What are the symptoms of an epigastric hernia. How is an epigastric hernia diagnosed. What treatment options are available for epigastric hernias. What are potential complications of untreated epigastric hernias. How is epigastric hernia surgery performed.

Understanding Epigastric Hernias: Location and Prevalence

An epigastric hernia is a specific type of abdominal hernia that occurs in the epigastric region – the area above the navel and below the breastbone. These hernias develop when weakened abdominal muscles allow fatty tissue or parts of the intestine to protrude through the abdominal wall.

How common are epigastric hernias? Studies indicate that epigastric hernias account for approximately 2-3% of all abdominal hernias. They can affect both adults and children, and are even seen in infants. However, the true prevalence may be underestimated as many cases go unreported due to a lack of noticeable symptoms.

Recognizing the Signs: Symptoms of Epigastric Hernias

What are the typical symptoms of an epigastric hernia? The most common sign is a visible bump or bulge in the upper abdominal area, between the breastbone and navel. This protrusion may be more noticeable when coughing, sneezing, or straining. Other potential symptoms include:

• Tenderness or discomfort in the epigastric region
• Mild to moderate pain, especially when bending or lifting
• A feeling of pressure or fullness in the upper abdomen
• Multiple small bulges in some cases

It’s important to note that many individuals with epigastric hernias experience no symptoms at all, which is why these hernias often go undetected for extended periods.

Unraveling the Causes: Why Do Epigastric Hernias Develop?

The exact cause of epigastric hernias is not fully understood, but several factors may contribute to their development:

1. Congenital weakness: Some individuals are born with weaker abdominal muscles in the epigastric region.
2. Increased abdominal pressure: Activities or conditions that strain the abdominal muscles, such as obesity, pregnancy, or heavy lifting, may increase the risk.
3. Aging: As we get older, our abdominal muscles naturally weaken, potentially leading to hernia formation.
4. Tension between abdominal wall and diaphragm: One theory suggests that increased tension where the abdominal wall attaches to the diaphragm may play a role in epigastric hernia formation.

While these factors may increase the likelihood of developing an epigastric hernia, it’s important to remember that hernias can occur in individuals without any clear risk factors.

Diagnosing Epigastric Hernias: Medical Evaluation and Imaging

How are epigastric hernias diagnosed? The process typically involves the following steps:

1. Physical examination: A healthcare provider will visually inspect and palpate the abdominal area to check for bulges or tenderness.
2. Medical history: The doctor will inquire about symptoms, lifestyle factors, and family history of hernias.
3. Imaging studies: In some cases, additional tests may be ordered to confirm the diagnosis or assess the hernia’s size and contents. These may include:

• Ultrasound: A non-invasive imaging technique that can visualize soft tissues
• CT scan: Provides detailed cross-sectional images of the abdominal area
• MRI: Offers high-resolution images without radiation exposure

These diagnostic tools help healthcare providers determine the most appropriate treatment approach for each individual case.

Treatment Options: From Watchful Waiting to Surgical Intervention

What are the available treatment options for epigastric hernias? The approach depends on various factors, including the hernia’s size, symptoms, and the patient’s overall health. Treatment options include:

1. Watchful Waiting

For small, asymptomatic epigastric hernias, doctors may recommend a period of observation. However, it’s crucial to monitor the hernia for any changes or development of symptoms.

2. Lifestyle Modifications

Certain lifestyle changes may help manage symptoms and prevent the hernia from worsening:

• Maintaining a healthy weight
• Avoiding heavy lifting or straining
• Quitting smoking to improve tissue health
• Eating a high-fiber diet to prevent constipation

3. Surgical Repair

Surgery is the only definitive treatment for epigastric hernias. It’s typically recommended for hernias that are:

• Causing pain or discomfort
• Increasing in size
• At risk of complications

How is epigastric hernia surgery performed? There are two main approaches:

1. Open surgery: The surgeon makes an incision over the hernia site to repair the weakened abdominal wall.
2. Laparoscopic surgery: A minimally invasive technique using small incisions and a camera to guide the repair.

In both cases, the protruding tissue is pushed back into place, and the abdominal wall is reinforced. This may involve using sutures alone or incorporating a synthetic mesh for added support, depending on the hernia’s size and characteristics.

Potential Complications: Understanding the Risks of Untreated Epigastric Hernias

While many epigastric hernias remain small and cause minimal problems, leaving them untreated can lead to potential complications. What are the risks associated with untreated epigastric hernias?

• Hernia enlargement: Over time, the hernia may grow larger, allowing more tissue to protrude through the abdominal wall.
• Increased pain and discomfort: As the hernia expands, it can cause more noticeable symptoms and affect daily activities.
• Incarceration: The protruding tissue may become trapped outside the abdominal cavity, leading to pain and potential tissue damage.
• Strangulation: In severe cases, the blood supply to the trapped tissue may be cut off, causing tissue death and requiring emergency surgery.
• Bowel obstruction: If part of the intestine becomes trapped in the hernia, it can lead to a dangerous blockage of the digestive tract.

These potential complications underscore the importance of regular monitoring and timely treatment of epigastric hernias, even if they initially appear small or asymptomatic.

Recovery and Follow-up: What to Expect After Epigastric Hernia Surgery

After undergoing surgical repair for an epigastric hernia, patients can expect a recovery period during which they’ll need to follow specific guidelines to ensure proper healing. What does the typical recovery process involve?

1. Immediate post-operative care: Patients are monitored for complications and pain is managed with appropriate medications.
2. Short-term recovery: Most individuals can return home within a day of the procedure, with instructions for wound care and activity restrictions.
3. Gradual return to activities: Over the course of several weeks, patients can slowly increase their activity levels as advised by their healthcare provider.
4. Follow-up appointments: Regular check-ups allow the surgeon to monitor healing progress and address any concerns.

What potential complications should patients be aware of after epigastric hernia surgery? While generally safe, any surgical procedure carries some risks. These may include:

• Infection at the surgical site
• Bleeding or hematoma formation
• Chronic pain or discomfort
• Recurrence of the hernia
• Reactions to surgical mesh (if used)

Patients should promptly report any unusual symptoms or concerns to their healthcare provider during the recovery period.

Prevention Strategies: Minimizing the Risk of Epigastric Hernias

While not all epigastric hernias can be prevented, certain lifestyle choices and habits may help reduce the risk of developing this condition. What steps can individuals take to minimize their chances of experiencing an epigastric hernia?

