Postoperative hernia on the abdomen: consequences and treatment. Torsional joints what to do reasons how to treat Is it necessary to remove a hernia on the abdomen

Hernia of the white line of the abdomen is a “cunning” pathology. Its trick is that at first it does not manifest itself in any way. The person does not even realize that he is faced with such a problem.

Very often the problem is identified during a random diagnostic examination. This, by the way, is one of the arguments why it is important to visit a doctor from time to time for preventive purposes.

As the hernia increases in size, it may “protrude” in the upper part of the midline of the abdomen. The place of “protrusion” is accompanied by pain, which intensifies with increasing physical activity.

A person may experience nausea, vomiting, belching and heartburn.

Is a hernia of the linea alba dangerous?

Have you noticed any of the listed symptoms? Make an appointment with your doctor. Don't wait for complications to arise.

By the way, about complications. Yes, the disease is not fatal and, according to official data, occurs in less than 15% of the total population.

However, the fact is that in the area of ​​the white line of the abdominal wall there are slit-like spaces. Blood vessels and nerves pass through them. It often happens that, increasing in size, the hernia gets into these cracks and puts pressure on the nerves and blood vessels. This has an extremely negative effect on the functioning of the nervous and circulatory systems.

A strangulated hernia is the most serious complication. If you consider that the gates are most often relatively narrow - 5-6 centimeters, then the risk increases many times over. In case of infringement, emergency surgical treatment is performed.

And, of course, one cannot fail to mention disturbances in the functioning of the gastrointestinal tract, inflammation, which are faithful companions of this problem.

Treatment is carried out through surgery and is successful if treated in a timely manner.

Surgery to remove a hernia of the linea alba

It is carried out only in a hospital setting. ON CLINIC offers modern operating rooms and wards for a comfortable stay with an automatic doctor call system. The friendly medical team at ON CLINIC will provide you with the necessary assistance at any time of the day or night.

ON CLINIC surgeons usually perform laparoscopic surgery. Such manipulation is a reliable way to get rid of the problem with minimal tissue trauma, minimal recovery period and maximum comfort during and after surgery.

Such results are achieved due to the fact that the doctor performs the procedure without incisions in the skin. He makes several small punctures on the patient’s body, through which he inserts equipment and performs the necessary manipulations.

During surgery, the surgeon, having gained access to the hernia, isolates it, places the internal organs from the hernial sac in their natural place in the peritoneal cavity and performs abdominal wall plastic surgery.

The specificity of the manipulation is the mandatory elimination of discrepancy or, scientifically speaking, diastasis of the rectus abdominis muscles.

As for plastic surgery, it can be performed either using the patient’s own tissues or using synthetic prostheses - a special mesh made of hypoallergenic materials.

The first method has limited use - only for small defect sizes and strong surrounding tissues. Otherwise, if the connective tissues are weak, which is common in older people, the chance of recurrence can be up to 40 percent. Synthetic mesh is an ideal material for closing a defect and an excellent way to reduce the risk of re-perforation to zero. Over time, as the mesh is completely implanted and becomes overgrown with body tissue, this protection becomes even more powerful.

The synthetic mesh used in ON CLINIC is hypoallergenic and safe for the human body.

How much does the operation cost?

The cost of surgery to remove a hernia of the linea alba depends on the size of the hernia and its characteristics, the presence or absence of complications, diagnostic and surgical methods, selected materials, qualifications of specialists and a number of other factors.

The anterior abdominal wall has several anatomically weak areas: the inguinal region, the umbilical ring and the linea alba. In these areas, a pathological process such as a hernia can be observed. Protrusion of internal organs under the skin and into the adjacent cavity occurs under the influence of high pressure against the background of muscle weakness.

These factors become the main causes of ventral hernias in young children, adults and the elderly. The formation on the abdomen requires surgical treatment, otherwise the pathology is complicated by conditions such as inflammation, strangulation, necrosis, and coprostasis.

Abdominal hernia surgery is performed as planned; surgery offers an open method and laparoscopy for this, and the choice of technique will depend on the severity of the disease and the patient’s condition. The postoperative period is even more important for recovery, and after the abdominal wall defect has been removed, treatment is just beginning.

All operations to remove a hernia have their own contraindications and risks, therefore, before choosing a technique, the surgeon prescribes a comprehensive examination and thorough preparation is carried out, including the sanitation of foci of infection, cleansing the intestines and the selection of conservative treatment options in the postoperative period.

Why do you need surgery for a hernia?

Surgery to remove an abdominal hernia is prescribed to everyone without exception, because no non-surgical treatment method can lead to closure of the abdominal wall defect. It is important to operate on the patient in order to return the organs to their place, followed by suturing the hernial orifice, which can be closed with the patient’s own tissue or a mesh implant.

