Hernia of the white line of the abdomen - symptoms, treatment, operation

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Hernia of the white line of the abdomen - symptoms, treatment, operation
Hernia of the white line of the abdomen - symptoms, treatment, operation
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Hernia of the linea alba

Hernia of the white line is a disorder in which clefts 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 contact the 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. This is a thin layer of connective tissue lining the inside of the abdominal cavity. It covers all the organs of the abdominal cavity.
  • Fat (preperitoneal fat).
  • Transverse fascia. It is a compacted layer of connective tissue that strengthens the abdominal wall.
  • Abdominal muscles. They cover almost the entire abdomen. Located on the right and left, covered with fascia (a layer of connective tissue) on the outside.
  • Subcutaneous adipose tissue covered by skin.

There is a narrow area along the midline where the muscle is. 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. Below the navel, it narrows. The likelihood of a hernia in the upper part is the highest. Often the defect is formed under the sternum.

What does a hernia of the linea alba mean?

Hernia of the white line of the abdomen
Hernia of the white line of the abdomen

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

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

  • Supraumbilical (located above the navel);
  • Perumbilical (located near the umbilical cavity);
  • Subumbilical (localized below the umbilical cavity).

Location of a hernia of the linea alba near and below the navel is uncommon.

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 the pathology and the symptoms accompanying it. 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 is the pinching of organs that are inside the hernial sac. In some cases, nerve compression occurs.

Causes of a hernia of the white line of the abdomen

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

Factors leading to weakening of connective tissue:

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

Risk factors associated with increased intra-abdominal pressure include:

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

Injury to the abdominal cavity can also cause education. Therefore, you need to train the muscles so that they become stronger and become a defense against a disease such as a hernia.

Symptoms of a hernia of the white line of the abdomen

Symptoms of a hernia of the white line of the abdomen
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, which increases with straining and intense movements. As the disease develops, pain can be of a different nature: sharp, intense, stabbing, prolonged, acute, "dagger", etc.e.

So, the disease is accompanied by the following symptoms:

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

When the condition worsens, the symptoms increase:

  • blood may come out during bowel movements;
  • pains increase and become unbearable;
  • constantly tormented by vomiting;
  • if at an early stage of the disease a hernia can be reduced independently, then with complicated forms it is impossible.

This is a common symptom, in medical practice there are three stages of the disease: lipoma, initial and formed hernia.

First, fat shows through the crevices in the white line. Further, this stage is replaced by the initial one, at which the bag is formed. With a 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 induration appears on the white line. The hernial orifice (through which the internal organs protrude) are oval or round in shape, reaching 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 pain.

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

Complications of a 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 squeezed in the place through which it comes out (at the hernial orifice).

Emergency medical attention is required for the following symptoms:

  • Nausea turning into vomiting;
  • The presence of blood in the feces, the absence of defecation;
  • Increasing abdominal pain;
  • Education is not reduced when lightly pressed in a horizontal position.

When the formation is pinched, the elements of the intestine and other organs that have fallen into the hernial sac are compressed, and the 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. Incarcerated hernia poses a danger to the patient's life.

Diagnosis of a hernia of the white line of the abdomen

Diagnosis of a hernia of the white line of the abdomen
Diagnosis of a hernia of the white line of the abdomen

Diagnostic methods include:

  • Examination by a surgeon;
  • X-ray of the stomach and duodenum;
  • Gastroscopy;
  • Herniography with the introduction of a contrast agent;
  • Ultrasound examination of a hernia;
  • Computed tomography of the abdominal organs.

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

Hernia is treated only surgically in a hospital. The operation to remove a hernia is referred to as a hernioplasty. To date, about 300 surgical methods for the treatment of hernias of the anterior abdominal wall have been developed. 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:

  • Plasty using local tissues (open intervention with tension plasty). The defect is sutured with a non-absorbable thread with the elimination of a possible divergence of the rectus muscles. Due to the weakness of the connective tissue and a significant load on the postoperative sutures, in 25-40% of cases, a relapse of the disease develops after the intervention, so this method is used infrequently. Another drawback is that the long incision leaves a large scar.
  • Plasty with synthetic prostheses and meshes (open intervention with tension-free plasty). 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 recurrence of 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 a prosthesis is installed. The mesh can be installed under the aponeurosis (tendon plate), as well as in its lumen and inside the abdominal cavity. Over time, the allomaterial grows into connective tissue, and it becomes impossible to distinguish it from one's own tissues. The outer seams are also invisible.
  • Laparoscopic intervention. With the advent of high-tech devices, this technique in the treatment of white line hernia is becoming increasingly popular. The incision is not made in this case. Instead, the surgeon makes several holes through which the formation is removed and a mesh prosthesis is inserted. Laparoscopic surgery minimizes the risk of recurrence of the disease and is less traumatic in general. The recovery period after laparoscopy is reduced to ten days (compared to other methods). After that, the patient can return to normal life. This operation is not suitable for patients with heart and lung diseases. 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 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 those of laparoscopy, but the intervention is somewhat more complicated. Because of this, the mesh prosthesis cannot be securely fixed.

