Piglet umbilical hernia what to do. Castration of a piglet with inguinal-scrotal hernia. Castration of piglet with inguinal-scrotal hernia

10.10.2019

Saratov State Agrarian University. N. I. Vavilov.

Department of Obstetrics and Surgery.

Course work

in surgery

on the topic: Operation for umbilical hernia in a piglet.

Completed by: student of group ______

_______________________________

Checked: ______________

Saratov 2004

Introduction. 3

1. General anatomical and etiological information about the operated areas. Classification.

2. Preparation for the operation.

3. Preoperative stage.

3.1. Animal fixation. 11

4. The content of the operation.

4.2. Operational access. 16

4.3. Operational reception. 17

5. Arising and possible complications. Ways to eliminate them. twenty

6. Postoperative stage. 22

7. Conclusion. 24

Bibliography. 25

Introduction

Abdominal hernia - displacement of organs together with the parietal sheet of the peritoneum outside the cavity, under the skin or into other tissues and cavities.

More often, umbilical hernia is observed in multiparous animals - piglets, puppies, much less often in animals of other species. The hernial opening here is the umbilical ring, which remains enlarged after childbirth, the hernial sac is the thinned peritoneum, and the contents are the omentum. With a significant diameter of the ring, the loops of the small intestine penetrate into it together with the omentum.

The main symptoms that occur with an umbilical hernia: A swelling is found in the navel, in the depth of which an enlarged umbilical opening is often palpated. With reducible hernias, the contents of the hernial sac are displaced through this opening into the abdominal cavity. After feeding, the swelling increases. When the intestine prolapses, its peristalsis is caught. With a strangulated hernia, a pronounced general anxiety of the animal appears, vomiting is observed. The swelling becomes painful and hot due to the rapid development of peritonitis.

1. General anatomical and etiological information about the operated area. Classification.

1.1. Anatomical and topographic structure of the umbilical region and umbilical hernia.

Anatomical and topographic structure of the umbilical region. By structure, the umbilical region consists of: skin, subcutaneous tissue, superficial two-layer fascia, deep fascia, external and internal oblique abdominal muscles, rectus and transverse abdominal muscles, transverse fascia, preperitoneal fat and parietal peritoneum.

The blood supply of the region is carried out at the expense of the last intercostal, lumbar, cranial and caudal epigastric arteries.

The region is innervated by the last intercostal ventral branches of the first and second lumbar nerves (ilio-hypogastric and ilio-inguinal).

umbilical hernia (Hernia umbilicalis) ) has the following anatomical features: a) hernial opening (gate); b) hernial sac and hernial contents.

hernial opening an abnormally wide natural gap (umbilical ring) or a rupture of the abdominal wall may serve. It is called a hernial ring when it is narrow and short, hernial ring - with a wide gap; hernial canal when it crosses the wall of the cavity at an angle and is elongated. The hernial opening gradually expands over time.

hernial sac formed by the parietal peritoneum, often with underlying fascia. In the median, ventral line, the wall of the hernial sac is represented by the peritoneum itself; here it is thinned out. The hernial sac, gradually expanding, sometimes reaches a huge size. It distinguishes between the mouth (the place of communication with the anatomical cavity), the neck (the narrowest part of the entrance to the bag), the body (the expanded part of the receptacle) and the bottom. In most cases, with a long-term existence of hernias, the sac in some places grows into scar tissue. At the same time, jumpers, adhesions appear in it, communicating chambers are formed.

hernial contents as part of the mobile organs adjacent to the hernial opening, it often protrudes from the cavity with its significant sections, deforming the corresponding parts of the body. Sometimes a large amount of transudate is added to the main hernial contents - “hernial waters”.

1.2. Classification and etiology of umbilical hernias.

Umbilical hernia by etiology can becongenital and acquired .

Hernias are congenital. In the etiology of umbilical hernias, many authors attach significant importance to congenital malformations with intrauterine formation of a wide umbilical ring, considering such a defect to be hereditary. An element of congenital predisposition should be considered a delayed reduction of the umbilical vein and umbilical artery with urachus.

Similar ligaments are formed from their remains - umbilical-hepatic and umbilical-vesical. The umbilical ring suspended on them stretches in opposite directions. In hernia carriers, these strands, acting as ligaments, are found even at 5 months of age. Such a stretching mechanism manifests itself during childbirth and subsequently until a stable compaction of the tissues involved in the formation of the umbilical ring.

The umbilical cord in multiparous animals is relatively short in relation to the length of the uterus in those fetuses that are located in the anterior sections of the horns. Its tension affects the state of the umbilical ring (expansion) before the release of the fruits of their birth canal.

Hernias acquired are formed due to damage to the abdominal wall, with excessive stress (difficult childbirth, fall, etc.).