Gymnastics, diet, bandage and medications are already measures after removal of the hernia, when the body is restored.

Even useful physical activity will not help eliminate the hernia, but, on the contrary, can become a factor in organ infringement. Exercise therapy will be prescribed after surgery to remove the tumor to strengthen the muscles in order to prevent relapse. As for the bandage, it is also harmful in case of a hernia, but it is needed as a retaining agent to prevent even more of the organ from coming under the skin.

A special belt does not cure, it helps before and after surgery to reduce the load on the abdominal muscles. Dietary nutrition is important during any period of the disease, because the state of the gastrointestinal tract depends on the quality of food and the frequency of food intake, and this directly affects the symptoms of a hernia. It is important to prevent bloating, constipation and diarrhea, all those phenomena that increase pressure inside the abdominal cavity and affect well-being.

Only after removal of an abdominal hernia is the risk of complications from the stomach and intestines reduced, because being in the hernial sac, these organs can be pinched at any time, which will lead to their death with the need for urgent excision of the affected tissue.

How is an abdominal hernia removed?

There are several hundred methods of hernia repair, but all of them can be combined into three groups:

1. Plastic surgery using your own tissues .
2. Laparoscopic plastic surgery.
3. Non-tension plastic.

Plastic surgery using the patient’s own tissues involves suturing the hernial orifice with muscles, fascia, and aponeurosis. Access to the hernia is made through a wide incision - 8-10 cm, so after the operation a cosmetic defect remains in the form of a scar. This hernia repair option has many disadvantages. Recovery after tension plasty lasts several months, and increasing the load is prohibited throughout the rehabilitation period.

The operation in 3-15% of cases ends in relapse or development of a postoperative hernia, which is also associated with a wide scar that can become a hernial orifice.

Laparoscopic hernioplasty is performed under general anesthesia with constant video monitoring. The operation is performed from inside the abdominal cavity, and access is created through small punctures (2 cm). Three incisions on the abdominal wall are needed to insert a camera and special instruments for excision of tissue, suturing it and fixing the mesh implant. Such an operation can only be performed as planned, when there are no contraindications to general anesthesia. The main advantage of the technique is the ability to simultaneously eliminate concomitant pathologies of the abdominal cavity.

The postoperative period after laparoscopic surgery is relatively short, wounds heal quickly, no wide scars remain, and the risk of relapse is almost completely eliminated.

Tension-free repair or Lichtenstein surgery is a method of closing the hernial orifice with the installation of a synthetic implant. Due to the absence of tension during the rehabilitation period, the pain syndrome is weak, the risk of relapse is lower than when suturing the defect with natural tissues. This operation can be performed either under local anesthesia or general anesthesia. Planned hernioplasty is performed on an outpatient basis, the patient returns home the very next day, and can return to physical work in a few weeks.

In the last decade, tension-free hernioplasty has gained great popularity, due to a number of advantages: rapid recovery, absence of pain, minimal risk of relapse.

Indications and contraindications

An abdominal hernia is dangerous not only to health, but also to life. Protrusion of organs under the skin in adults and children can be asymptomatic for a long time, and only a slight swelling is visible in the abdominal wall, which does not bother you at all. A hidden disease is even more dangerous, because at any moment, under the influence of high load, an injury can occur.

A hernia is an indication for elective surgery, but there are conditions that require immediate assistance from a surgeon.

Emergency surgery is performed for complications for which the following symptoms are typical:

• acute abdominal pain, hardness and tension of the abdominal wall;
• nausea with vomiting, bleeding with vomit;
• absence of bowel movements or diarrhea with blood in the stool;
• absence of cough impulse, non-reduction of protrusion;
• a sharp deterioration in health, pale skin, tachycardia;
• general malaise, severe thirst, increased sweating.

Each surgical technique has relative contraindications. When a hernia becomes complicated, the surgeon weighs the degree of danger of the condition and the potential harm of the operation, making a decision to save the patient’s life.

Planned hernia repair requires preparation:

• abstinence from alcohol a week before surgery;
• refusal of medications 2 weeks in advance;
• refusal to eat the evening before surgery;
• treatment of concomitant gastrointestinal pathologies;
• vitamin therapy 2 weeks before surgery.

Hernia repair is carried out in case of colds, infectious diseases in the acute stage, and during pregnancy. The operation can be performed 14 days after recovery, except for emergency indications.

Complications

After removal of the hernia, mild pain is present for several days. The patient experiences discomfort during movement; there are difficulties when walking, bending and squatting. Unpleasant sensations completely disappear after 7-14 days, subject to compliance with the rehabilitation regime. Residual symptoms may bother you for up to two months, which is also normal.

