Treatment of hernia at babies: surgeon or healer?
of Hernia of a forward belly wall are the most widespread surgical pathology at children. Subject this rather trivial, known to any doctor and most of parents. Long ago aspects of diagnostics, terms and methods of surgical treatment of hernias are developed. It is possible to find enough information and on character of this disease, and on where and how to consult and treat the child in the Internet. However the number of late addresses to a hospital with the restrained inguinal hernias, detection of earlier not diagnosed various hernias of a forward belly wall at teenagers still surprises. And of course nonconventional ways of treatment of hernias obviously inefficient, but unusually popular recently at various folk healers, midwives etc. revolt. Considering listed “but“, we will carry out small “educational program“ among young parents.
Hernia is a pathological protrusion which can arise in various anatomic areas. Hernia consists of a hernial bag, hernial contents, and also hernial gate which leave a hernial bag with contents (see fig. 1).
We will stop on inguinal and umbilical hernias since they are most widespread.
What is inguinal hernias?
Inguinal hernia at children is the protrusion in inguinal area caused by the existence of an open vaginal shoot containing a gut loop, an epiploon or an ovary.
Such hernias occur more than at 5% of children, but they are found in premature by 3 - 5 times more often than among full-term. At the children suffering from violation of development of connecting fabric against genetically caused diseases, hernias of a forward belly wall can be observed 2 - 3 times more often. Rather often inguinal hernias are combined with various congenital orthopedic pathology (for example, congenital dislocation of a hip) and malformations of nervous system (spinal hernias).the Ratio of the boys and girls having this disease makes
, according to different data, from 3:1 to 10:1. Perhaps, it is connected with process of omission of testicles (testicles) at boys from an abdominal cavity in a scrotum. According to some authors, right-hand inguinal hernia, and in 10% of cases - bilateral inguinal hernia occurs at boys in 60% of cases. In more than 50% of cases diagnose inguinal hernias from two parties for girls. >
When studying hereditary predisposition it was found out by p that at 11,5% of children with inguinal hernias one of parents was operated concerning the same disease earlier.
of Display of a disease
the Main symptom of inguinal hernia at boys and at girls is protrusion in inguinal area. At pakhovo - moshonochny hernia hernial protrusion extends to the bottom scrotums. Especially noticeable protrusion becomes after physical activity, during the crying, shout of the child that is connected with increase of intra belly pressure. Uncomplicated inguinal hernia has a myagkoelastichny consistence, when pressing it is easy, is without effort set in an abdominal cavity, sometimes with rumbling if contents is the gut loop. The palpation and reposition of uncomplicated inguinal hernia does not cause any discomfort to the child.
Dropsy of covers of a small egg rather often occurs at newborn boys. At the same time the swelling in the field of a scrotum, disappearing, increasing visually is defined, especially at shout, crying.
As a rule, dropsy of covers of a small egg at children of early age is passed spontaneously within the first year of life. At preservation of dropsy at more advanced age (after 2 years) expeditious treatment is required.
the Major role in formation of inguinal hernias at children is played by an “a vaginal shoot“ (see fig. 2) which develops in an abdominal cavity of a fruit from 12 weeks of pre-natal development. In fact the vaginal shoot is protrusion of a peritoneum to the inguinal area, out of limits of an abdominal cavity. The main objective of a vaginal shoot - bringing down of gonads (process of omission of testicles of an abdominal cavity in a scrotum). After omission of testicles occurs - difficult, hormonedependent process of an obliteration (zarashcheniye) of a vaginal shoot (fig. 2a). Violation of this process also creates prerequisites for development of inguinal hernias (fig. 26), dropsy of covers of a small egg or a cyst of a seed kanatik. Introduction in a vaginal shoot of a lock salnika1, gut loops, and at girls - an ovary in overwhelming number of cases leads to formation of inguinal hernia. Thus, the vaginal shoot is a hernial bag on which back wall at boys there pass elements of a seed kanatik, and girls have a round ligament of a uterus and the elements accompanying it.
of Emergence of hernial protrusion parents and to become a reason for the address to the children`s surgeon. Now planned expeditious treatment of inguinal hernias at children can be carried out right after establishment of the diagnosis. However children till 6 months have lives, especially with any accompanying pathology, in the presence of free reposition of hernial contents expeditious treatment can be postponed until the second half of the first year of life. At the same time it is necessary to remember that this child has to be under supervision of the children`s surgeon, and parents have to be informed on symptoms of infringement of hernia. Even one episode of infringement is the indication for planned operation.
the Restrained inguinal hernias
the Infringement is a sdavleniye of contents of a hernial bag with development of violation of blood circulation in the restrained bodies up to a necrosis (necrosis of fabrics).the Restrained inguinal hernias quite often are observed by
at children till 1 year, usually at premature. At boys the loop of a gut or a lock of an epiploon is most often restrained, girls have an ovary, is more rare - a uterine tube or a loop of a gut. Contents of a hernial bag through an internal abdominal ring get into the pakhovy canal. The infringement is connected with development of gradual hypostasis of contents of a hernial bag, violation of venous and lymphatic outflow, strengthening of hypostasis that leads to a sdavleniye. Inflow of arterial blood is broken and the necrosis of the restrained body develops. At the same time it is visually possible to define signs of a sdavleniye (strangulyation) of contents of a hernial bag: hernial protrusion dense, is expressed painful, in inguinal area hypostasis and reddening develop.
at change of the general condition of the child (sharp concern, a pain syndrome, vomiting, children about one year have a sucheniye legs, refusal of food, temperature increase) in combination with emergence in inguinal area of dense, painful education, not reducible in an abdominal cavity. This state is regarded as infringement of inguinal hernia. Delay in the request for medical care can lead to serious consequences: to a necrosis of the restrained bodies, development of an atrophy of testicles.
to the blood supply termination. Even the small duration of infringement can lead to a necrosis of body. The infringement of an ovary also causes death of ova that can be reflected further in reproductive abilities. Considering these circumstances, at infringement of inguinal hernias at girls it is accepted to carry out the emergency surgery.