The umbilical ring can expand when the piglets, trying to get the nipple, tip over each other, stretch out, bending their backs. The crawling of piglets through low manholes is also unfavorable, as they, in a hurry to slip to the sow, strongly bend the spine, stretch the ventral wall of the abdomen, pressing it with the drying umbilical cord to the floor.

With the start of additional feeding at 2-3 weeks of age, young piglets often experience constipation, diarrhea, and sometimes vomiting, which is accompanied by tenesmus with an increase in intra-abdominal pressure, which also contributes to the expansion of the umbilical ring and the occurrence of a hernia.

Forced expansion of the umbilical ring is inevitable when the umbilical cord is torn off in a newborn, if it is performed without proper fixation of the remaining stump.

Surgical intervention is also often accompanied by the formation of hernias, when the restoration of the abdominal wall is performed without proper, consistent closing of its tissue layers.

Factors contributing to the formation of hernias are errors in the feeding and maintenance of queens and suckers. This refers to the imbalance of diets; insufficiency of vitamins, macro- and microelements; keeping animals in darkened rooms in the absence of sufficient exercise. This predetermined the occurrence of a large number of hernias, especially in piglets born in winter and early spring, when adequate feeding and favorable conditions are more difficult to provide.

According to the state of the contents, hernias are distinguishedreducible , illegitimate, crippled.

Reducible hernia (H. reponibilis ) is characterized by free mobility of the content. Filling the bag is not accompanied by pain. In this case, the tissues of its wall are only somewhat stretched, but remain as elastic as after the reposition of the contents, which is easily achieved by uniform pressure by hand or by changing the position of the animal's body. Other symptoms determined by palpation (consistency of the contents, features of its displacement in the hernial ring), auscultation (peristaltic noises, the presence of gases), supplement specific data to clarify the diagnosis, to determine the size, shape, density of the hernial ring.

Hernia irreducible (H. irreponibilis ) is characterized by fusion of the wall of the hernial sac with the abdominal cover of the contents.

strangulated hernia (H. incarcerata ) is a life-threatening complication. It is due to compression of the contents at the level of the hernial ring. Distinguish infringementselastic and fecal .

elastic infringement occurs in connection with the reduction of the tissues of the hernial opening and adjacent sections of the abdominal wall. The elastic ring circularly compresses the intestinal loop. In the future, reflex spasm, predetermined by pain, intensifies.

Fecal the infringement is due to the mechanism of squeezing the abducting knee with increasing filling of the adductor. In this case, reflex spasm also joins. It will be most correct to take into account the combined action of both of these mechanisms: in one case, elastic strangulation is supplemented by filling the adductor knee of the intestine, in the other, spastic compression of the ring is added to the pressure of the adductor knee, which is filled with mushy contents and gases.

At the heart of pathological and anatomical changes in the infringement is a violation of blood and lymph circulation. Initially, it is characterized by edema of the contents, due to compression of the lymphatic vessels and veins; at the level of the hernial ring, a strangulation groove is formed, and transudate accumulates in limited quantities in the hernial sac. With an increase in venous congestion, the strangulated organ becomes cyanotic, and later - blue-purple; this edema does not disappear under the pressure of the finger, which indicates the onset of stasis. Such an irreversible condition occurs in the intestinal loop within 10-12 hours; the mucous membrane becomes permeable to microbes and gangrene of the hernial contents, the sac and its integument occurs.

2. Preparation for the operation.

2.1. List of necessary tools, materials and preparations.

To carry out this operation, you must have the following tools: sterile scalpels, scissors, tweezers, intestinal pulp, needle holders, injection and surgical needles, syringes of various capacities; safety razors.

It is necessary to have suture and dressing material.

Of the drugs, the presence of anesthetic solutions (0.5% solution of novocaine - for infiltration anesthesia, 1% solution of aminazine (etaperazine)), antiseptics and antibiotics is mandatory.

2.2. Methods of sterilization of the instrument, suture and dressing material.

Sterilization of surgical instruments.

There are many methods of sterilization, but one of the most common and effective isboiling .

Pour tap water into the sterilizer and add sodium hydroxide (2.5 g per 1000 ml):

Rp.: Sol. Natrii hydrooxydi 0.25% - 1000 ml D. S. For sterilizing metal instruments for 10 minutes

The sterilizer is connected to the mains or put on a heating source and wait for the solution to boil. Tools can also be boiled in a 3% solution of sodium bicarbonate or a 5% solution of sodium tetraborate (borax):

Rp.: Sol. Natrii hydrocarbonatis 3% - 1000 ml D. S. For sterilization of metal instruments for 15 min.

The addition of alkali improves sterilization efficiency, prevents metal corrosion, deposits salts in water and reduces sterilization time:

Rp.: Sol. Natrii tetraboratis 5% - 1000 ml D. S. For sterilizing metal instruments for 20 minutes

After boiling the solution for three to five minutes (during this time, the water will be freed from oxygen and neutralized with alkali), a grate with tools is lowered into it. At the same time, large and complex instruments are disassembled, injection needles are freed from mandrins, sharp parts of instruments, and glass ones are wrapped in gauze.