• Maintain a healthy body weight: Excess abdominal fat puts additional strain on the abdominal muscles.
• Practice proper lifting techniques: When lifting heavy objects, use your legs rather than your back and avoid straining.
• Strengthen core muscles: Regular exercise focusing on abdominal and back muscles can help support the abdominal wall.
• Manage chronic cough: Seek treatment for persistent coughing, which can increase abdominal pressure over time.
• Avoid straining during bowel movements: Treat constipation promptly and maintain a high-fiber diet.
• Quit smoking: Smoking can weaken connective tissues and increase the risk of hernias.

By incorporating these strategies into daily life, individuals may be able to reduce their risk of developing epigastric hernias or prevent existing small hernias from worsening.

Living with Epigastric Hernias: Managing Symptoms and Quality of Life

For individuals diagnosed with epigastric hernias who are not immediate candidates for surgery or choose to delay surgical intervention, managing symptoms and maintaining quality of life becomes a priority. What strategies can help patients cope with epigastric hernias in their daily lives?

1. Wear supportive garments: Abdominal binders or hernia belts can provide compression and support, potentially reducing discomfort.
2. Modify activities: Avoid exercises or movements that exacerbate symptoms, and find alternative ways to stay active.
3. Practice good posture: Maintaining proper alignment can help reduce strain on the abdominal muscles.
4. Manage pain: Over-the-counter pain relievers, as recommended by a healthcare provider, can help alleviate discomfort.
5. Stay vigilant: Monitor the hernia for any changes in size, appearance, or associated symptoms.

It’s crucial for individuals living with epigastric hernias to maintain open communication with their healthcare providers, reporting any significant changes or concerns promptly.

Advances in Epigastric Hernia Treatment: Emerging Techniques and Research

The field of hernia repair continues to evolve, with ongoing research and technological advancements aimed at improving outcomes for patients with epigastric hernias. What are some of the latest developments in epigastric hernia treatment?

• Robotic-assisted surgery: This advanced technique offers enhanced precision and visualization during minimally invasive repairs.
• Biosynthetic mesh materials: New mesh designs aim to reduce the risk of complications and improve long-term outcomes.
• Tissue engineering: Research is exploring the potential of using patient-derived cells to create stronger, more natural repairs.
• Non-surgical interventions: Studies are investigating potential non-invasive treatments for small hernias, such as injectable biomaterials.

While many of these approaches are still in the experimental stages, they highlight the ongoing efforts to enhance epigastric hernia treatment and improve patient experiences.

Special Considerations: Epigastric Hernias in Infants and Children

Epigastric hernias can occur in pediatric populations, including infants and young children. How do these cases differ from adult epigastric hernias, and what special considerations are involved in their management?

Prevalence and Characteristics

Epigastric hernias in children are often congenital, meaning they’re present at birth or develop shortly after. They tend to be smaller than adult hernias and may be more likely to close on their own in some cases.

Diagnosis

Pediatric epigastric hernias may be detected during routine check-ups or when parents notice a small bump on their child’s abdomen. Diagnostic approaches are similar to those used in adults but with a greater emphasis on non-invasive techniques.

Treatment Approach

The management of epigastric hernias in children often involves:

• Watchful waiting: For very small, asymptomatic hernias in infants, doctors may recommend monitoring for potential spontaneous closure.
• Timing of surgery: If repair is necessary, it’s often recommended before the child starts school to prevent complications and allow for easier recovery.
• Surgical techniques: Pediatric surgeons may use specialized approaches tailored to the child’s size and developmental stage.

Parents should work closely with pediatric specialists to determine the best course of action for their child’s specific case.

Epigastric Hernias vs. Other Abdominal Hernias: Understanding the Differences

While epigastric hernias share some similarities with other types of abdominal hernias, there are key distinctions in their location, characteristics, and management. How do epigastric hernias compare to other common hernia types?

Epigastric vs. Umbilical Hernias

• Location: Epigastric hernias occur above the navel, while umbilical hernias are centered around the belly button.
• Prevalence: Umbilical hernias are more common, especially in infants.
• Spontaneous closure: Umbilical hernias in children have a higher chance of closing on their own compared to epigastric hernias.

Epigastric vs. Inguinal Hernias

• Location: Inguinal hernias occur in the groin area, while epigastric hernias are in the upper abdomen.
• Gender prevalence: Inguinal hernias are more common in males, while epigastric hernias affect both genders equally.
• Surgical approach: The techniques used for repair may differ due to the anatomical differences between these hernia types.

Epigastric vs. Hiatal Hernias

• Location: Hiatal hernias occur in the diaphragm, allowing part of the stomach to push into the chest cavity.
• Symptoms: Hiatal hernias often cause acid reflux symptoms, which are less common with epigastric hernias.
• Treatment: Management of hiatal hernias may involve medications and lifestyle changes more often than surgery, unlike epigastric hernias.

Understanding these differences can help patients and healthcare providers better navigate the diagnosis and treatment process for various hernia types.

Epigastric Hernia: Symptoms, Diagnosis, and Treatment

Epigastric Hernia: Symptoms, Diagnosis, and Treatment

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Medically reviewed by Andrew Gonzalez, M. D., J.D., MPH — By Diana Wells — Updated on August 29, 2017

Overview

A hernia is a generic term for a hole caused by a weak spot in your abdominal wall. An epigastric hernia is a type of hernia in the epigastric region of the abdominal wall. It’s above the belly button and just below the sternum of your rib cage.

This type of hernia is a somewhat common condition in both adults and children. About 2 to 3 percent of all abdominal hernias are epigastric hernias. It’s also seen in infants.

Most of the time, you’ll have no symptoms or only minor symptoms with an epigastric hernia. A lack of symptoms means that this condition tends to go unreported.

An epigastric hernia usually causes a bump to occur in the area below your sternum, or breastbone, and above your belly button. This bump is caused by a mass of fat that has pushed through the hernia.

The raised area may be visible all the time or only when you cough, sneeze, or laugh. This bump, or mass, can grow and become larger in some cases. You can have more than one epigastric hernia at a time.

An epigastric hernia can also cause tenderness and pain in the epigastric region. However, it’s common for an epigastric hernia not to show any symptoms.

An epigastric hernia can occur when the tissues in the abdominal wall don’t close completely during development. Research continues to look for the specific causes of this type of hernia. Not as much is known about epigastric hernias possibly because they aren’t reported many times due to a lack of symptoms.

However, one theory has gained some credibility. It’s believed that the epigastric hernia may be caused when there is tension in the area where the abdominal wall in the epigastric region attaches to the diaphragm.

