis of the rectus muscles (divergence) develops. Normally, the white line should not be wider than three centimeters; if it is modified, the width can be up to ten centimeters.

Factors leading to weakening of connective tissue:

• Hereditary tissue weakness;
• Overweight;
• Postoperative defects, non-healing wounds.

Risk factors associated with increased intra-abdominal pressure include:

• Physical activity, lifting weights;
• Pregnancy, childbirth, complicated labor;
• Chronic constipation
• Infectious diseases accompanied by prolonged cough;
• Chronic diseases;
• Accumulation of fluid in the abdominal cavity.

Injury to the abdominal cavity can also cause an abdominal mass. Therefore, you need to engage in muscle training so that they strengthen and become protection against a disease such as a hernia.

Symptoms of a hernia of the white line of the abdomen

A hernia may not manifest itself in the form of specific symptoms, but only manifest itself as a protrusion during physical exertion and straining. As for the symptoms that will arise in the future with the development of the disease, it should be noted the pain syndrome, aggravated by straining and intense movements. Pain as the disease develops can have a different character: sharp, intense, stabbing, prolonged, acute, "dagger", etc. etc.

So, the disease is accompanied by the following symptoms:

• painful bulging in the midline (usually in the upper section);
• nausea, periodically turning into vomiting;
• stretching the muscles along the midline;
• pain with sudden movements, turns, bends;
• pain after eating;
• dyspeptic disorders (belching, hiccups, heartburn).

As the condition worsens, the symptoms intensify:

• blood may be released during bowel movements;
• pain increases and becomes unbearable;
• vomiting constantly;
• if at an early stage of the disease the hernia can be corrected independently, then with complicated forms this is impossible.

This is a general symptomatology; in medical practice, three stages of the disease are distinguished: lipoma, initial and formed hernia.

First, fat appears through the crevices in the white line. Further, this stage is replaced by the initial one, at which the bag is formed. With the rupture of the abdominal muscles and the progression of the disease, a small intestine or omentum partially appears in the hernial sac.

The third phase is accompanied by a formed hernia - a painful seal appears on the white line. The hernial gates (through which the internal organs protrude) have an oval or round shape, reach up to 12 cm in diameter. Often, multiple formations are diagnosed along the white line, which are located one above the other.

The nerve endings of the preperitoneal tissue are often pinched at an early stage and bring painful sensations.

Emergency medical care should be provided when the hernial contents are pinched, especially when the umbilical hernia is pinched, the main signs of which are sharp pains, nausea, vomiting, defecation disorders, etc.

Complications of hernia of the white line of the abdomen

The most common complication of a white line hernia is its pinching. The hernial sac is suddenly compressed at the point through which it exits (in the hernial orifice).

Emergency medical attention is required for the following symptoms:

• Nausea that turns into vomiting;
• The presence of blood in the feces, the absence of an act of defecation;
• Increasing abdominal pain
• The lesion does not adjust when pressed lightly in a horizontal position.

When the formation is pinched, the elements of the intestine and other organs trapped in the hernial sac are compressed, blood flow is disturbed. Gradually, the hernia dies off, but the patient's condition only worsens. The skin turns pale, the stomach hurts even more, the abdominal muscles harden. Infringement of the hernia is life-threatening for the patient.

Diagnostics of the hernia of the white line of the abdomen

Diagnostic methods include:

• Surgeon's examination;
• X-ray of the stomach and duodenum;
• Gastroscopy;
• Herniography with the introduction of a contrast agent;
• Ultrasound examination of hernial formation;
• Computed tomography of the abdominal organs.

Surgery to remove a hernia of the white line of the abdomen

A hernia is treated only surgically in a stationary setting. An operation aimed at removing a hernia is referred to as hernioplasty. To date, about 300 surgical methods have been developed for the treatment of hernias of the anterior abdominal wall. Both simple techniques using the patient's own tissues and complex reconstructive interventions using artificial materials are used.