When the solution boils again, the instruments are sterilized for 10 minutes. The duration of sterilization in a soda solution is 15, and with the addition of borax - 20 minutes. At the end of sterilization, remove the cover of the sterilizer, take out the grate with tools, and pour out the water. Then distilled (boiled, rain) is poured into the sterilizer and disassembled syringes are lowered into it, wrapping each part in gauze. After the water boils, needles are lowered into it without mandrins, pinned onto gauze. Boiling should last 30 - 40 minutes.

After sterilization, all instruments are dried.

Sterilization of suture, dressing material and surgical linen.

Lye is sterilized according to the methodSadovsky , and catgut - according to the methodSadovsky-Kotylev and way Pokotilo .

A skein of lye is washed in hot water with soap for 2 minutes, then it is rinsed, wound on coils and immersed for 15 minutes in a 2% formalin solution for 70 0 alcohol.

Rp.: Liquoris Ammonii caustici 0.5% - 500 ml D. S. For immersion for 15 min. After washing in hot water with soap and rinsing _______________________________________________ Rp .: Formalini 4.0 Spiritus aethylici 70 0 ad 200 ml M. D. S. For lye sterilization for 15 min.

The catgut is placed for 30 minutes in a 2% formalin solution in 65% alcohol.

Rp.: Liquoris Ammonii caustici 0.5% - 500 ml D. S. For immersion of catgut for 30 minutes ______________________________________________
Rp.: Formalini 4.0 Spiritus aethylici 65 0 ad 200 ml M. D. S. For immersion of catgut for 30 min.

To sterilize lye, it can be placed for a day in a 1% alcohol solution of iodine. For the same purposes, the catgut is dipped for three days in a 4% formalin solution -method Pokotilo .

Rp.: Sol. Formalini 4% - 300 ml D. S. For catgut sterilization. Exposure 72 hours Method Pokotilo

If possible, then it is possible to sterilize the dressing and suture material in an autoclave at a temperature of 110 - 120 0 C, under a pressure of 1.5 - 2 atm. within 20 - 30 min. respectively.

2.3. Preparing the animal for surgery.

Preparation of the animal for surgery is an essential measure, which often determines the favorable outcome of surgery. Before the operation, first of all, the condition of the animal's vital organs is examined: heart, lungs, kidneys, liver.

In the study, infectious diseases should be excluded, and at the slightest suspicion of their presence, measures are taken for the final and possibly quick diagnosis, for which appropriate allergic, serological and other special studies are used. If the operation is not performed urgently, then before it the animal is reduced to feed or not given at all. The use of laxatives is not recommended; they are replaced with an appropriate diet that limits the vital activity of the intestinal microflora; give easily digestible food, enveloping, disinfectant and anti-fermentation agents - phenyl salicylate (salol), sulfonamides, etc. With a weakening of the general reactivity and resistance of the patient's body, measures are taken to increase them (blood transfusion, antibiotics, sulfonamides, autohemotherapy, giving vitamins, etc.).

Preparation before the operation includes cleaning and general or partial washing of the animal. Places of constant contamination (perineum, thighs, distal extremities, etc.) are washed with a brush and soap, and where possible, a 2% creolin or lysol bath is made and a protective bandage is applied.

3. Preoperative stage.

3.1. Animal fixation.

To ensure the best access to the operated area, as well as for greater convenience of the surgeon and his assistants, the piglet can be fixed on a special operating table, which has a number of devices (rings, ribbons, etc.) that facilitate the fixation of the limbs and head. The animal is fixed in a supine position, on its back.

However, it is not always possible to use such equipment, so in some cases it is allowed to use an impromptu operating table. In the absence of a special operating table, it can be successfully replaced by an ordinary table (fixation of the limbs in this case is carried out by tying to brackets or rings previously nailed to its side surfaces).

Fixation of the piglet is facilitated by the small size of the animal, in addition, for general calming and immobilization, it is recommended to administer antipsychotics to animals (see "Rationale for methods of anesthesia").

3.2. Preparation of the operating field.

Processing of the surgical field includes four main points: removal of hair, mechanical cleaning with degreasing, disinfection (asepticization) of the surface with tanning and isolation from surrounding areas of the body.