This type of hernia won’t go away on its own, and complications will eventually lead you to surgery. Surgery is the only way to repair an epigastric hernia. It’s the recommended treatment, even for infants, due to the risk of the hernia enlarging and causing additional complications and pain.

To complete the repair, you might only need sutures, or you may require an implanted mesh. The use of mesh or sutures is determined by the size of the hernia and other factors.

If your epigastric hernia hasn’t been treated, you should get medical treatment immediately if you have vomiting or fevers and an increase in abdominal pain. These may indicate a bowel blockage.

Surgery to repair an epigastric hernia can lead to certain serious complications. If you have any of the following symptoms after surgery, you should seek medical attention:

• high fever
• difficulty urinating
• discharge from the surgical site
• an increase in pain or swelling at the surgical site
• bleeding that won’t stop
• nausea
• vomiting

The complications for an untreated epigastric hernia include the following:

• enlarged hernia, which eventual allows parts of the bowel to push through
• increase or onset of pain and tenderness
• bowel blockage
• loss of domain, in which the hernia becomes so large that’s nearly impossible to repair even with a mesh

The complications for the surgical repair of epigastric hernia includes any basic complications surrounding surgery and general anesthesia as well as those related to this specific surgical procedure. These complications may include:

• bleeding
• pain
• wound infection at the surgical site
• scarring left after healing
• blood clots
• development of a lump that isn’t a hernia
• a low chance of the hernia recurring
• mesh infection (in the event an artificial mesh is used to repair the hernia)

Surgical repair of an epigastric hernia is a common procedure and has a very positive outlook. Most people are able to go home the same day as the surgery.

You might even be able to return to work or school within a day or two with some minor restrictions. Specifically, most surgeons don’t want you lifting any weight heavier than a gallon of milk for six to eight weeks.

Your doctor will tell you how quickly you should return to your normal activities. Usually, your restrictions will include no heavy lifting and no strenuous activities or sports for a brief period of time.

Last medically reviewed on August 28, 2017

How we reviewed this article:

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• Coats RD, et al. (2000). Presentation and management of epigastric hernias in children [Abstract]. DOI:
  10.1053/jpsu.2000.19242
• Corsale I, et al. (2000). Diagnosis and treatment of epigastric hernia. Analysis of our experience. [Abstract].
  ncbi.nlm.nih.gov/pubmed/11155474
• Debrah SA, et al. (2013). Epigastric hernia in pregnancy: A management plan based on a systematic review of literature and a case history. DOI:
  10.1007/s12262-012-0632-3
• Epigastric hernia repair. (n.d.).
  ruh.nhs.uk/patients/services/upper_gi/documents/epigastric_hernia4.pdf
• Parsons S. (2010). Epigastric hernia repair.
  bmihealthcare.co.uk/treatments/general-surgery/epigastric-hernia-repair
• Ponten JE, et al. (2012). Pathogenesis of the epigastric hernia. [Abstract]. DOI:
  10.1007/s10029-012-0964-8
• Venkatesh M, et al. (n.d.). Epigastric hernia.
  radiopaedia.org/articles/epigastric-hernia

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Medically reviewed by Andrew Gonzalez, M.D., J.D., MPH — By Diana Wells — Updated on August 29, 2017

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Acquired Abdominal Intercostal Hernia: A Case Report and Literature Review

Case Rep Surg. 2014; 2014: 456053.

Published online 2014 Aug 17. doi: 10.1155/2014/456053

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Author information Article notes Copyright and License information Disclaimer

Acquired abdominal intercostal hernia (AAIH) is a rare disease phenomenon where intra-abdominal contents reach the intercostal space directly from the peritoneal cavity through an acquired defect in the abdominal wall musculature and fascia. We discuss a case of a 51-year-old obese female who arrived to the emergency room with a painful swelling between her left 10th rib and 11th rib. She gave a history of a stab wound to the area 15 years earlier. A CT scan revealed a fat containing intercostal hernia with no diaphragmatic defect. An open operative approach with a hernia patch was used to repair this hernia. These hernias are difficult to diagnose, so a high clinical suspicion and thorough history and physical exam are important. This review discusses pathogenesis, clinical presentation, complications, and appropriate treatment strategies of AAIH.

Intercostal hernias are rare phenomena caused by a disruption or weakness in the thoracoabdominal wall musculature resulting in herniation of fascia layers between adjacent ribs. Historically, these hernias have been characterized by their contents. They may only be an empty sac comprised solely of fascia elements [1] or may contain abdominal and thoracic viscera, such as liver [2], lung [3], small and large bowel [4, 5], omentum (present case), or gallbladder [6]. Intercostal hernias have also been categorized on the basis of their etiology, with majority resulting from trauma (blunt injury [7], penetrating injury [8], rib fractures [9], or prior surgery [4]). Rarely, they occur spontaneously or with congenital syndromes [10–12]. Recently intercostal hernias have been divided into two types: those with a diaphragmatic defect and those without a diaphragmatic defect [9, 13]. Many authors, however, do not distinguish between the two [2, 9, 12, 14–16], as several cases labeled as intercostal hernias without diaphragmatic involvement had, upon careful examination, diaphragmatic defects [9, 12, 13, 17]. We, however, believe that the term “acquired abdominal intercostal hernia” (AAIH) could be reserved for cases in which the intra-abdominal contents reach the intercostal space directly from the peritoneal cavity through an acquired defect in the abdominal wall musculature or fascia [9, 13]. When viscera herniate through a diaphragmatic defect, the term “transdiaphragmatic intercostal hernia” (TIH) should be used. Since the two types may have overlapping but distinct clinical presentations, pose unique therapeutic challenges, and may require different surgical strategies, they should remain as separate pathologic entities.

This is a fifty-one-year-old obese and hypertensive female who presented with a painful mass at her left upper abdominal quadrant and lower chest for about 24 hours. In addition to pain, she complained of nausea but denied vomiting or changes in bowel habits. She reported a history of stab injury to her left chest about fifteen years ago. She has had this mass for several years but had remained asymptomatic. Workup by her primary care in the past including a computed tomography (CT) scan concluded that the mass was most likely a lipoma.

On physical examination, the patient was noted to be obese with a tender, firm, and nonreducible mass at the left upper quadrant and lower chest measuring about 8 × 8 cm. A new CT scan was obtained showing an abdominal intercostal hernia between the 11th rib and 10th rib. The hernia content was comprised of omentum, and no evidence of a diaphragmatic defect was seen on CT (Figures and ).

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Axial CT view: intercostal hernia between 10th rib and 11th rib at left midaxillary line (white arrow).

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Coronal CT view: intercostal hernia between 10th rib and 11th rib at left midaxillary line (white arrow).

