Hernia of the white line of the abdomen (synonym: epigastric hernia) is called the penetration of the abdominal organs (usually intestinal loops) beyond the peritoneum, into the subcutaneous tissue in the midline of the abdominal muscles.
Pathology arises due to the weakness of the tendon fusion of the left and right half of the abdominal muscle, which leads to the formation of a hernia gate. This form of the disease is not very common, in contrast to hernias of other sites. However, even it can lead to the development of life-threatening complications.
During the illness, a gradual protrusion of preperitoneal fat with the formation of so-called preperitoneal lindens, as well as the formation of a hernial sac, in which a part of the abdominal organs is located, occurs through the holes and crevices in the white line of the abdomen. Painful attacks can be triggered by an increase in intra-abdominal pressure as a result of sudden physical exertion.
Causes of abdominal white line hernia can be expressed by insufficiently developed connective tissue from the birth or acquired during life of the described area. In some cases, this causes its thinning and subsequent expansion.
The weakening of the connective tissue occurs under the action of:
- genetic predisposition;
- abdominal trauma;
- scars that have appeared after the operation;
- rapid rise in intra-abdominal pressure.
Intra-abdominal pressure may increase due to:
- great physical exertion;
- prolonged incessant cough;
- difficulty urinating;
- development of prostate adenoma;
- prolonged crying in infants.
Mainly affected by men aged 20-30 years and 40-50-year-old women. Depending on the location relative to the umbilical cavity, the following types of hernias are distinguished:
- supra umbilical (located above the navel) - approximately 80% of cases;
- paraumbilical (located near the umbilical cavity) - found in 18% of cases;
- sub umbilical (localized below the umbilical cavity) - very rarely occur, about 1-2%.
The white line of the abdomen should have a width of 1 to 3 cm, whereas when it changes, this indicator can be equal to 10 cm, this will depend on the degree of diastasis.
Symptoms of abdominal white line hernia
Hernia of the white line of the abdomen symptoms, which are mainly hidden, most often manifested by the appearance of a bulge, accompanied by discomfort when you press it.
The main symptoms are as follows:
- painful bulging in the midline (usually in the upper section);
- nausea, occasionally turning into vomiting;
- muscle strain along the midline;
- pain during sudden movements, bends, bends;
- pain after eating;
- dyspeptic disorders (belching, hiccups, heartburn).
When the condition worsens, the symptoms increase:
- during bowel movements, blood may be secreted;
- pains increase and become unbearable;
- constantly vomiting;
- if at the early stage of the disease a hernia can be adjusted independently, then with complicated forms this is impossible.
A strangulated hernia of the white line of the abdomen occurs when the hernial contents are squeezed in the area of the hernial ring. This condition is accompanied by rapidly increasing abdominal pain, nausea, vomiting, stool retention, blood in the feces and the inability to reduce the protrusion.
Hernia of the white line of the abdomen: photo before and after
What does a hernia look like before and after surgery, we offer for viewing detailed photos.
In order to correctly diagnose a hernia of the white line of the abdomen and subsequently to prescribe treatment, a number of diagnostic measures should be taken. First of all, this examination by a surgeon, after consultation can be appointed:
- radiography of the stomach and duodenum;
- gastroscopy (endoscopy, esophagogastroduodenoscopy);
- herniography is a rentological method consisting in the introduction into the abdominal cavity of a special contrast agent for the purpose of researching a hernia;
- Ultrasound of the hernial protrusion;
- computed tomography (CT) scan of the abdominal organs.
For accurate diagnosis of hernia using the method of X-ray. If the diagnosis is indeed confirmed, herniography may be performed - an additional radiopaque hernia examination.
Treatment of hernia of the white line of the abdomen
Elimination of pathology in adults mainly occurs with the use of surgical intervention - this is the best treatment option for hernia of the white line of the abdomen. In modern medicine, surgery offers the following options for removing the disease:
- Plastic with the use of special synthetic prostheses - a special mesh of hypoallergenic materials, which is installed in order to close the aponeurosis defect. This happens after excision of diastasis of recti in the white line of the abdomen. In this case, the probability of recurrence of the disease is very small. In the future, the networks can either be completely absorbed, or partially, depending on the material used. Over time, there is a complete implantation of the mesh into the walls of the abdomen and its fouling with tissues. Often the question of the implantation of synthetic prostheses is solved already during the operation, when it becomes possible to assess the condition of the patient’s own abdominal muscles.
- Plastic surgery using local tissue of the patient. In this operation, the removal of muscle diastasis is combined with the closure of the defect. According to statistics, relapses can account for 40% of all cases.
- In the event of an abdominal hernia injury, the operation is performed on an emergency basis and may include a significant amount of resection.
Access to the hernia is carried out according to three methods, each of which has positive and negative sides, and depends on both indications and contraindications. The choice of methods for each patient is individual.
- Laparoscopic access is performed using special tools and video equipment through three small punctures on the abdomen.
- Preperitoneal access, like laparoscopic, is performed through small punctures using special tools and video equipment without penetration into the abdominal cavity due to the detachment of the peritoneum with a special balloon and without filling it with gas.
- Open access is performed using a cut length that corresponds to the vertical size of the protrusion.
You should also understand that in the event of a hernia of the white line of the abdomen, treatment without surgery is impossible. The bandage, on which many have pinned their hopes, only to some extent slows down the expansion of the abdominal wall defect. Wearing it is prescribed only to those patients who have serious contraindications to surgery:
- severe diseases - cardiovascular insufficiency, oncological diseases, cirrhosis in the decompensation stage, etc .;
- the presence in the body of the source of infection;
- pregnancy at any time;
- hernia failure
Acceptance of painkillers in the form of tablets, which is a way to relieve pain, can only briefly improve the condition, but will not get rid of the problem. Therefore, if there are no contraindications, one of the above-mentioned operations to restore the white line is performed.
Cost of operation
The cost of an operation to remove a hernia of the white line of the abdomen depends on the size of the hernia and its features, the presence or absence of complications, diagnostic methods and surgical intervention, selected materials, qualifications of specialists and a number of other factors.
In Moscow, for example, hernia of the white line of the abdomen in a private clinic costs from 25,000 rubles.
A special diet does not eliminate the hernial protrusion, but to some extent will reduce the rate of progression of the disease, and reduce the chances of development of infringement. Such foods should be limited or eliminated from the diet:
- fried and spicy dishes;
- harmful food: chips, canned food, convenience foods;
- foods that cause bloating.
You need to eat in small portions, but often. The last meal should be planned at least 3 hours before bedtime.
With timely and rational treatment of abdominal white line hernia, the prognosis is favorable. The probability of hernia recurrence is determined by the method of hernioplasty and the way of life that the patient adheres to after the operation.