The hairline is trimmed or shaved. During mechanical cleaning and degreasing, the surgical field is wiped with a swab or a napkin moistened with a 0.5% solution of ammonia or alcohol-ether (equally), you can clean gasoline, etc. There are many ways to disinfect and tan the surgical field. Yes, byFilonchikov's method tanning is carried out by double treatment of the surgical field with a 5% alcohol solution of iodine, and the interval between treatments should be at least three minutes:

Rp.: Sol. Jodi spirituosae 5% - 20 ml D. S. External. For double disinfection and tanning of fat-free skin of the surgical field Filonchikov's method

By Mouse way the surgical field is treated three times with a 5% aqueous solution of potassium permanganate:

Rp.: Sol. Kalii permanganatis 5% - 100 ml D. S. External. For triple treatment and degreasing of the skin of the surgical field

Effective means for these purposes are a 1-3% solution of surface-active antiseptics Katapol and Etonium. Treatment of the surgical field with a solution of furacilin is as follows. First, the hairline is removed. Mechanical cleaning and degreasing of the skin is carried out with an aqueous solution of furatsilin at a concentration of 1:5000, disinfection and tanning - with an alcohol solution of furatsilin at a dilution of 1:1500.

Each method of processing the surgical field ends with its isolation from the surrounding areas of the body with a sheet with a slit in the center.

In the absence of a sheet, the hairline is cut (shaved) on a significant area of the animal's skin.

3.3. Treatment of the hands of the surgeon and operating nurses.

Treatment of the skin with various antiseptic substances is unreliable, since weak solutions of antiseptics do not destroy microorganisms, while strong solutions cause irritation and inflammation of the skin. On the other hand, no matter how powerful antiseptics are, they cannot affect microbes located deep in the skin. Therefore, modern methods of preparing hands for surgery are based on the use of the tanning properties of antiseptics, which thicken the upper layers of the skin and thereby close the skin openings of the gland ducts, blocking the exit of microorganisms from them for the duration of the operation. There are three main methods of modern hand preparation for surgery: a) mechanical cleaning, b) chemical disinfection and c) skin tanning. Some antiseptic substances often combine bactericidal and tanning properties (iodine alcohol solution, brilliant green solution, etc.), thus representing a bactericidal tanning agent or a tanning antiseptic. Processing of hands is carried out from the tip of the fingers and further to the elbows.

The most common and suitable for veterinary practice are the following methods:

Spasokukotsky-Kochergin method - one of the most popular. For mechanical cleaning and deep degreasing of the skin, a freshly prepared 0.5% solution of ammonia in hot water is used. Hands are washed alternately in two basins for 2.5 minutes. or under a fluid jet using a gauze pad. After repeated washing, the liquid in the basin should remain clear. If not, wash your hands again. Disinfection and tanning of the skin is carried out as follows: hands are treated dry for 3-5 minutes. gauze soaked in ethyl alcohol, and fingertips, subungual spaces and nail beds are smeared with a 5% alcohol solution of iodine. During the operation, if the hands are contaminated, they are washed again and tanned with alcohol is repeated.

Kiyashov's method . Hands are mechanically cleaned and degreased with a 0.5% ammonia solution for 5 minutes. Alternately in two basins or under a stream, and then process for 3 minutes. under the stream with a 3% solution of zinc sulfate, which has a tanning and bactericidal effect at the same time. Fingertips are smeared with iodine solution. This method is the most accessible for veterinary practice due to its simplicity, reliability and low cost.

Olivkov's method. After washing and mechanical processing according to one of the methods, the hands are wiped twice with a swab soaked in 1:3000 iodized alcohol.

4. The content of the operation.

4.1. Justification of methods of anesthesia.

Typically, deep anesthesia is avoided in animals, and small doses of drugs are administered in combination with local anesthesia. Such anesthesia is called combined. The use of local anesthesia or anesthesia in combination with neuroplegics (chlorpromazine, etaperazine, rompun, etc.) or vagolytics (atropine sulfate), as well as analgesics (morphine, promedol), etc., is called potentiated analgesia. The above drugs increase pain relief, eliminate unwanted side effects (salivation, slowing of cardiovascular activity, etc.).

When carrying out this operation, it is advisable to use combined, potentiated anesthesia, where chlorpromazine or etaperazine is used as a neuroleptic (intramuscularly, at a dose of 0.08 ml / kg of body weight, used in 1% concentration), and local infiltration anesthesia is used as local anesthesia 0, 5% novocaine solution.

Local anesthesia is understood as the temporary elimination of sensitivity in the area of the operated area of the body by the action of local anesthetics.

With infiltration anesthesia, 0.25 - 0.5% novocaine solutions are used, which are prepared in a 0.85% sodium chloride solution. This is the most common type of local anesthesia. The method consists in injecting an anesthetic solution into the dissected tissues, while the anesthetic acts on the nerve trunks and sensitive endings. A long and thin needle is first injected into the thickness of the skin almost parallel to its surface and 1-2 ml of the solution is injected until a slight swelling appears; advancing the needle further, continue its introduction until the formation of an infiltration roller of the required length. Then the tip of the needle is passed under the skin and the solution is injected again to the required length. After dissection of the superficial layers, the infiltration of deeper tissues continues, alternating between the needle and the knife. As a result of layer-by-layer injections, an insensitive area is formed over the entire depth of the incision. The anesthetic solution is injected into the thickness of the tissues continuously both during the injection process and when the needle is removed. During the injection, in order to form a sufficiently wide painless strip during the movement of the needle in the tissues, it is given an alternate direction in both directions from the intended incision line. This will allow during the operation to painlessly push the tissues apart with hooks and expand the wounds to the desired size. If the proposed incision is to be large or irregular in shape, then, for convenience, infiltration can be carried out from two or more opposite points.