The patient was taken to the operative room where she was placed in a right lateral position. Under general anesthesia an incision was made over the hernia along the intercostal space. The hernia sac was identified and dissected clean of the surrounding subcutaneous tissue (Figures and ).

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Exposure of the hernia sac.

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Dissection of the hernia sac of the surrounding subcutaneous tissue.

The hernia sac was opened and found to contain omentum, which was reduced back into the peritoneal cavity. The sac was subsequently excised, exposing a clear defect between the tenth rib and eleventh rib ().

A self-expanding polypropylene and ePTFE hernia patch (VENTRALEX Hernia Patch) () was then used to secure the defect, and the fascia of the intercostal and external oblique was approximated on top of the mesh using interrupted Vicryl stiches (). The patient’s postoperative course was uneventful and was discharged home on postoperative day two.

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VENTRALEX Hernia Patch.

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Approximation of muscle fascia on top of the patch.

Acquired abdominal intercostal hernia (AAIH) is an extremely rare phenomenon having only 19 cases reported in the literature worldwide [9]. By definition, AAIH does not involve a defect in the diaphragm, which, if present, is called transdiaphragmatic intercostal hernia (TIH). Our patient’s hernia was previously reducible; however, at the time of presentation the hernia was incarcerated. The diagnosis of the AAIH was confirmed with computed topography (CT) scan and an open intercostal hernia repair with patch was performed.

Abdominal intercostal hernias (AIH) are due to weakened or torn muscular layers of the thoracoabdominal wall, which is unable to provide adequate resistance to the outward forces of visceral contents pressing against it during variations in internal pressure [18]. The outer layers of the hernia sac itself in AIH include the transthoracic fascia, transversalis fascia, and peritoneum [19] and may or may not contain contents from the peritoneum or thorax [9]. One mechanism causing tissue disruption, and accounting for 65% of all AAIH [9, 10, 20], is by major trauma: blunt forces, deceleration injuries, or penetrating injuries from sharp objects, like knives or fractured ribs [12]. Unlu et al. report several predisposing conditions to patients with intercostal hernias after minor traumatic events: COPD, asthma, diabetes mellitus, advanced age, treatment with steroids, excessive weight loss, and increased intra-abdominal pressure [12]. Such sudden or chronic increases in pressures may cause microtrauma to the fascia or muscles of thoracoabdominal wall [18]. Rib fractures can complicate the picture of AAIH because, in some instances, the jagged edges of the fractured ribs penetrate abdominal wall tissue, predisposing to a traumatic intercostal herniation [18, 22]. Other rare pathophysiological mechanisms that weaken the chest wall include congenital conditions decreasing tissue strength such as Ehlers-Danlos syndrome [23] and congenital conditions associated with chest wall defects like Poland syndrome  [11].

While disruption of the thoracoabdominal wall seems to be the only pathogenesis for the occurrence of abdominal intercostal hernias, it appears that it is not sufficient for all cases. It is likely that a combination of weakened tissues in the event of sudden increases in intra-abdominal pressure results in intercostal hernias or incarceration of previously reducible ones. This may explain why some patients with a distant history of anterior abdominal wall trauma, like in the case presented here, suddenly develop complications after years of being asymptomatic. The time interval between trauma and hospitalization for abdominal intercostal hernia, spontaneous or acquired, is highly variable. Some authors report hospitalization within the same day after trauma [24], while others report a 20 years span between trauma and hospitalization [25]. In the present case, the patient was hospitalized 15 years after a stab wound because of symptoms of pain and swelling that developed over the course of 24 hours. While it is not clear what triggered the sudden incarceration of the hernia and the subsequent symptoms in our patient, obesity was a notable risk factor. This case also emphasizes the importance of a thorough history, as this patient’s stab wound 15 years ago helped support the diagnosis of AAIH.

Specific areas of the chest wall are more vulnerable to herniation than others due to inherent weakness in certain anatomical zones [18]. The chest wall is weak anteriorly from the costochondral junction to the sternum, as it lacks the support of the external intercostal muscle. Posteriorly, the internal intercostal muscles are absent from the costal angle to the vertebrae, contributing to another weak point [12, 26]. Interestingly, our patient’s intercostal hernia did not occur around these areas of vulnerability but in a more reinforced area of the chest wall where all intercostal muscles reside. Most AAIH are located under the 9th rib without a preference to side, and main symptoms include chest swelling (85%) and pain or discomfort (76%) [9]. If bowel herniates, symptoms of obstruction may be present, with the most specific sign for this being the presence of bowel sounds in the chest   [19].

The diagnosis of any type of intercostal hernia can be difficult to make due to edema, hematoma, or obesity, which obscure the protruding abdominal wall contents [2]. For this reason, CT is the best diagnostic tool, since it not only provides excellent visualization but also offers a reliable means to establish a preoperative plan to repair the defect   [2].

Surgical management is necessary in nearly all cases due to risk of incarceration and strangulation of organs [27]. In fact, Erdas et al. report that 15% of AAIH are complicated by incarceration and strangulation of omentum, small and large bowel, or liver [9]. Other complications include a missed diaphragmatic tear or defect, which can predispose patients to recurrent intercostal hernias [9, 18]. Although deaths have not been reported in cases of AAIH, they have been reported in transdiaphragmatic intercostal hernias, mostly occurring as a consequence of hemorrhage from other associated injuries [18, 28]. Rarely, conservative management is warranted in elderly patients with multiple comorbidities who pose a high surgical risk. Conservative management has been reported in some asymptomatic patients [21, 27], but we recommend that nonsurgical measures in asymptomatic patients should only be undertaken after careful consideration of patient’s age, risk of recurrence, acuteness of the hernia, comorbidities, surgical risk factors, and type and size of hernia.

Because there are so few reports of acquired abdominal intercostal hernias, determining the efficacy of various surgical techniques employed is difficult. The surgeon must account for many factors about the patient and the injury before deciding on a repair technique. Closure of the defect can be achieved by the direct approach, as in the present case, which consists of a thoracotomy (open intercostal incision) performed along the intercostal space. It can also be done by an indirect approach, which consists of laparoscopy or open abdominal incision (laparotomy) [2, 13, 26]. A combined open (direct) and laparoscopic (indirect) method was also successfully performed [27]. Techniques to repair the defect include primary closure, absorbable and nonabsorbable meshes and patches, and prosthetic mesh reinforced by cable banding [29].