If after the operation there is pain for a long time, the wound becomes inflamed, the condition worsens, this indicates the addition of complications.

Possible complications after surgery and their prevention:

1. Local- inflammation, necrosis, abscess, ischemia, phlegmon, hematoma.Prevention- compliance with the rules of asepsis during the operation, routine treatment of the wound after hernia repair, and the use of antiseptics.
2. Are common- thromboembolism, pneumonia, compartment syndrome.Prevention- comprehensive examination before surgery, treatment of infectious pathologies, restorative therapy, taking antibacterial agents.

Postoperative rehabilitation

In the early period after surgery (the first 2 weeks) there are a number of restrictions and rules:

• Before removing the stitches, you need to go to dressings and follow all instructions;
• it is important to take laxatives to avoid constipation;
• a strict diet and nutrition regimen is observed;
• physical activity, heavy lifting, and bending forward are excluded;
• You need to maintain weight after surgery for six months, otherwise there is a risk of sutures coming apart.

The first weeks after hernia repair are the most difficult, because there are many factors that can lead to increased intra-abdominal pressure and suture divergence. To minimize risks, it is important to exclude damage to the respiratory tract, stop smoking, and avoid inhaling dust, pollen and other irritants.

After elective surgery, bed rest is not necessary.

The patient is discharged from the hospital the next day and can move independently, take care of himself, eat and drink as usual with only minor changes. Already on the 3rd day after hernia repair, you can leave the house, take walks, and do light physical work, but only in a postoperative bandage.

Diet

The diet after surgery is selected to avoid bloating and constipation. In the early period of rehabilitation, you need to eat in small portions several times a day. Particular attention should be paid to the diet if you are overweight, because obesity is a risk factor for the development of abdominal hernia.

The goal of dietary nutrition will also be to reduce the load on the intestines, which puts more pressure on the area of ​​the operation than other organs. The main emphasis in nutrition is on boiled and steamed dishes.

Heavy foods should be excluded: fatty meat, mushrooms, legumes, cabbage. Portions should be small, but you need to eat at least 5 times a day.

After hernia repair, low-fat soups, vegetable purees, milk porridges, and vegetable salads are recommended. It is better to drink clean water from the liquid, and do this half an hour before eating. Compotes, weak green tea with honey, and jelly will be useful. Under no circumstances should you drink sweet carbonated drinks, strong coffee, or alcohol. The therapeutic diet is prescribed by a doctor, and it must be strictly followed, regardless of how you feel.

An abdominal hernia (abdominal or ventral) is a dangerous disease that causes severe complications. With pathology, tissue fibers diverge or break. Through the resulting defect, a fatty layer protrudes with a hernial sac, which has pulled in the internal organs.

Minor discomfort at the beginning of the disease gradually progresses and ultimately causes strangulation of the hernia, tissue necrosis and peritonitis. Doctors insist that surgery to eliminate a hernia should take place in the initial stages, when the size of the protrusion is small. Whereas later, the consequences can be unpredictable.

Causes

The formed abdominal muscles reliably fix the organs located in the abdominal cavity and prevent them from falling out.

The white line is a vulnerable part of the abdominal wall. It is formed by connective tissue structures. Muscle tissue does not participate in the formation of the white line. The lack of muscle makes the linea alba the most vulnerable part of the abdomen.

In normal condition, the width of the line is 1-3 cm. As the connective tissue structures become thinner, they stretch. This leads to divergence of the muscles, allowing the formation of a hernial orifice. The wider the gate, the more severe the disease.

There are other weak spots in the anterior wall of the abdomen. Hernial protrusions, having pushed apart a thin layer of connective tissue and muscle fibers, emerge under the skin.

Increased intracavitary pressure pushes the hernial sac through weakened muscle walls. Factors that create high intra-abdominal pressure include:

• prolonged inadequate physical activity;
• large fetus in pregnant women;
• systematic constipation;
• debilitating cough caused by asthma, bronchitis, pneumonia;
• obesity;
• full stomach with constant overeating;
• weakening of muscle tone and aging of tendon tissue in old age.

The appearance of hernia formations is influenced by damage to the abdominal cavity. Hernias also occur after abdominal surgery. Their formation is provoked by surgical interventions performed on the genitals, stomach, intestines, and gall bladder.

Types of abdominal hernia

Based on location, ventral hernias are divided into:

• umbilical (supra-, sub- and peri-umbilical);
• inguinal;
• femoral;
• postoperative;
• protrusion of the linea alba.

According to etiology they distinguish:

• Congenital protrusions. Usually the baby is immediately born with a pathology. Sometimes it occurs in a newborn after some time.
• Acquired education. A bulge occurs when tissues lose their elasticity. Muscle elasticity decreases with age and when the body is exhausted.