4.2. Operational access.

After fixation of the animal, preparation of the surgical field, sedation and local anesthesia, an operative access is performed by cutting the tissues above the hernial opening in the longitudinal direction. Why the skin is taken into the folds with two tweezers and carefully dissected, the subcutaneous tissue and fascia are separated. Then, by means of a scalpel handle, scissors or gauze swabs, the hernial sac is separated from the skin and abdominal wall to the hernial ring and beyond at a distance of 2–3 cm.

Such operative access is carried out both in the case of hernia repair without opening the abdominal cavity, and with its opening. However, with a strangulated umbilical hernia, and such an operation is an emergency surgical intervention, surgical access must be performed somewhat differently. After exposure and preparation of the hernial sac, under the control of a finger, the hernial ring is carefully dissected with a scalpel, the hernial sac is opened and the strangulated intestinal loop is removed.

4.3. Operational reception.

When conducting hernia repair without opening the abdominal cavity after performing an operative access, the hernial contents are simply inserted into the abdominal cavity through the hernial opening, and a surgical needle with a ligature is injected at a distance of 2–2.5 cm from the hernial opening and removed on the same side near its edge. In the same way, but in the opposite direction, a stitch is made on the opposite side of the abdominal wall. In order not to pierce the peritoneum and sew on the intestinal loop (which is unacceptable), the sutures are placed under the control of a finger inserted into the hernial opening, similar to the seromuscular type in the intestine. Depending on the size of the hole, 3-5 sutures are applied. In the presence of a wide hernial opening (gate), loop-shaped sutures are used. The wound is treated, powdered with antibiotic powder and the ends of the ligatures are tied. Thus, the hernial opening is securely closed.

Olivkov's method . In the presence of a wide hernial opening (gate) and a large hernial sac, the author suggested closing the ring with the help of a "corrugation" of the hernial sac.

The essence of the method lies in the fact that after an operative access to the hernial sac and its preparation, the contents of the sac are displaced into the abdominal cavity. Then the hernial sac is sutured with long threads (slit) at equal distances from each other. The first injection captures the abdominal wall at a distance of 0.7 - 1 cm from the edge of the hernial opening, then the bag is stitched through the thickness of its wall to the opposite edge of the hernial opening, and the last injection is made near the hernial ring on the abdominal wall (as at the beginning).

When applying subsequent ligatures, the gaps between them should be 1 - 1.5 cm. After flashing the hernial sac along its entire length and powdering with antiseptic powder, the threads are tightly tightened together and fixed with a surgical knot. In this case, the hernial sac gathers into folds (corrugation) and is fixed between the edges of the hernial ring. In this case, the hernial sac serves as a biological tampon involved in the closure of the hernial ring.

When conducting hernia repair with opening of the abdominal cavity after performing an operative access and reduction of the hernial contents, an intestinal pulp is applied to the hernial sac, close to the hernial opening (in extreme cases, hemostatic tweezers). They retreat 0.5 - 1 cm from the instrument and cut off the hernial sac, after making sure that it does not contain an intestinal loop, etc. After that, a continuous suture is applied to the stump. Then the instrument is removed and the hernial opening is additionally closed with sutures according to the type of serous-muscular on the intestine, i.e. Injection is done at a distance of 2-3 cm from the hernial opening, and puncture - near its edge; on the opposite side, repeat in reverse order. Thus, the stump of the hernial sac is closed with sutures. The wound is powdered with penicillin powder, the ends of the ligatures are tied.

In the presence of an animal with a narrow hernial opening, you can do the following. After dissection of the hernial sac, it is captured with hemostatic tweezers and twisted along the longitudinal axis by 180 - 360 0 (at the same time, the hernial contents are displaced into the abdominal cavity) and the top of the hernial sac is sutured with a ligature. After that, one of the ends of the ligature is passed through the edge of the hernial opening and removed at a distance of 0.5 - 0.8 cm through the abdominal wall of the same side (the needle is passed under the control of a finger inserted into the hernial opening). Do the same with the other end of the ligature on the opposite side. The ends of the ligatures are pulled together and tied so that the twisted bag sinks inward. The edges of the hernial ring are connected with knotted sutures such as Lambert.

At irreducible umbilical hernia (the hernial sac has adhesions with the intestinal loop) should be done as follows. After preparing the surgical field and performing anesthesia, the hernia sac, exposed and dissected from the skin, is opened in an area free from adhesions. Then, with a circular incision directly along the edges of the adhesions, the intestine is separated from the hernial sac. The intestinal loop, together with the area of the soldered hernial sac, is pushed into the abdominal cavity.