In emergency situations, the open abdominal approach is the most prudent operative choice as it allows the surgeon easy access to other intra-abdominal injuries often associated with blunt or penetrating injuries to the abdomen and thorax [27]. Laparoscopic repair has also been performed in emergent settings where a visceral injury was present or could not be determined preoperatively [30]. Laparoscopy has its advantages, as it enables adequate management of compromised hernia contents, allows treatment of other intraperitoneal injuries, and is minimally invasive. However, its disadvantages make it less favorable than the open intercostal approach in noncomplicated cases [9]. Such disadvantages include a greater level of expertise required, the placement of the mesh intra-abdominally, and a reported increased risk of bowel injury and pain [9].

In nonemergent settings, as in our case, the direct intercostal approach has been shown to be effective and safe [10, 27]. The application of prosthetic reinforcement is favored in most cases, especially for very large or recurrent defects [35], since the absence of prosthetic support is associated with higher rates of recurrence [21, 27]. For our patient, we opted to use an 8 cm diameter patch (VENTRALEX Hernia Patch) whose straps were anchored to the fascia of the external oblique and intercostal muscles. Some surgeons advocate the application of fibrin glue, instead of sutures or tacks, to anchor the mesh in an attempt to limit postoperative discomfort and mesh migration [9]. They report no hernia recurrence or discomfort at 2-year followup. Although these results are a reassuring alternative to sutures, more controlled studies are needed to determine the short term and long term clinical effectiveness of fibrin glue in AAIH repairs.

While Losanoff et al. found success using cable loops to approximate the ribs [2], such an approach, as a general rule, should be avoided as it may cause chronic pain and discomfort as well as intercostal nerve damage  [9, 31]. However, some authors advocate its use under special circumstances: when a displaced rib creates a widened intercostal space, when there is a very large defect, or when the periosteum of the ribs provides a more secure anchoring structure than the tissue around the defect, which in some patients may be weakened by scar tissue, comorbidities, or congenital syndromes that compromise tissue integrity [2, 4, 9, 13, 14, 24, 32–34]. In the preoperative planning for our patient, we decided that the use of cables was unnecessary, since there was no displaced or fractured rib to create a widened intercostal space; also, we wanted to avoid the risk of chronic pain symptoms in the patient.

Regardless of approach, the most recent comprehensive literature review on AAIH by Erdas et al. reports that recurrences occurred in 28.6% [9] of cases and were seen in up to 12 months [29]. This number could be underestimated, since several cases had short follow-up times of less than 3 months [24, 25, 30] or were not followed up at all [33, 34]. Theories explaining the high recurrence rate are missed diaphragmatic tear [2], ripping of sutures, or the development of another defect from the jagged edges of rib fractures [10, 35]. Future studies are needed to shed light on more effective ways to prevent recurrent hernias.

In conclusion, physicians must maintain a high index of suspicion for both abdominal and transdiaphragmatic intercostal hernias in patients who present with palpable bulges over the chest wall, especially in those with a history of penetrating or blunt trauma to the abdomen and thorax. The CT is the diagnostic instrument of choice. Because there are so few reports of acquired abdominal intercostal hernias, determining the efficacy of various surgical techniques employed is difficult. The surgeon’s experience and patient factors should be considered before deciding on a repair technique. Although the rates of recurrences and complications for AAIH have limited statistical credence, the cases reported in the literature do lend support for their potential in causing significant morbidities. Therefore, swift surgical management should be pursued in symptomatic patients with AAIH.

The authors declare that there is no conflict of interests.

Salim Abunnaja and Kevin Chysna contributed equally to this paper.

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Diagnostics and methods of treatment of intercostal hernia

Free appointment
and diagnostics

Pain relief
in 1-2 sessions

Author’s method
treatment

Internships in the USA,
Israel, Germany

Intercostal hernia in female and male patients is diagnosed with the same frequency. Pathology is accompanied by degeneration of muscle tissue. The probability of the appearance of dystrophic changes increases under the influence of an inactive lifestyle, impaired posture, and alcohol abuse.

1

Positive dynamics in 97% of cases

The results of the treatment course are confirmed by control MRI images.

2

No side effects

The methods used in our clinic are safe and have no side effects.

3

Long-term effect

Treatment minimizes the risk of new hernias in other segments, as well as hernia recurrence.

What is the disease

The patient is diagnosed with an abnormal location of the pleural membrane, which is accompanied by defragmentation of the lung alveolar tissue. In this case, the hernial sac protrudes into the formed hole. With such a disease, the condition of the intercostal muscles worsens.

In the spine treatment clinic of Dr. Length, it is possible to correct intercostal hernia without surgery. Manual therapy helps to eliminate the defect in muscle tissue in the affected area, which reduces the risk of recurrence.

The main causes of development

As a rule, the formation of a hernia occurs under the influence of several provoking factors:

• Previous injuries (fractured ribs, sprain, contusion of the chest).
• Scoliosis.
• Osteochondrosis, accompanied by degenerative-dystrophic changes. With this disease, the condition of the cartilaginous tissue of the structures of the ribs and spine worsens.
• Bronchial asthma. This pathology is characterized by attacks of shortness of breath and cough. In this case, there is an increase in intracavitary pressure in the chest, which causes protrusion of the intercostal space.
• Chronic pathologies of the respiratory system (pleurisy, emphysema, chronic bronchitis of various nature, chronic obstructive pulmonary disease).
• Ascites, which is accompanied by a sharp increase in intra-abdominal pressure.
• Occupational activities of the patient. The high-risk group includes musicians who play wind instruments, glassblowers.

One of the reasons for the appearance of pathology is the deterioration of the tone of the intercostal muscles, which develops against the background of the formation of Schmorl’s hernia. In this case, the motor fibers of the spinal roots are infringed.

Types of disease

Selected types of intercostal hernia are listed in the table below.

Treatment success is 90% dependent on experience
and physician qualifications.

Free medical consultation and diagnostics

• Chiropractor
• Vertebrologist
• Osteopath
• Neurologist

During the consultation, we carry out a thorough diagnosis of the entire spine and each segment. We are for sure
we determine which segments and nerve roots are involved and cause symptoms of pain. As a result of the consultation
We give detailed recommendations for treatment and, if necessary, prescribe additional diagnostics.

1

Perform functional diagnostics of the spine

2

Let’s perform a manipulation that significantly relieves pain

3

We will create an individual treatment program

Book a free appointment

The most dangerous location of the hernia is in the upper intercostal spaces (on the left side). Such a pathology often provokes a deterioration in hemodynamics in the systemic circulation. At the initial stage of the disease, a partial dislocation of the heart muscle is often diagnosed.

