• 06 JUN 13
    • 0

    Hernia, popularly considered “breaking praporelui is medically defined as” a visceral externalizing anatomically preformed paths. “The most common bowel or bladder externalizes and anatomical tracts are primarily interested in the inguinal canal, femoral and umbilical. Resulting in the most common hernias: inguinal, femoral and umbilical.
    More recently, the influence of Anglo-Saxon medicine resulted extending the hernia and what in Romania called in French, eventration, postoperative or posttraumatic. The abdominal wall rupture after surgery or after violent blows with externalizing viscera under the skin is called, increasingly more often, instead of eventration postincizionala or posttraumatic hernia.
    Hernias are a significant pathology including Romania, affecting between 4% and 12% of the population (after various statistics), age differentiation represents an important criterion because hernias frequency is higher in children (congenital) and elderly (weakened muscle wall other associated diseases)
    Attempts to solve the non-surgical hernias were no dintoteauna: by putting a penny in child navel or a ball and press it, connecting with a waist belt or the hernia or using a medical device specifically designed for this purpose. If a part of newborn hernias (small) resolves itself with growth remaining conservative solutions are limited to a husk, generally elderly, which, due to multiple diseases associated can not handle surgery.

    For all other patients with hernia, (ie the vast majority), the only way to solve is the surgery. For surgeons, hernia has always been a problem because, although still over a hundred years ago have imagined solving multiple processes always there was a high rate of recurrence (return hernia).
    So every school of surgery tried to find a new method better than the other, gathering Thus over a hundred classic techniques, more than for any other surgical condition. Most of these methods have begun to resolve the hernia defect (“hole in the abdominal wall) through different ways of sewing the muscle and aponeurotic structures around, in one or more layers with different threads from catgut and silk until the steel or even leather lacing. What united all these surgical procedures, however, was that the suture was made “in power” meaning they sewed Fort distant structures, pulling them up is approaching. This cause greater postoperative pain (by pulling the threads nerve) and create conditions for a recurrence, by cutting the wires sometimes musculo aponeurotic layers.

    Opposite these classic techniques of hernia repair is tension free process pressure (tension – free), known by Lichtenstein, American surgeon who described and made known worldwide.
    • Lichtenstein began and he tried to find a method that is better than the other acquaintances you suturand meticulous certain muscular structures apparently stronger than the other, which seemed promising to lower hernia recurrence. Later, with the winning of impressive experiences (institute has 11 floors in Los Angeles where he operates only hernias) realized that in fact the main problem-solving techniques hernia surgery was to create tension between the wires trying to close distant structures.
    • From here came the idea of ​​a tension-free process and the solution was very simple: using a piece of plastic, so-called net (`mash`) to cover the hernia hole and sutured to the deep structure is easy, with no kind of traction.
    • The results were surprisingly good: significantly decreased postoperative pain and recurrence were almost nonexistent. In addition, the use of local anesthesia has added a new option in the therapeutic arsenal of hernias – ambulatory surgery without hospitalization, the patient being able (due to reduced pain data without power), to go home on their own shortly after intervention surgery.
    • With all these benefits it brought new technique, surgeons Conservative has said the word and it took several years for the process to begin to be known worldwide.
    Meanwhile surgical mesh quality has progressed to scarring generation possessing properties much better and almost complete tolerance to tissue and
    other surgeons have expanded even use mesh (Stoppa for example) treating bilateral hernias than 80×30 cm mesh that reinforces all the lower abdomen.
    The Western method of Lichtenstein mesh enough to get first place in the hierarchy hernia surgical techniques and there are already several improved versions of nets, some even allowing athletes to resume work in 2-3 days surgery.
    And in Romania use of “tension-free” has become usual for surgeons open minded. Also practicing in outpatient without hospitalization of these surgical procedures is enthusiastically received by our center patients medical.Revenirea family, society and the profession is done very quickly (3-4 days) without discomfort or pain.

    Dr Stefan Jianu
    chief surgeon, Doctor of Medicine, a member of the American Hernia Society

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