According to the type of course, abdominal hernias are divided into:

• Full. The filled sac penetrates through the gap in the hernial orifice.
• Incomplete. The formations remain in the abdominal cavity. This phenomenon is observed in early pathologies.

Other hernias include:

• Reducible hernia formations. The prolapse moves and changes location through the opening of the hernial sac. It either comes out under the skin or goes back into the abdominal cavity.
• Irreversible protrusions. The hernia cannot be repaired. Organs pulled into the bag cannot be returned to their original anatomical position.

The classification of hernias of the white line depends on the severity of the pathology:

• I degree. The width of the white line is 3-5 cm.
• II degree. The white line expands by more than 7 cm;
• III degree. Organs fall out, the stomach drops.

Symptoms

In the early stages, the main symptom is a periodically disappearing protrusion. During this period, the hernia causes almost no discomfort to the patient. He is occasionally bothered by transient pain of a dull nature. As the pathology develops, acute, sharp pain occurs.

In addition, the patient is worried about belching, constipation, nausea and vomiting syndrome, and poor health.

Complications

Neglected hernias cause dangerous complications. Pinching of the hernial sac is life-threatening. When pinched, the digestive organs are compressed. In clamped organs, there is a complete or partial blocking of blood vessels transporting nutrients. Due to lack of nutrition, tissue necrosis begins, which leads to gangrene of the intestines.

The walls of the peritoneum become inflamed. The outbreak of purulent processes leads to peritonitis - a dangerous complication that can be fatal.

The strangulation causes intestinal obstruction. The intestines become clogged with feces. Toxins accumulated in the body in incredible quantities cause intoxication. The body's excretory system cannot cope with neutralizing poisons. The patient experiences renal failure.

The first signs of an abdominal hernia are a serious cause for concern and a visit to the hospital for medical help. Removal of a hernia in the initial stages guarantees a favorable outcome of the disease.

Removal methods

Sometimes patients naively believe that diets, bandages and physical therapy can help eliminate hernial formation. This is a dangerous misconception. Such methods do not treat abdominal hernias; surgery is the only salvation from an abdominal defect and a chance for recovery.

Exercise increases the risk of strangulation of the hernia formation and subcutaneous fat layer. Diet provides temporary relief, possibly through weight loss. At the slightest load on the abdominal area or awkward movement of the body, the hernial sac falls out again.

The bandage is not capable of permanently holding a loop of intestine inside the abdominal cavity. It is impossible to replace the surgical removal of a hernial protrusion by wearing a bandage, no matter how much time it takes. With prolonged wear, on the contrary, adhesions appear in the hernial sac, and the hernia becomes irreducible. Unjustified long-term wearing of the device has the opposite effect. Mechanical loads from the abdominal muscles are transferred to the bandage, which leads to weakening of the muscles, stretching of connective tissue structures and the growth of hernia formation.

It is advisable to wear a bandage for people whose surgery has been postponed for a short period of time. In these cases, a bandage is worn to prevent the progression of the pathology.

Abdominal hernia corrects itself only in children under 5 years of age, including through exclusively traditional methods of treatment.

But sometimes babies also need surgery. The indications for it are the size of the hernial formation. Large defects in a child are eliminated until the tissue loses its elasticity.

How the operation is performed

Operations are divided into planned and emergency. Planned intervention is indicated for patients who feel discomfort at the site of the formation, without strangulation of the hernial sac.

The following signs indicate infringement:

• unbearable pain in the abdomen;
• the formation is not reduced;
• nausea and vomiting syndrome;
• disappearance of bowel movements;
• blood inclusions in stool;
• accumulation of gases in the intestines.

Preoperative preparation

Patient preparing for surgery:

• refuses to drink alcoholic beverages 3 days before the surgical procedure;
• does not use drugs with acetylsalicylic acid 14 days before surgery (they reduce blood clotting);
• eats rationally and takes vitamins 14 days before treatment.
• The last time he eats is before 20-00 the previous day.

Surgery is postponed for patients who have had infectious diseases. The interval between the end of treatment for infections and surgery is 14 days (except in emergency situations).

The patient is sent for a medical examination. The study includes:

• blood analysis;
• tests for sugar, group and rhesus, prothrombin index (PTI);
• testing for infections (syphilis, hepatitis, HIV);
• electrocardiogram.

Operating methods

Surgery is performed under local anesthesia or general anesthesia. It is preferable to remove non-strangulated hernia formations using local anesthesia. Local anesthetics do not have a negative effect on the cardiovascular system. After them, the person does not require long-term observation. The patient does not feel sick and can eat food without fear.