When the pathology is localized in the region of the apex of the lung, the cicatricial deformity of the organ progresses rapidly. This can lead to the development of chronic respiratory failure.

Main signs and diagnosis

Degenerative intercostal hernia is often characterized by lability. It is noticeable during a deep breath, a prolonged attack of coughing. In a normal state, such a hernia completely disappears. Pathology has no pronounced symptoms. A degenerative intercostal hernia is often discovered by chance, during an examination by an osteopath. Such a pathology is dangerous because with its sudden infringement, necrosis of lung tissue can occur.

When an intercostal hernia is located on the right side, there is a periodic tingling sensation in the affected area. Discomfort is aggravated by a sharp turn in the prone position. Increased pain is provoked by:

• fall;
• increased physical activity;
• pathology of the abdominal organs.

One of the most informative methods is magnetic resonance imaging. This technique is used for the differential diagnosis of intercostal hernia with cancer.

Computed tomography is an x-ray method that involves layer-by-layer scanning of tissues. The technique allows you to accurately identify the localization of adverse changes.

Methods of treatment

When treating a disease, the following therapeutic methods are used:

• performing a special course of therapeutic exercises designed to strengthen the muscular frame of the back;
• reflexology to stimulate the process of regeneration of affected tissues;
• osteopathy, which improves the circulation of lymphatic fluid in the focus of pathology.

The course of treatment is developed individually. You should first make an appointment with a chiropractor in our clinic.

Medicines

Your doctor may prescribe the following drugs:

• Non-steroidal anti-inflammatory drugs. Such drugs have a complex effect. Non-steroidal anti-inflammatory drugs eliminate pain, reduce swelling, and eliminate the inflammatory process. Medicines are taken strictly for a limited time. Otherwise, there is a negative effect on the mucous membrane of the digestive tract.
• Glucocorticoids. Means are prescribed for severe pain syndrome. Glucocorticoids are known for their pronounced anti-inflammatory and analgesic properties. Means are taken strictly in the dosage prescribed by the doctor.
• Vitamin and mineral preparations that enhance immunity. These products provide the body with essential nutrients.
• Cough suppressants. Assign as part of a comprehensive treatment of the disease in the event that a cough provokes an increase in hernia. In this case, mucolytics, expectorant drugs, preparations for inhalation and rinsing are used.

Traditional methods

As part of complex therapy, traditional methods can be used:

• Herbal teas based on oregano, St. John’s wort, chamomile, thyme. Medicinal plants have antiseptic, anti-inflammatory properties. Herbal teas stimulate the rapid discharge of sputum. Homemade drinks have a soothing effect on the irritated pharyngeal mucosa in people with tobacco dependence.
• Rubbing camphor oil on the chest. The warming procedure has a positive effect on blood circulation. Rubbing with camphor oil improves blood microcirculation in the affected part of the lungs.

Folk methods are resorted to only after consulting a doctor. Before using such products, you should make sure that there is no allergic reaction to the components.

Possible complications

In the absence of timely treatment, the risk of the following complications increases:

• Pleurisy. The inflammatory process in the region of the pleural petals occurs due to the compression of part of the lung by the ribs.
• Shortness of breath, breathing problems.

One of the consequences of the disease is an increase in the size of the protruding lung fragment. This often causes the patient considerable discomfort in everyday life.

Other diseases that are successfully treated in the spine clinic Doctors Length

You should also contact the clinic if you have the following pathologies:

• arthrosis of the knee joint;
• pain in the tendons;
• bursitis of the knee;
• spinal dysplasia in adults.

Doctors Length’s Spine Clinic also provides assistance in the treatment of gonarthrosis. As part of the complex therapy of the disease, taping, orthopedic insoles, and the unique Di-Tazin therapy method are used.

Treatment of intercostal hernia in the clinic helps to get rid of pain. When using effective therapeutic methods, the nutrition of the affected tissues improves.

We are recommended by 94% of patients.
Thank you for your trust and your choice.

Material checked by expert

Mikhailov Valery Borisovich

Manual therapist, vertebrologist, neurologist

Work experience – 25 years

Video reviews of patients

Articular block in the neck neck

Dr. Length clinic I came with spinal problems. With two intervertebral lower hernias and two intervertebral hernias in the neck. I was assigned a comprehensive 10 step program. For 4 months, my lower vertebrae completely disappeared and crunches in my neck disappeared …

Lumbo-sacral hernia

“After the first time, my back stopped hurting. I felt relieved. Now 7 sessions have already passed and the back really does not hurt. I began to forget about it. And at first it hurt a lot.”

Inflammation of the sciatic nerve

“For 4 months I suffered from severe inflammation of the sciatic nerve on the right side. After the first visit, relief came immediately within six hours. After 6 courses, the pain was almost gone.

Pain in the lower back and leg

Yakovleva Natalya Mikhailovna
Head of the department, surgeon of the highest category, oncologist-mammologist
I want to express my deep gratitude for the fact that I was put on my feet in the truest sense of the word. I came to the clinic a month and a half ago with severe pain in the lower back and leg. These complaints were long enough and the treatment that I used in the past was ineffective. Fortunately, I ended up in the clinic of Dr. Length and his team of super professionals!

Osteochondrosis of the cervical spine

“I applied 2 months ago with osteochondrosis of the cervical spine. I have a sedentary job and my neck muscles were very cramped. It was impossible to work. Before that, I went to other doctors, but this did not solve my problem. For 2 months I have a fairly positive dynamics. Every week it gets better and better.”

Bechterew’s disease

“I have had Bechterew’s disease for 10 years. The vertebrae began to move out, I began to slouch. I turned to other chiropractors, very famous, media ones. In the end, I didn’t get any results. After 2 sessions I felt much better. Now I don’t have any pain.”

Pain in the spine

“I came in with problems in my back, cervical, thoracic and lumbar spine. I was prescribed procedures, had a massage, and was assigned to do physical education at home. This made it much easier for me. I’m already turning my head. I have no pain.”

Shoulder shoulder periarthrosis

I went to the clinic with severe pain in my shoulder. My hand did not rise, I could not sleep at night, I woke up from pain. After the first treatment session, I felt much better. Somewhere in the middle of the course, my hand began to rise, I began to sleep at night.

Arthrosis of the knee joint, 2nd degree

She came in with a very serious illness. I could not walk, I have arthrosis of the 2nd degree of the knee joint. I went through a course of treatment at the Clinic and now I am going 100%.

Herniated disc

“I came to the clinic after I had back pain and it turned out to be a herniated disc. I went to other places, but they only relieved attacks of pain. Hope for a return to normal life was given only by Sergei Vladimirovich, his golden hands!

