In the last issue, we talked about the relevant knowledge of hernia, and saw that many netizens and expert outpatients were consulting me about hernia**: Is it okay not to operate?What are the risks if you don't have surgery?
In this issue, let's talk about whether it is okay to have a hernia without surgery, and what are the risks of being conservative without surgery?
We know hernia – this is when an organ or tissue in the body leaves its normal anatomical site and passes through a gap, defect, or weak part of the body into another site. The occurrence of general hernia must be due to the existence of a defect or weak point in the body, which may be due to congenital immature problems, such as the occurrence of infantile hernia;It may also be due to the atrophy and degeneration of acquired body tissues, such as hernias in elderly patients.
Most patients do not feel pain or itch in the early stage of hernia, except for a few who may have a little discomfort of swelling, so this makes many people think that they do not need it, or think that it is conservative. If it is delayed, it may lead to intestinal obstruction, intestinal perforation, intestinal necrosis, acute peritonitis septic shock and other risks, which is life-threatening.
1.Intestinal obstruction: The hernia is relatively small in the early stage, and the hernia contents such as the protruding intestinal tube may disappear when lying flat or resting, and you will not pay too much attention to it if you feel that it is not painful or itchy. However, with the progress of the disease, over time, the protruding hernia content will become more and more, when the protruding mesenteric mesangial and other hernia contents are too much to be returned normally, it will be stuck in the hernia ring orifice, resulting in the appearance of intestinal obstruction, the proximal intestinal dilation at the incarceration is obvious, and the distal intestinal tube is empty.
2.As the hernia becomes more timely, if the medical treatment is not timely or cannot be repaid, the intestinal tract at the incarceration entrapment will have obvious blood vascularization disorders, including arterial blood supply and venous return problems, and further development may cause necrosis or perforation of the intestinal tube, and then surgery** It may not be a simple hernia repair surgery, but may involve partial resection of the intestinal tube and anastomosis of the intestinal tube, which makes the relatively simple and less invasive surgery become a complex and traumatic emergency surgery, which increases the risk and difficulty of the operation, and also increases the patient's hospital stay and economic burden. In addition, due to the contamination of the surgery, hernia repair was not possible in this emergency surgery. After recovery, another surgery is performed for hernia repair.
3.Septic shock in acute peritonitis. With the prolongation of incarceration, necrosis and perforation of the intestinal tract appear, and the necrotic material of the intestinal contents flows into the abdominal cavity after necrosis perforation, which will cause the manifestations of acute peritonitis, such as abdominal pain and unbearable passive bending positionAt the same time, necrotic poison, an inflammatory medium of the necrotic intestinal tract, is released into the blood, which can cause septic shock manifestations, such as increased heart rate, decreased blood pressure, clammmy and cold limbs, confusion and apathy of the patient, and other clinical manifestationsIf further treatment is not taken at this time, the patient's life may be endangered.
In addition, some patients ask which hernias can be treated without surgery, what should be paid attention to if they are not operated, and can they take medicine to cure the hernia?Do the hernia bags or hardeners mentioned on the Internet really work?
Patients who do not operate:
1) Infants: The abdominal wall is not well developed, you can wait for the abdominal wall to fully develop before deciding whether to undergo surgery**. Since the disease may recover on its own, it is recommended to be observed within 6 months without rushing to surgery. If the mass protrudes repeatedly and gradually increases over 6 months of age, the possibility of spontaneous healing is lost and surgery is required**. If the child is younger than 1 year of age, the risk of anesthesia is relatively high, and surgery can be considered when the child is 1 to 3 years old.
2) Elderly: Surgery is not recommended if the general condition is relatively poor and cannot tolerate surgery.
In addition to this, surgery should be performed as soon as possible after a hernia.
For hernia can be cured by medicine, this is very clear, there is currently no oral medicine can **hernia, if you can claim oral medication**hernia, 100% is**, be careful not to be deceived!
Hernia bags are only a stopgap measure for those who are not suitable for surgery or cannot be operated on in the near future**, not a long-term solution.
For the injection of sclerosing agent, it is not currently used for clinical hernia, because the blind use of sclerotherapy injection often causes male spermatic cord injury ** atrophy, female adnexa and uterine damage, serious will cause intestinal obstruction, intestinal necrosis and even life-threatening.
Finally, with the aging of the population, there are more and more elderly hernia patients, but it does not mean that older people are not suitable for surgery. Elderly patients often have a variety of chronic diseases, and it is necessary to undergo surgery as soon as possible according to their own condition after detailed assessment of cardiopulmonary organ function, so as to avoid incarceration and strangulation and forced emergency surgery after increasing the risk of surgery. In addition, the function of various organs in the body of elderly patients gradually decreases with age, so elderly patients are still recommended to operate as soon as possible after the hernia is clear, and the risk of surgery for elderly patients today is definitely lower than that of surgery in three or five years, because the older the age, the higher the risk of surgery
Remarks
1) Thanks to Dr. Yangyang Wang, Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, for his contribution to this articleIf there is any clerical error, please criticize and correct!This article is a popular science article, if it is infringing, contact me to delete the article!
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