The following types of operations are distinguished:

• Plastic using local tissues (open surgery with tension plastic). The defect is sutured with a non-absorbable suture to eliminate possible divergence of the rectus muscles. Due to the weakness of the connective tissue and a significant load on the postoperative sutures, a relapse of the disease develops after the intervention in 25-40% of cases, therefore this method is rarely used. Another disadvantage is that the long incision leaves a large scar.
• Plastic surgery using synthetic prostheses and meshes (open surgery with tension-free plastic). To close the defect after the elimination of diastasis, a mesh of allomaterial is installed. Dentures and meshes provide a strong framework, so the likelihood of re-developing the disease is low. This is a minimally invasive technique; during the operation, a small incision is made in the umbilical region. Through this incision, not only the hernial formation is removed, but also the prosthesis is installed. The mesh can be installed under the aponeurosis (tendon plate), as well as in its lumen and inside the abdominal cavity. Allomaterial over time grows with connective tissue, and it becomes impossible to distinguish it from its own tissues. The outer seams are also invisible.
• Laparoscopic intervention. With the advent of high-tech devices, this technique in the treatment of hernia of the white line is becoming more and more popular. The incision is not made in this case. Instead, the surgeon makes several holes through which the mass is removed and the mesh prosthesis is inserted. Laparoscopic surgery minimizes the risk of recurrent disease and is less traumatic in general. The recovery period after laparoscopy is reduced to ten days (compared to other techniques). After that, the patient can return to normal life. This operation is not suitable for patients with heart or lung disease. Also, its implementation is impossible in the absence of the necessary equipment and qualified specialists.
• Paraperitoneal intervention. In this case, several punctures are also performed, however, unlike laparoscopy, the peritoneum is not pierced, and the instruments are not inserted into the cavity. A special balloon is placed between the peritoneum and adjacent tissues. Due to its inflation, a space is formed that opens access to the hernial formation. The advantages of this method are the same as for laparoscopy, but the intervention is somewhat more complicated. Because of this, the mesh prosthesis cannot be securely fixed.

A feature of the radical treatment of a hernia of the white line is that one removal of the formation is not enough. Elimination of the divergence of the rectus muscles is required.

The operation can be carried out as planned. The surgeon examines the patient, conducts an examination, makes an accurate diagnosis and appoints the date of the operation.

As noted above, nowadays, mainly tension-free techniques are used to eliminate a hernia of the white line and eliminate diastasis.

The advantages of such an operation are as follows:

• Reliability, minimal risk of re-development of the disease;
• Simplified intervention technique, which allows its use in outpatient practice;
• Possibility of using minimally invasive techniques with the introduction of synthetic implants;
• Small tissue trauma, due to which in the postoperative period the patient experiences less pain;
• Reduction of the rehabilitation period and temporary disability;
• Good cosmetic effect.

How is the operation going?

Before the intervention, the patient undergoes a series of tests:

• Blood and urine for general analysis;
• Blood biochemistry;
• Tests for hepatitis, syphilis and HIV;
• Undergoes an electrocardiogram.

During the intervention, the surgeon separates the hernial sac, opens it, assesses the condition of the organs inside and places them in the abdominal cavity. The hernial sac is tied up and cut off, its base is sewn on. After that, diastasis is eliminated and the white line is strengthened.

With a strangulated hernia, the operation is performed on an emergency basis. The surgeon opens the bag, evaluates the part of the intestine that has got into it. If she is dead, she is excised. In some cases, a significant part of the intestine dies - then the incision is enlarged and all dead tissue is removed.

The intervention is performed under general anesthesia, the duration of the operation is about an hour (if there are no complications). If a planned operation is performed, the patient leaves the clinic the very next day. Dressings are done twice a week. For 10-12 days, the stitches are removed.