Scoliosis

“Since I was a teenager, I have suffered from scoliosis in the thoracic region. I felt a feeling of discomfort, tension, periodic pain in the spine. I turned to various specialists, a massage therapist, an osteopath, but I did not feel a strong effect. After treatment, Length S.V. I almost have a straight spine. Currently, I do not feel any problems and discomfort.”

Intervertebral hernia

“At the 5th-6th session there was an improvement. I felt much better. The pain is gone. Improvement progressed more and more each time. Lesson 10 today. I feel great.”

Pain in the lumbar and cervical region

“I am 21 years old. I went to the clinic with discomfort in the lumbar and cervical region. I also sometimes had sharp pains. After undergoing therapy, I felt a significant improvement in my back. I have no pain. The condition as a whole has improved.”

Pain in the back

“At the beginning of the path of treatment, my back hurt very badly. I could no longer walk. I take 5 steps and stop. My entire journey consisted of such stops. In the very first procedure, I left the office with no pain in my spine.”

Cervical hernia

“I came in with a problem in my neck and my right arm was very sore. The neck did not turn, the hand did not rise. After the 3rd session, I felt better. After the 5th, all this pain began to decrease. It turns out I have 2 hernias in my cervical vertebrae. After the sessions, I did an MRI and one hernia decreased. Now he began to move, his hand earned.

Pain in the neck

“I went to Dr. Long because I had a very bad pain in my neck on the right side. I fell on a snowboard 5 years ago, even went to an osteopath, but somehow it didn’t really help. Now everything is fine, there are some consequences left, the muscles were spasmodic. When I came, I had steel muscles, now my neck is very soft.”

Pain in the thoracic region

“I came to the clinic with back pain, namely in the thoracic region. After 10 sessions of treatment, I could already calmly go about my usual business, sit at work until lunch, without howling in pain. Now I’ve come back for an adjustment after 2 months. I’m fine, my back doesn’t hurt.”

Hernia and protrusion

“I came to the clinic with L4-L5 hernia and L5-S1 protrusion. Today the course of treatment has ended. Lower back hurt, it was difficult to bend down. After completing the course and receiving instructions in the form of physical exercises, it became much easier. After a month of treatment, I do not feel any stiffness of movements. ”

Pain in the lower back and hip joint

“I have been suffering from back pain since I was young. When they became unbearable, I went to Dr. Length’s clinic. Already after the first procedure, the pain in the hip joint was gone. After the third procedure, the shooting pains in the lower back stopped.

Applying today will help

avoid surgery tomorrow!

Relieve pain and inflammation

After 2-3 treatments, exhausting pain goes away, you feel better.

Eliminate the cause of the disease

Comprehensive rehabilitation of the spine improves well-being: you feel a surge of strength and energy.

Let’s start the process of regeneration

The process of restoration of damaged tissues begins, hernias and protrusions decrease.

Let’s strengthen the muscular corset

Strong back muscles support the spinal column, preventing the recurrence of the disease.

We treat

• Inflammation of the joint due to arthrosis of the knee
• Treatment of osteochondrosis of the thoracic spine
• Pain in the back between the shoulder blades
• Osteoarthritis of the shoulder joint
• Effective treatment of sciatica
• Chronic spinal spondylodiscitis

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All about hernias

go back to the outpatient surgery department

ALL ABOUT HERNIAS

What is a “hernia”?
A hernia is a protrusion of the abdominal organs under the skin through weak points in the abdominal wall. The outgoing organs are located in the hernial sac formed by the peritoneum (the inner lining of the abdominal wall). In the hernial sac, there can be almost any organ of the abdominal cavity (intestinal loops, bladder, less often – the stomach or part of it), the omentum, extremely rarely – the liver, spleen.

Fig. Incisional ventral hernia

Why does a hernia occur?
The abdominal wall, consisting of muscles and aponeuroses, performs a number of functions, one of which is holding the internal organs in their natural position and counteracting the intra-abdominal pressure they create. Under the action of intra-abdominal pressure, a defect (hernial orifice) can form in the weakest places of the abdominal wall, through which a hernia emerges. Predisposing factors such as:

• Increasing intra-abdominal pressure may contribute to this

1. excessive exercise

2. severe cough, including chronic (smoker’s cough)

3. constipation

900 02 4. diseases in which shortness of breath develops with difficulty exhaling (bronchial asthma)

• Conditions and diseases associated with the development of weakness of the connective tissue (obesity, varicose veins of the legs, congenital pathologies of the connective tissue, hereditary predisposition)
• Patients previously operated on for hernia are also at risk for predisposing factors
• A hernia may go unnoticed or be accompanied by intense pain. In the future, under the influence of the same factors, a gradual increase in hernia occurs, up to the exit of most of the abdominal organs into the hernial sac.

Who can get a hernia?
Any person can develop a hernia, regardless of gender or age.
External signs and symptoms.
The appearance and symptoms of hernias may develop gradually or occur over a short period of time.

• Feeling of pressure, weakness or pain in the abdomen, groin or scrotum, arising or aggravated by exertion, straining.
• Visually defined “bulging”, bulge on the abdomen, in the inguinal region, scrotum, appearing or increasing in size during physical exertion, straining. Also, in the area of ​​the above formations, a feeling of discomfort or pain may appear during physical exertion, coughing, straining.

If you have any of the above symptoms, you should consult your doctor. The sooner the diagnosis is made and treatment is carried out, the higher the chance of preventing the development of complications, sometimes fatal.

Learn more about hernia types.

Fig. Classification of hernias of the anterior abdominal wall

Lumbar hernias of the anterior abdominal wall walls . The main anatomical formations through which lumbar hernial formations arise are the Petit triangle (Petit) and the Greenfelt-Lesgaft gap, aponeurotic fissures.
Petit’s triangle is bounded behind by the outer edge of the broad back muscle, in front by the inner edge of the external oblique muscle, from below by the iliac crest. In the region of the Petit triangle, under the superficial fascia and thin aponeurosis, there is an internal oblique muscle.
The Greenfelt-Lesgaft interval often has a quadrangular shape. Its upper border is formed by the lower serratus posterior muscle and the XII rib, medially it is delimited by the longitudinal muscles of the spine, the square muscle of the lower back, and the edge of the internal oblique muscle runs in front and below. The shape and size of the gap can vary depending on the length of the XII rib – with a long rib, the Greenfelt-Lesgaft gap is sometimes absent or looks like a gap, and with a short rib it increases in size.
Aponeurotic fissures usually form at the site of passage of vessels and nerves, but can sometimes appear as a result of rupture or maldevelopment of the aponeurosis. Among the causal factors contributing to the occurrence of hernial formation in these areas is the weakness of the connective tissue and muscle atrophy, inflammatory processes. Hernial protrusions are more common on the left than on the right, bilateral are rare.