If there is no strangulation, surgery for abdominal hernia with mesh is performed quickly, without complications.

Classic operations are performed by tensioning weakened layers. A positive outcome of the operation is noted in 60-80% of patients. Relapses occur in 20-40% of patients. Repeated loss occurs due to the enormous stress on the scars. With strong tension in the abdominal cavity, the threads cut through the weakened tissue, opening the exit to the hernial sac.

Hernioplasty with mesh graft

The best way to excise a hernia is considered to be a surgical procedure with the introduction of a mesh endoprosthesis. The entire resulting load falls on the sewn-in implant. The mesh is implanted without complications and is overgrown with connective tissue.

The defect, closed with a mesh prosthesis, turns into a homogeneous structure that is resistant to stretching and tearing. The newly formed wall prevents the repeated protrusion of the internal organs.

Laparoscopy with surgical mesh implantation

Small formations are removed by laparoscopy. Thanks to a fiberoptic probe, which displays an image of the abdominal organs on the monitor, the doctor assesses the situation and performs precise manipulations.

The procedure does not require extensive abdominal dissection. Only small punctures are made through which a probe, instruments and a mesh implant are inserted. There is no heavy bleeding during the operation. Minor tissue damage heals quickly.

The method is not suitable for people who have suffered from abdominal diseases. Laparoscopy is not performed for large hernial protrusions and strangulated hernia.

Postoperative period

Patients who have undergone removal of a strangulated hernia, in which tissue necrosis and peritonitis have occurred, require a long rehabilitation period. In this situation, the surgeon removes dead tissue and sanitizes the abdominal cavity. After the operation, the patient is prescribed drug therapy. He takes anesthetics and antibiotics.

If an unstrangulated hernia was operated on, the postoperative period ends quickly. The patient is discharged from the clinic one day after surgery. He is able to:

• move around the house (walking promotes healing);
• eat regular foods;
• leave the house on the 3rd day after surgical treatment.

Although the field surgical regimen is flexible, the patient is advised to adhere to certain rules:

• do dressings in the clinic until the stitches are removed;
• use laxatives (constipation during the rehabilitation period causes suture dehiscence and hernia recurrence);
• refrain from bending forward;
• do not do physical therapy and yoga until the excisions heal;
• do not lift heavy loads for 2-3 months (after removal of stitches, lifting objects over 5 kg is prohibited);
• control body weight for at least six months (excessive load can provoke divergence of fragile tissues and cause prolapse of a hernial protrusion);
• try to avoid factors that contribute to the appearance of cough (when coughing, a person strains the abdominal walls, which can cause a relapse)

Compliance with prevention and careful attention to health does not allow serious complications to arise during the rehabilitation period.

An abdominal hernia must be removed surgically before complications occur. The operation in the early stages is not dangerous. Treatment of small hernias is more effective than large and strangulated ones. Following medical recommendations during the rehabilitation period prevents the recurrence of a hernia.

Back pain is becoming a common problem for modern people due to underdeveloped back muscles and uneven heavy loads. It is necessary to pay close attention to the unpleasant sensations that arise in the spine area. The cause of pain may be a developing intervertebral hernia, which can gradually lead to loss of motor ability and paralysis of the limbs. The only way to get rid of a hernia and prevent the development of pathologies is surgery.

Types of operations to remove spinal hernia

There are several types of spinal surgeries that have varying degrees of effectiveness, risk, and varying lengths of recovery periods. The following types of surgical intervention are considered the most optimal and modern methods of recovery, which specialist surgeons select for their patients, depending on individual characteristics:

Endoscopic

Endoscopic – surgical removal of intervertebral space hernia and release of compressed nerve endings of the spinal cord to reduce pain and neurological damage, which does not require large incisions in the tissue.

Experts highlight such advantages of hernia endoscopy as minor injury to soft tissues, preservation of the integrity of the intervertebral disc, low percentage of postoperative complications, low blood loss during hernia removal, and absence of postoperative pain.

Indications for the use of this type of operation are:

• protrusion of a hernia on the side of the intervertebral disc;
• inflammatory phenomena in the spinal canal;
• development of a neurological syndrome with severe pain radiating to the side and lower back;
• lack of a pronounced effect from long-term treatment with conservative methods;
• development of sexual dysfunction.

Contraindications for this type of surgery are:

• oncological diseases with secondary lesions in the spine;
• narrowing of the vessels of the spinal canal;
• pregnancy;
• development of infectious lesions at the site of the hernia;
• previous diseases of the cardiovascular system;
• median hernia.