Recovery after surgery

With an exacerbation of the disease, surgical intervention is inevitable, but the scale of resection in this case can be expanded. If the formation has already formed, it makes no sense to wear a bandage, since this will only aggravate the situation (squeezing the protrusion is highly not recommended).

Bandages are worn in two cases: to prevent the development of the disease and in the period after surgery to maintain the integrity of the seams and maintain the weakened abdominal muscles.

After the operation, you should also not strain the site of the removed hernia. Lifting weights is prohibited, physical activity should be avoided in general. In two to three months, when the body has fully recovered after the intervention, on the contrary, special exercises are recommended to strengthen the abdominal muscles. You should not make up the complex on your own - for this you need to consult a doctor who will recommend an effective restorative set of exercises.

After the intervention, it is imperative to follow a special diet. The consumption of foods that cause gas formation and stool retention is prohibited. The diet should be as gentle as possible in order to maintain the integrity of the postoperative sutures and not injure the operated areas. Food should be eaten in small portions. The consumption of liquid meals and cereals is recommended.

If there are problems with weight, in order to eliminate the risk of recurrent hernia, it is necessary to normalize body weight and strengthen the muscle corset.

Prognosis after surgery. After open interventions with tension methods, the likelihood of relapse is high: in 25-40% of patients, hernia recurs. With tension-free, minimally invasive techniques, the risks of relapse are low.

In general, the likelihood of relapse depends on how conscientiously the patient fulfills the surgeon's recommendations in the postoperative period.

Prevention of white hernia

Prevention of white line hernia includes:

• Use of a bandage during pregnancy;
• Compliance with the principles of healthy eating;
• Workouts aimed at strengthening the abdominal muscles;
• Normalization of body weight;
• Compliance with the correct technique for lifting weights.

Separately, you should consider the point that concerns the wearing of a bandage. The abdominal bandage is a knitted tape up to 20 cm wide. A special "pad" is located on it, which is placed in the area of the probable appearance of a hernia.

It is impossible to get rid of a hernia with a bandage. Its use can only aggravate the situation: the bandage, having assumed the functions of the abdominal muscles, weakens them. As a result, they diverge even more, and the hernial protrusion increases.

However, in some cases, doctors still recommend wearing a bandage:

• A short time before the intervention to prevent increased protrusion;
• At the stage when there is only a preperitoneal lipoma, but the hernial formation itself is not yet there;
• For prevention in people with weak abdominal muscles;
• After operations to prevent re-development of the disease and reduce pain in the seam area;
• People whose work is connected with hard physical labor, professional weightlifters;
• Elderly people, weakened people, who have contraindications to surgery.

How to use the bandage correctly:

• The bandage is put on while lying down;
• If wearing a bandage is recommended before surgery, the protrusion should be directed into the abdomen with a gentle pressure motion;
• The pad must be placed in the area of the hernial formation;
• The band is wrapped around the torso and secured with a sticky retainer;
• A correctly fixed bandage should fit snugly around the torso and press on the hernial formation. At the same time, he should not squeeze too much and cause severe inconvenience.

To prevent the risk of developing the disease, you need to take special preventive measures. To prevent ailment, pregnant women should wear a bandage, and also after childbirth, if the belly does not fall off. If you are overweight, you need to take measures to reduce it. Moderate exercise will strengthen your abdominal muscles, which will also help prevent hernia development. It is important to monitor the diet - food should be healthy and balanced to avoid possible gastrointestinal problems. Lifting heavy objects must be avoided.

In the postoperative period, it is important to adhere to all the doctor's recommendations: follow a special sparing diet and avoid any physical activity. It is impossible not to treat a hernia, since it is possible to develop serious complications that threaten life. It is necessary to understand the full danger of the consequences and take measures to eliminate it at the first sign.

Taking painkillers for a hernia of the white line gives only a temporary effect, but does not contribute to recovery in any way. This is especially fraught with consequences during pinching, since the patient requires urgent medical attention.

The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist

Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.