At strangulated umbilical hernia after the preparation of the hernial sac and the removal of the strangulated intestinal loop, the latter must be carefully examined. If it is viable (pink), it is inserted into the abdominal cavity, and the hernial sac is amputated and the operation is completed in the usual way. At the same time, sutures are additionally applied to the dissected hernial ring. If the strangulated intestine is not viable (cyanotic), it is resected within healthy tissues, the ends of the intestine are sutured and the operation is completed in the usual manner.

4.4. The final stage of the operation.

All operations to remove an umbilical hernia are completed with the impositionnodal sutures . This is one of the types of intermittent sutures applied to the skin. A simple knotted suture is applied with separate threads 15–20 cm long each. The edges of the wound are fixed with surgical tweezers; the needle, clamped by the needle holder, is injected at a distance of 0.5 - 1.5 cm from the edges of the wound, and, acting simultaneously with tweezers and the needle in opposite directions, the tissues are laid on one side of the wound; on the other side, in the same way, a needle is passed from the inside of the wound to the outside. Stitches are applied at a distance of 0.75 - 1.5 cm from one another. After the application of each stitch, the threads are tied, ensuring that the edges of the wound are precisely matched without undue force. Knots should be placed on the side of the wound, on the side of the needle injection.

After performing an operation to remove an umbilical hernia, it is also advisable to applyseam with the formation of a skin fold . After an interrupted suture is applied to the skin, two parallel folds of skin are brought together above the latter, they are stitched with separate stitches of the interrupted suture, placing a gauze layer under the folds.

After that, a collodion dressing should be applied to the wound surface.

A collodion bandage is a type of adhesive bandage, where the adhesive iscollodion - a viscous solution of colloxylin in a mixture of alcohol and ether, after evaporation of the solvent forms a dense film. Such a bandage is attached directly to the skin or coat. The main advantages of this dressing are: ease of application, a minimum amount of dressing material is required, does not constrain organs and does not interfere with normal blood and lymph circulation, allows you to freely observe the circumference of the wound, and also allows you to change the dressing material directly adjacent to the wound without removing the dressing. surfaces.

5. Arising and possible complications. Ways to eliminate them.

In the postoperative period, various complications may occur, usually associated with improper performance of the surgical intervention, improper observance of the rules for caring for the animal or its maintenance during this period. Basically, this is due to a violation of the rules of asepsis and antisepsis during the operation or in the postoperative period.

So, if it gets on the wound surface, clostridium can occur at the site of the operationanaerobic surgical infection, symptoms of which are: severe pain in the wound area, swelling, skin tension at the site of infection, gas crepitus. Wound exudate is cloudy, high general temperature, depression of the animal. Treatment requires early surgical intervention and tissue oxygenation. Oxidizing agents are used - boric acid, hydrogen peroxide, chloramine, chloracid, potassium permanganate, chlorhexidine.

The entry of aerobic microflora into the wound (streptococci, staphylococci, cryptococci, Pseudomonas aeruginosa, Escherichia coli) contributes to the developmentaerobic purulent infection , which causes the formation of abscesses in the operated area. Treatment is complex, it should include both local and general effects on the body. At the beginning of the development of a purulent infection, a short novocaine block with antibiotics is produced. Such treatment interrupts the infectious process and recovery occurs. At the stage of abscess formation, broad-spectrum antibiotics are administered intramuscularly. The formed abscess is opened. The cavity is washed with a solution of furacilin, a solution of sodium sulfacyl, a solution of ethacridine lactate or potassium permanganate.

A fairly common complication after hernia repair isperitonitis (inflammation of the peritoneum). Peritonitis can also occur as a result of an aerobic purulent infection, when opening abscesses formed in the abdominal cavity. As a rule, in this case, acute peritonitis occurs, the symptoms of which are: fever, decrease or loss of appetite, depression, increased heart rate and respiration, tension and soreness of the inflamed areas of the abdominal wall. Usually the disease is fibrinous or fibrinous-purulent in nature, which is accompanied by the formation of adhesions. To prevent the formation of adhesions and prevent peritonitis, it is recommended to use proteolytic enzymes and antihistamines.

In the absence of timely treatment of closed purulent, putrefactive and anaerobic foci, the occurrence ofsepsis .

Sepsis - This is an infectious-toxic process, accompanied by a sharp deterioration in all body functions, resulting from the absorption of toxins and microbes from the primary infectious focus. Surgical sepsis is divided into general purulent infection with metastases, orpemia, and general purulent infection without metastases, orsepticemia .

Symptoms: severe general condition, high body temperature, refusal to feed, rapid breathing. In sepsis with metastases, the fever is remittent. Significant fluctuations in temperature are associated with the absorption of microbes and toxins into the blood. With a favorable course of sepsis, the temperature gradually decreases, the general condition improves. With an unfavorable outcome of the disease, the temperature decreases during the day, the pulse quickens, barely perceptible. Usually after that the animal quickly dies. At autopsy, metastases are found. With septicemia, severe depression is observed, patients lie down, refuse food and water, quickly lose weight, and have a very high temperature. Persistent fever.