Laser

Laser - the effect (heating and evaporation of liquid) of low-power laser beams on the core inside the intervertebral disc to reduce or remove it with further retraction of the hernial contents, which puts pressure on the nerve roots and causes intense pain. The core is a dense formation of jelly-like consistency, consisting of 70% water. A distinction is made between laser vaporization (or denucleation) and reconstruction of intervertebral discs.

The advantages of this method of surgical treatment of spinal hernia:

• minor discomfort and complete absence of pain during manipulation;
• the structure of healthy tissues surrounding the spinal column is not disturbed and scars do not form;
• the fastest recovery time, which does not require strict restrictions and bed rest;
• use of local anesthesia.

A hernial protrusion in the spine, which requires laser treatment, has the following symptoms:

• small size of bulge;
• absence of any complications;
• the patient's age is in the range of 20-50 years;
• lack of improvement with drug treatment;
• degenerative processes in the disc tissues of the spine.

Experts identify several contraindications for laser vaporization of discs:

1. the size of the hernial protrusion is significantly larger than 6 mm;
2. age-related degenerative processes in the tissues of a patient over 50 years of age;
3. ossification of the intervertebral disc core, spinal cord damage.

Interlaminar

Removal of a protrusion of the nucleus of an intervertebral disc of significant size (more than 6 mm) in the lumbosacral region, where the spinous processes are anatomically well distinguished with the installation of an implant. The implant is made slightly larger than the truncated disc. The advantage of this method is that the implant fixes the vertebrae and maintains the stability of the ligaments and segments, so as not to provoke a relapse of compression of the nerve roots.

This method of hernia removal can only be performed on patients without diseases or pathologies of the cardiovascular and respiratory systems, without a progressive infectious or inflammatory process.

Endoscopic surgery to remove a hernia of the lumbar spine

Preparing for surgery

Before deciding on the date of the operation, the attending physician collects the necessary clinical tests:

• general blood analysis;
• testing for sugar levels and personal antigenic characteristics;
• general urine examination;
• rheumatic thrombosis to identify the degree of susceptibility of internal organs, joints and all types of body tissue to the inflammatory process;
• description of the electrocardiogram;
• MRI data.

On the day of surgery, you must refrain from consuming liquids and food 7-8 hours in advance, and also consult with an anesthesiologist about long-term illnesses and allergic reactions to anesthesia drugs.

Before the operation, X-ray marking is carried out to accurately determine the location of the bulging nucleus of the intervertebral disc and pinched nerve.

How long does the operation take?

The duration of the procedure depends on how severely the intervertebral discs are affected, on the size of the protrusion and on the skill level of the surgeon. On average it lasts from 50 to 120 minutes.

The essence of the operation

The patient is given local anesthesia - epidural anesthesia, during which he can describe his sensations during the manipulations.

The doctor makes an incision 0.5 - 1.5 centimeters in size in the place where the hernia is located and spreads the tissue to access the spine. Then a needle is inserted into the hole, which serves as a guide for a medical spinal endoscope.

An endoscope is a device equipped with an electron-optical converter that helps the doctor remove the protruding nucleus pulposus without serious tissue injury and monitor the accuracy of his actions on the monitor screen.

The surgeon guides the endoscope into the canal where the spinal cord meets the nerve roots. Excision and removal of the protruding part of the disc and dead tissue, which pinches the nerve ending and causes a painful neurological syndrome, is performed. After all manipulations are completed, the incision is treated with an antiseptic and a suture is placed on it.

You can read complete information about spinal surgery methods, as well as patient reviews after treatment on the Artusmed website.

Is the operation dangerous?

Unlike abdominal surgery, endoscopic removal of a hernial protrusion carries several serious risks that occur in a small percentage of operated patients:

• introduction of infection;
• hematoma, accompanied by prolonged pain;
• reappearance of a hernia in the same place of the spine after some time;
• decrease in tissue elasticity due to the development of the inflammatory process and the transition of soft connective tissue to hard fibrous tissue, forming a scar;
• narrowing of the spinal canal, causing pain in the lower back and legs;
• injury to the nerve root or dura mater by the operating surgeon during manipulation (“human factor”).

Additional Information!

If the operation is successful, the patient may experience symptoms of “operated spine syndrome” - destruction of the intervertebral disc, cyst of the synovial cavity of the joint, vertebral dislocation, formation of a false joint, radiculitis.

Removal of a hernia of the lumbar spine with a laser

Preparing for surgery

A few days before the operation, the patient needs to visit a radiologist or neurosurgeon who will perform the manipulations. The doctor must be highly qualified, undergo special training and receive a document confirming permission to perform such operations. Then an appointment with a therapist will be scheduled to determine whether there are individual contraindications for this type of operation, an examination of the general condition and an analysis of clinical studies:

• general stool and blood tests;
• blood test for sugar levels;
• ECG results;
• radiography;
• computed tomography of the spine.