At receipt in the boy`s hospital with small prescription of infringement of inguinal hernia and lack of symptoms of a sdavleniye (strangulyation) of contents of a hernial bag can hold a complex of the conservative events directed to relaxation of muscles, reduction of hypostasis and reposition of hernial contents. To the child inject spazmolitik, the calming drugs.
At reposition of inguinal hernia and improvement of a condition of the child recommend to execute planned surgery. At a satisfactory condition of the child and absence of any serious associated diseases it is not necessary to postpone for a long time expeditious treatment as there is always a threat of repeated infringement which can proceed less safely. Besides, numerous infringements of inguinal hernias complicate surgery in connection with formation of dense unions between a hernial bag and elements of a seed kanatik.carry out by
in the absence of effect of conservative actions at the restrained inguinal hernias expeditious treatment in the emergency order. At big prescription of infringement and existence of symptoms of a sdavleniye of contents of a hernial bag start operation immediately without attempts of conservative treatment.it is slightly simpler than
In view of anatomic features of the technician of operation at girls, than at boys. At the restrained inguinal hernias during operation estimate a condition of the restrained body (a loop of a gut, an epiploon, an ovary). At violation of blood circulation in the restrained body hold a complex of the conservative events directed to restoration of viability of the last. In the absence of effect the nekrotizirovanny body is deleted. Fortunately, it happens rather seldom: according to foreign authors, at infringement of a loop of a gut carrying out a resection of an impractical site (removal of part of body) is required in 1,5% of cases.
One more complication of infringement of inguinal hernia at boys - violation of blood circulation of a small egg. This complication occurs at 5% of children with the restrained inguinal hernias and, in cases of late diagnostics, can lead to an atrophy (reduction of the sizes and termination of work) of a small egg. whether
- and it will disappear by itself. Whether so it? Everything is explained by
simply. Shamans and midwives know about opportunities of spontaneous closing of defect of an umbilical ring at children till 3 - 5 years. These scientific knowledge give them the chance for certain material benefits effectively “to treat“ children. It is the sure bet allowing to support the myth about extraordinary opportunities of nonconventional methods of treatment.
Recurrence of inguinal hernias, according to world medical literature, makes less than 1% and most often arises at premature children and at children with diseases of connecting fabric. Some authors claim that rather often recurrence of inguinal hernias arises after the emergency surgeries. Thus, timely diagnosis of inguinal hernias with the subsequent planned treatment allows to reduce number of complications and the risk which always is present at the emergency operations.
On our supervision, nonconventional methods of treatment of inguinal hernias (including plots) not only do not lead to recovery, but also complicate the subsequent expeditious treatment in view of development of adhesive process. Inclusion in adhesive process of a semyavynosyashchy channel can lead to its closing with development of violations of reproductive function. Quite often huge belief of parents owing to plots and obtusion of their vigilance is led to late addresses to a hospital at infringement of hernia that is fraught with development of the listed complications.
Umbilical hernia is one of the most frequent surgical pathologies of children`s age and occurs at every fifth child, and among premature children - at every third. At the birth the minimum defect of an umbilical ring is defined practically at each newborn. At shout, crying of the baby there is a hernial protrusion that usually guards parents. Often parents connect concern of the child with existence of umbilical hernia. However cases of infringement of umbilical hernia are extremely rare.Umbilical hernias are inclined
to spontaneous closing. At the same time the extent of defect of an umbilical ring is important: with its diameter less than 1,5 cm, as a rule, by 3 - 5 years of life defect closing is noted. If umbilical hernia remains after 5 years, then expeditious treatment is necessary.independent closing is almost impossible for
with defect of an umbilical ring of big diameter that also demands carrying out operation - perhaps, at earlier age (3 - 4 years). Thus, umbilical hernia demands supervision of the child from the children`s surgeon for treatment tactics definition.showed
of the Practician that sticking up of a navel, applying of coins to area of a navel do not give any effect and rather often cause irritation of skin of okolopupochny area.
can refer the general massage, massage of a forward belly wall, a vykladyvaniye on a stomach, physiotherapy exercises To the conservative actions directed to closing of defect of an umbilical ring at children about one year. The general massage and physiotherapy exercises is carried out by massage therapists and doctors of LFK. Massage of a forward belly wall - stroking of a stomach clockwise - any parents before each feeding then the child is recommended to be laid out on a stomach for 5 - 10 minutes can do. However at hernias of the big size it is not necessary to hope for these methods.
the Purpose of operation at umbilical hernia the ushivaniye of defect of an umbilical ring consists. The section of the small size is made over a navel in a skin fold that, along with cosmetic seams, does a postoperative hem almost imperceptible. With age elasticity of fabrics decreases, and the small defect of an umbilical ring which is not liquidated at children`s age turns into big umbilical hernia at adults. Often umbilical hernia begins to increase after the delivery at women. Umbilical hernias at adults are inclined to infringement and frequent recurrence. Therefore around the world it is accepted to treat hernias of a forward belly wall at children`s age, it is better to school.