Treatment is complex, early, aimed at suppressing the microbial factor, neutralizing and removing toxins from the body. The complex of measures includes: mobilization of the body's defenses, increased reactivity of the body, measures to eliminate dehydration, removal of the parabiotic state of the nervous system, suppression of infection, replenishment of the energy deficit, neutralization and elimination of toxins, reduction of sensitization, symptomatic treatment, local treatment.

In the postoperative period, complications associated with improper suturing can also be observed: their divergence, as well as insufficient closure of the umbilical ring. As a result, a relapse of the disease may occur.

6. Postoperative stage.

In the postoperative period, the animal must be kept in a warm, bright, clean room. If possible, it is necessary to exclude factors that contribute to the contamination of the postoperative wound, as well as the ingress and development of microorganisms, a decrease in the overall resistance and reactivity of the body (keeping in a dirty room, high humidity, lack of sunlight, drafts, inadequate feeding, indigestible feed, etc.). All maintenance activities should be aimed at eliminating these negative factors.

In addition to improving the conditions of keeping and caring for the animal, it is necessary to conduct regular examination and antiseptic treatment of the postoperative wound, as well as change the dressing material.

After surgery for a strangulated umbilical hernia with resection of the intestinal loop, the animal is prescribed a diet.

7. Conclusion.

The economic damage caused by hernia in the umbilical region in pigs is significant. A sick piglet lags behind its peers in weight gain by about 10 kg during the first 2.5 - 3 months. A significant part of the piglets are operated on, more than half are killed before fattening, many die.

Bibliography.

Gavrish V. G., Kalyuzhny I. I. et al. “Reference book of a veterinarian”. Rostov n/a: "Phoenix", 2001

Kovalev M. M., Petrakov K. A. “Workshop on operative surgery with the basics of topographic anatomy of domestic animals”, Minsk: “Urajay”, 1991

Kuznetsov A. F., Andreev G. M. et al. “Veterinarian's Handbook” St. Petersburg: “Lan”, 2000

Magda I. I., Itkin B. Z. “Operational surgery”, Moscow: “Agropromizdat”, 1990

Shakalov K.I. “Private veterinary surgery”, Leningrad branch: “Agropromizdat”, 1986

MINISTRY OF AGRICULTURE AND FOOD OF THE RUSSIAN FEDERATION

ULYANOVSK STATE AGRICULTURAL ACADEMY

Department of Surgery and organization of veterinary business.

COURSE WORK

by discipline: Operative surgery with the basics of topographic anatomy

on the topic: Operation of umbilical hernia in piglets

ULYANOVSK 2008

PLAN

1. Introduction

a) Brief description of the disease

b) Overalls of a veterinarian

c) Preparing the surgeon's hands for surgery

d) Sterilization of instruments, suture and dressing materials

e) Preparing the animal for surgery

2. Technique of operation of umbilical hernia in piglets

a) Preparation of the surgical field

b) Technique of infiltration linear anesthesia

c) Operation technique according to the Gutman method

Conclusion

List of used literature

Appendix

1 . INTRODUCTION

a) Brief description of the disease

An umbilical hernia is a protrusion of the peritoneum and the exit of the internal organs of the abdominal cavity (intestine, omentum, etc.) through the expanded umbilical ring.

Causes of a hernia can be congenital or acquired. The former occur in cases where an overly wide umbilical opening remains uncovered after the birth of the animal, the latter - due to an injury to the abdominal wall (hit by a horn, hoof, fall, etc.). Acquired hernias are also possible after abdominal operations, with excessive tension of the abdominal muscles as a result of increased intra-abdominal pressure (during childbirth, hard work, with strong tenesmus, etc.).

Pathogenesis. Congenital hernias develop as a result of untimely fusion of the umbilical ring in the postnatal period. The umbilical ring shortly after birth (in piglets during the first month) is obliterated and overgrown with fibrous tissue. If this does not happen, then the young connective tissue covering the umbilical ring, under the influence of intra-abdominal pressure, stretches and gives rise to the formation of a hernia.

The formation of acquired umbilical hernias is based on an imbalance between abdominal pressure and abdominal wall resistance. The tension of the abdominal wall during falls, blows, hard work and strong tenesmus leads to an increase in intra-abdominal pressure. The latter contributes to the divergence of the edges of the hernial ring, protrusion of the peritoneum and viscera through an artificially formed hole.

Clinical signs. In each hernia, a hernial opening is distinguished through which the internal organs exit; hernial sac - protruding parietal peritoneum; hernial contents - omentum, intestinal loops, etc.