The day before the scheduled operation, an anesthesiologist is consulted to select an anesthetic drug that does not cause allergies.

The essence of the operation

The patient undergoes an anesthesia procedure at the location where the laser is exposed, and then a puncture is made on the skin at the site of damage to the intervertebral disc. The neurosurgeon inserts a special puncture needle with a quartz LED into the resulting hole. The needle should reach the core of the disc. The doctor carries out all manipulations using tomographs - computer and x-ray, which enlarge the image and allow the specialist to see the smallest details and control the accuracy of his movements. The LED emits enough energy to heat the core up to 70 degrees. The liquid contained in the core, under the influence of temperature, takes the form of steam and is discharged through small holes in the needle. Thus, the nucleus decreases in size, but does not change the composition of the tissue. The pinched nerve root is released due to the fact that the hernial contents located outside the fibrous ring are retracted back. The duration of the operation is from 30 to 60 minutes.

Additional Information!

About 40% of patients felt a significant reduction in pain already during the operation.

Price (operation cost)

The price of laser surgery is a combination of several factors: the level of complexity of the operation (from 1 to 5), the reputation and qualifications of the operating specialist and team of doctors, the clinic’s pricing features, the inclusion of additional procedures in the preoperative and recovery period.

Interlaminar surgery to remove a hernia of the lumbar spine

The essence of the operation

The attending physician prescribes preliminary clinical studies similar to those described for laser and endoscopic interventions. They will help the operating surgeon understand the appropriateness and necessity of installing a stabilizing implant. The patient is given anesthetic drugs, then the neurosurgeon makes an incision at the level of the hole between the vertebral arches. Using a surgical microscope, the protrusion is removed and an implant is inserted in its place, mechanically restraining the decrease in the clearance between the vertebrae and preventing compression of the nerves.

Consequences of spine surgery

Many patients who have undergone spinal surgery hope to return to normal life in a short time. But for a complete recovery, a lot of work needs to be done to eliminate the consequences of surgery.

Video

Qualified surgeons talk about the consequences of the operated spine in the video.

Rehabilitation after surgery

Postoperative period

Return to normal life after surgery to excise a bulging nucleus of the intervertebral disc proceeds differently in all patients. And this depends on a combination of factors: the general condition of the body systems, the size of the hernia and the complexity of the situation, the strictness of compliance with the doctor’s prescriptions, as well as the method of removing the protrusion.

Experts distinguish three postoperative periods, each of which is characterized by certain sensations in the patient and corresponding therapeutic measures.

In the first week (early rehabilitation) after surgery, the doctor monitors and responds to pain sensations arising at the site of manipulation, and provides therapeutic and medicinal support to the patient’s body. Physical activity is not allowed. After endoscopic surgery, medications are prescribed to help speed up the regenerative function of the body:

• anti-inflammatory drugs – up to 10 days;
• antibiotics and decongestants – 5 days.

• antiphlogistic agents – up to 7 days;
• individually selected physiotherapy and plasma lifting.

After interlaminar surgery, the neurologist prescribes a course of:

• chonroprotectors;
• vasodilators
• microrelaxants.

After 2 weeks (late recovery period), specialists help the patient adapt to normal life through lifestyle correction and the slow introduction of optimal loads. During this period, wearing a special corset is prescribed for 1 month, physical activity and intense sports are prohibited for 1-3 months.

The deferred period after two months of rehabilitation lasts until the patient recovers completely.

How long does sick leave last?

The recovery period under the supervision of doctors with hospital stay and release from work with the issuance of sick leave for all types of operations has different durations:

Exercise therapy

The most important measure that promotes rapid recovery of the spine after surgery is the correct and systematic implementation of preventive gymnastics exercises. Training allows you to get rid of pain, strengthen your back muscles, and eliminate physical limitations by improving the mobility of the intervertebral discs.

Video

Depending on how long ago the operation was performed, the doctor gradually introduces and complicates movements, such as those presented in the video

In the early rehabilitation period, the patient performs a small set of the simplest movements while lying on his back for 10–15 repetitions:

1 Place your palms on your chest, spread your elbows to the sides and forcefully press them against each other. 2 Alternately, slowly bend your knees and pull them towards your chest, holding in this position for 30 - 45 seconds. 3 Cross your arms over your chest, bend your legs at the knees, and press your head to your chest. Slowly raise your torso forward and freeze for a few seconds. 4 Bend your knees and firmly press your feet, raise your pelvis and hold this position for 10-20 seconds. 5 Legs bent at the knees and smoothly turn to the sides.