Recurrent hernias
They are a complication of surgical treatment of hernias.
The causes of recurrent hernial protrusion may be related to the patient’s lifestyle and structural features of his body.

For example: non-compliance with the terms of the recovery period, when a person begins active physical activity ahead of schedule.
With age-related changes and a number of pathological conditions, when tissues can become flabby, change elasticity and structure, which also affects the quality and duration of healing after the operation. So in elderly, malnourished or very obese patients, relapses can be observed regardless of the method of operation and the course of the postoperative period
Main causes of recurrent hernia formation:

• errors related to surgical technique
• connective tissue deficiency
• wound infection during or after surgery
• excessive physical exertion, especially shortly after surgery

The only treatment for recurrent hernias is surgery. At the same time, various methods of hernioplasty are selected using various mesh prostheses.

Fig. Removal of old and deformed graft

Fig. Restoration of the integrity of the inguinal canal and reprosthetic hernioplasty according to Liechtenstein

Why is a hernia dangerous?
In addition to the obvious inconvenience associated with the presence of a cosmetic defect, reduced physical activity and ability to work, a hernia carries the risk of developing a number of complications. These include violations of the functions of organs located in the hernial sac – constipation, urination disorders, with the release of large volumes of organs from the abdominal cavity – respiratory disorders. A formidable complication is the development of hernia incarceration.
Incarceration – compression of the hernia in the hernial orifice, resulting in the development of necrosis of the contents of the hernial sac. The infringement is accompanied by a sharp pain in the area of ​​the hernial protrusion. The most dangerous in case of infringement is the development of intestinal obstruction (the loop of the intestine is infringed) and the peritonitis that follows it. This situation requires immediate resolution through surgery. By and large, regardless of which organ is the contents of the hernial sac, the end result without appropriate treatment is one – peritonitis, the difference is only in time. Peritonitis – inflammation of the peritoneum – a formidable complication of a large number of diseases, including strangulated hernias, the development of this pathological condition is one of the most difficult problems in surgery. Age, obesity, the presence of concomitant pathology further exacerbate this situation. Without surgery, the only outcome is death. Even if the operation is performed, but more than a day has passed since the infringement began, up to 30% of patients die in the postoperative period. No need to bring such a small problem as a hernia to such a tragic situation.

How is a hernia treated?
The only way to treat a hernia in adult patients is to perform an operation (hernia repair).

When should a hernia be treated?
Following from the above, the earlier the operation is done, the better.

Is it possible to do without surgery?
-No.
For adult patients with a hernia, the only treatment is surgery.

Are there any contraindications for surgery?
Herniotomy should not be performed in the presence of severe concomitant pathology, when the operation can only harm, not help. Such cases include: the coming months after myocardial infarction, stroke, a number of other extremely severe comorbidities. It should be remembered that the presence of chronic diseases is not an absolute contraindication to the operation, but only requires appropriate correction in the preoperative period.

Can other surgeries be performed at the same time as hernia surgery?
Yes. An operation for a hernia can be supplemented by almost any surgical intervention.
Often, especially in older patients, there are several problems that require surgical intervention. In such situations, it is preferable to get by with one operation that combines the removal of a hernia and some other problem. The implementation of combined operations is a priority method, as it allows solving two (or more) problems in one surgical intervention, relieves the patient of psycho-emotional problems associated with the need to undergo several operations.

What types of operations are performed to repair a hernia?
To date, more than 300 methods of hernia repair are known – ventral, inguinal, umbilical, femoral, postoperative. But all of them can be fundamentally divided into two groups:

• with plasty with own tissues – tissues of the abdominal wall around it are used to close the hernia opening
• with plasty with synthetic materials (or “tension-free” plasty) – synthetic prostheses made from surgical threads are used to close the hernial opening.

Plastic surgery with own tissues is the oldest group of methods, born in the second half of the 19th century, it is the most extensive and widespread. Its essence is the closure of the hernial ring with the patient’s own tissues (muscles, fascia and aponeuroses) in one way or another. The frequency of hernia recurrence after these operations varies from 20% to 70% depending on the condition of the patient’s tissues, the method of hernioplasty and the correctness of its choice. The main disadvantages are a pronounced pain syndrome for the first days after surgery due to tissue tension and long periods of physical rehabilitation. Intensive physical labor is contraindicated for at least 3 months after surgery.

Tension-free plasty methods for the patient’s own tissues have existed since the second half of the 1960s. They are distinguished from methods of plasty with their own tissues by the use of “patches” made of synthetic materials to close the hernial orifice. In recent years, these methods have gained great popularity, which became possible due to the creation of perfect synthetic materials and the development of new methods for closing the hernia orifices, which practically guarantee the patient from the occurrence of hernia recurrence. The recurrence rate does not exceed 1% in specialized clinics, regardless of the type of hernia. Despite the skin incision over the hernia, pain after surgery is minimal, because. there is no tension on one’s own tissues. Intensive physical labor is possible a month after the operation, household physical activity is not limited. This allows such operations to be performed on an outpatient basis. A positive point is also the possibility of performing the operation under local or spinal anesthesia, which is especially important for the elderly and patients with heart and lung diseases. Due to its reliability and simplicity, hernioplasty according to the I.L. Lichtenstein method – for inguinal hernias – has received the greatest prevalence. It is applicable for any type and size of inguinal hernias.

Fig. Plastic surgery of the inguinal canal with a mesh polypropylene prosthesis according to Liechtenstein .

Laparoscopic (through punctures of the anterior abdominal wall) methods of hernia repair should also be mentioned. These are operations that are performed under the control of a laparoscope – a device that allows using a mini-video camera to eliminate a hernia from the abdominal cavity without cutting the skin over the hernia. They were born in the early 80s of the twentieth century with the advent of video technology. In most cases, the abdominal wall defect is closed from the inside of the abdominal cavity with a synthetic mesh prosthesis. The frequency of hernia recurrence after this repair is 2-5%, which is determined by the type of hernia and the preparedness of surgeons. Important advantages of these methods are low invasiveness, which means a slight pain syndrome after surgery, short rehabilitation periods (up to a month with physical labor), as well as the possibility of performing bilateral plastics and, if necessary, combined operations in the abdominal cavity through the same punctures of the abdominal wall.