The peculiarity 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 sets the date of the operation.

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

The advantages of this operation are as follows:

  • Reliability, minimal risk of disease recurrence;
  • Simplified intervention technique, which allows it to be used in outpatient practice;
  • Possibility of using minimally invasive techniques with the introduction of synthetic implants;
  • Slight traumatism of tissues, due to which the patient experiences less pain in the postoperative period;
  • Reduction of the rehabilitation period and temporary disability;
  • Good cosmetic effect.

How is the operation going?

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

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

During the intervention, the surgeon separates the hernial sac, cuts it open, evaluates 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 sutured. After that, diastasis is eliminated and the white line is strengthened.

In case of a strangulated hernia, the operation is carried out on an emergency basis. The surgeon opens the bag, evaluates the part of the intestine that has fallen into it. If she died, 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 carried out twice a week. Stitches are removed on the 10-12th day.

Recovery after surgery

When the disease worsens, surgery 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, as this will only aggravate the situation (squeezing the protrusion is highly discouraged).

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 sutures and maintain weakened abdominal muscles.

After the operation, you should also not strain the site of the removed hernia. Heavy lifting is prohibited, physical activity should be avoided in general. After two or three months, when the body is fully restored after the intervention, on the contrary, special exercises are recommended to strengthen the abdominal muscles. You should not compose a 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. It is forbidden to consume foods that cause gas formation and stool retention. 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. Liquid meals and cereals are recommended.

If there are problems with weight, to eliminate the risk of re-development of a hernia, you need to normalize body weight and strengthen the muscle corset.

Prognosis after surgery. After open interventions with tension methods, the likelihood of recurrence is high: in 25-40% of patients, a hernia occurs again. With tension-free, minimally invasive techniques, the risk of recurrence is low.

In general, the likelihood of recurrence depends on how conscientiously the patient follows the recommendations of the surgeon in the postoperative period.

Prevention of white hernia

Prevention of white hernia
Prevention of white hernia

White line hernia prevention includes:

  • Using a bandage during pregnancy;
  • Compliance with the principles of a he althy diet;
  • Abdominal workouts;
  • Normalization of body weight;
  • Keeping proper lifting technique.

A separate point should be considered regarding the wearing of a bandage. The abdominal bandage is a knitted tape up to 20 cm wide. It has a special "cushion", which is placed in the area of the likely occurrence 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 intensifies.

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

  • Short time before intervention to prevent increased protrusion;
  • At the stage when there is only a preperitoneal lipoma, but there is no hernial formation itself yet;
  • For prevention in people with weak abdominal muscles;
  • After operations to prevent the recurrence of the disease and reduce pain in the suture area;
  • People whose work involves hard physical labor, professional weightlifters;
  • The elderly, debilitated people who have contraindications to surgery.

How to use the bandage correctly:

  • The bandage is put on in the prone position;
  • If wearing a bandage is recommended before surgery, the protrusion should be corrected into the abdomen with a slight pressure movement;
  • The pad should be placed in the area of the hernia;
  • The bandage is wrapped around the torso and secured with a sticky retainer;
  • A properly fixed bandage should fit snugly around the body and press the hernial formation. At the same time, it should not squeeze too much and cause pronounced inconvenience.

To prevent the risk of developing the disease, special preventive measures must be taken. To prevent the disease, pregnant women should wear a bandage, as well as after childbirth, if the stomach does not subside. If there is excess body weight, measures must be taken to reduce it. Moderate exercise will strengthen the abdominal muscles, which also helps prevent the development of a hernia. It is important to monitor the diet - nutrition should be he althy and balanced in order to avoid possible problems with the gastrointestinal tract. Avoid lifting heavy objects.

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

Taking painkillers for hernia of the white line gives only a temporary effect, but does not contribute to recovery. This is especially fraught with consequences during pinching, as the patient requires emergency medical care.

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