2 weeks after the operation, with a gradual improvement in the condition, the doctor complicates the exercise program and increases the number of repetitions. However, it is necessary to avoid stress on the lumbar spine, so the patient is not offered exercises in a sitting position:

1 Lying on your back, imitate the movements of a cyclist with your legs. 2 Lying on your side, raise your legs. 3 Shallow squats with a straight back. 4 Lying on your stomach, pull your knees to your elbows. 5 Push-ups from the floor with outstretched arms. 6 Standing on all fours, alternately stretch out the opposite straight limbs, trying to keep your back straight. 7 Lying on your stomach, simultaneously raise your outstretched arms and legs, holding this position for 15–20 seconds.

After 1–1.5 months, training in a sitting position is allowed:

1 Sitting on the floor, spread your arms to the sides and try to keep your pelvis suspended. 2 Using the knee-elbow support, slowly bend your back down and up, fixing yourself in the lower and upper positions. 3 Smooth turns of the body to the sides.

In addition to gymnastics, the patient must follow several rules:

• do not overcool;
• do not stay in the same position for a long time;
• go swimming;
• do not lift weights or jump;
• add therapeutic and preventive massage from a specialist.

When performing gymnastic movements, you need to carefully listen to your sensations and the body’s capabilities and prevent a recurrence of the pain syndrome.

Diet

Compliance with the diet will allow you to quickly restore the coordinated functioning of all body systems and prevent the development of undesirable postoperative consequences. Food should be soft, low-calorie, easily digestible and not conducive to excess weight gain. An important component is fiber, which facilitates the work of the intestines and does not create additional pressure on the abdominal muscles. Preference should be given to the following products:

• vegetables (white cabbage, carrots, broccoli) and fruits;
• taiga and marsh berries (cranberries, lingonberries, blueberries) in the form of fruit drink or decoction;
• greenery;
• boiled lean meat (turkey, chicken, veal);
• gelatin in jelly, jelly, fruit jelly and marmalade.

Note!

It is necessary to avoid foods that cause flatulence, bloating and increased gas formation in the digestive system and alcohol, even in the smallest doses.

Corset

• stabilization of the site of manipulation;
• reducing the natural load on the spinal column while walking;
• improving blood flow;
• restoration of muscle tone;
• accelerates the healing of sutures (if an incision was made) and promotes tissue scarring.

Depending on the level of complexity of the operation, there are 3 types of corsets:

hard– when removing a vertebra and installing an implant to completely fix the position of the vertebrae,

semi-rigid– when removing a hernia to prevent complications and partially relieve the load,

soft– used in the late recovery period after endoscopic surgery.

The duration and frequency of wearing any type of corset, its size and material of manufacture are determined only by a doctor. Most often, operated patients begin to wear semi-rigid corsets daily in the early recovery period, no more than 3 hours a day. The following rules must be observed:

• put it on while lying on your back
• over linen made from cotton fabrics,
• throughout the entire period of wearing, monitor the absence of unpleasant sensations,
• Be sure to remove it before resting.

Refusal to wear a corset occurs gradually over 2–3 months.

Pain after surgery

Pain during the postoperative period after removal of an intervertebral hernia occurs for several reasons and can be localized not only at the site of the operation, but also in the legs. There are “natural” pains that appear as a reaction of the body to surgical intervention, and do not indicate painful processes in the body that require adjustment:

• slight feeling of tightness or dryness at the site of manipulation;
• dizziness;
• minor pain or feeling of heaviness in the lower back and legs after a night's sleep;
• temperature increase within 37-38 degrees.

If the patient feels severe weakness, chills, difficulty urinating, or pain in the legs and lower back that is much stronger than the preoperative sensations, then it is necessary to immediately contact a surgeon for an examination.

Paraparesis

A serious complication that occurs due to compression of nerve endings by the protrusion of the nucleus of the intervertebral disc is called paresis. This syndrome has many manifestations. One of them is characterized by impaired sensitivity and decreased reflex abilities, weakened motor ability or complete immobilization of the lower extremities due to the fact that nerve signals do not pass through and the muscles work weakly (paraparesis).

There are rare cases when paresis develops after injury to the spinal canal of the spine, caused by an error by the operating surgeon, or the development of an inflammatory or infectious process.

You can get rid of this type of complication with complex therapy - exercise therapy, massage, acupuncture, physical stimulation procedures - electromyostimulation and electromagnetic influence. In extremely rare cases, surgery is used.

Surgical assistance in getting rid of a hernial protrusion in the spine for many patients becomes the only opportunity to lead a full-fledged life. Modern medicine offers a sufficient selection of various types of almost painless and bloodless manipulations, which the surgeon can select taking into account the individual characteristics of the patient.

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