With the development of an umbilical hernia in the umbilical region, a sharply limited, painless, soft swelling often of a hemispherical shape appears. On auscultation of the swelling, intestinal peristaltic sounds are heard. With a reduced hernia, its contents are reduced into the abdominal cavity, after which it is possible to probe the edges of the hernial ring, determine its shape and size. An irreducible hernia does not decrease in volume from pressure, its contents cannot be pushed into the abdominal cavity due to the presence of adhesions of the hernial sac with hernial contents. Irreducible hernias can be infringed. In these cases, the animal is initially very worried, and later it is depressed, refuses to feed. Along with this, there is a lack of defecation, an increase in body temperature, a frequent and weak pulse. The swelling in the umbilical region becomes painful and tense.

With large umbilical hernias, inflammation of the hernial sac is sometimes observed as a result of injuries, and when microbes invade the area of the sac, abscesses form, tissue necrosis occurs, and skin ulcerations appear.

Forecast. With reducible hernias, the prognosis is favorable, with strangulated hernias with intestinal necrosis - from doubtful to unfavorable (especially in foals).

Treatment. With umbilical hernias, various conservative and surgical methods of treatment are used. Conservative methods of treatment include dressings and bandages, rubbing irritating ointments into the hernia area, subcutaneous and intramuscular injections around the circumference of the hernial ring of 95% alcohol, Lugol's solution or 10% sodium chloride solution in order to cause inflammation and closure of the hernial ring of the newly formed scar tissue. All these methods are ineffective, and they are almost never used. Operative methods of treatment give good results.

Prevention. Comply with zoohygienic and veterinary rules for feeding and keeping animals and caring for them. Take steps to prevent injury.

b) Overalls of a veterinarian

You must enter the operating room only in gowns. During the operation, walking and talking should not be allowed. The surgeon and his assistants immediately before the operation must put on sterile gowns, caps and masks.

v) Preparing the operating field and the surgeon's hands for surgery

Preparation of the operating field and hands for surgery is one of the most important measures that ensure aseptic surgery. The skin of any part of the animal's body contains a huge amount of microbes that are not only on the surface, but also settle in various folds, in the ducts of the sebaceous and sweat glands, in hair follicles, and scales of the sloughing epithelium.

Hand preparation. The hands of veterinarians during everyday medical work (treatment of wounds, abscesses, autopsy of animal corpses, etc.) are constantly contaminated with pathogenic microbes. A significant number of them are located in the area of the nail fold, in the subungual spaces, skin folds. Care of the skin of the hands must be given due attention. To preserve the softness and elasticity of the skin of the hands, they are lubricated at night with nourishing creams, Tushnov's liquid (castor oil - 5 g, glycerin - 20, ethyl alcohol 96% - 75 g) or Girgolov (glycerin, ethyl alcohol, 10% solution ammonia and distilled water, 25 g each).

Modern methods of preparing hands and the surgical field for surgery are based on the use of the tanning properties of antiseptics, which thicken the upper layers of the skin and thereby close the skin openings of the gland ducts, blocking the exit of microorganisms from them during the operation.

Preparation of hands for surgery involves three main procedures: 1) mechanical cleaning; 2) chemical disinfection; 3) leather tanning. Some antiseptic substances combine bactericidal and tanning properties (iodine alcohol solution, brilliant green solution, etc.).

10-20 minutes before the operation, the nails are cut short, the burrs are removed, the subungual spaces are cleaned and the hands are thoroughly washed with soap and brushes. The brushes are pre-boiled for 20-30 minutes and stored in glass jars in a 3% solution of carbolic acid or a 0.1% solution of mercury dichloride.

The most common hand sanitizers are: .

Spasokukotsky-Kochergin method. It is based on the property of ammonia solution to dissolve fats with which bacteria are washed away. Handwashing with soap and water is not required.

A freshly prepared 0.5% ammonia solution is poured into two enameled basins and hands are washed in turn with a gauze napkin. First, they wash their hands in one basin for 3 minutes, and then in another for 3 minutes. In this case, the solution in the second basin should remain transparent.

Hands can also be washed under a weak stream of 0.5% ammonia solution for 5 minutes.

Hands are washed in the following sequence: first the fingertips and subungual spaces, then the palmar and back surfaces of the hand, and finally the forearms. After washing, the hands are wiped with a sterile towel and treated with napkins or cotton balls moistened with 96% ethyl alcohol for 3-5 minutes. In conclusion, fingertips, subungual spaces, nail beds are lubricated with a 5% alcohol solution of iodine.

d) Sterilization of instruments, suture and dressing materials

In our case, we sterilize the instruments by boiling. We sterilize metal instruments with the addition of alkali solutions. Boil 3-5 min. complex instruments (scissors, needle holders, etc.) are sterilized in disassembled or half-open form. We wrap cutting objects with gauze.

We sterilize glass instruments separately from metal instruments in distilled water. Syringes are boiled disassembled, previously wrapped in gauze. Sterilize glassware for 15 minutes.

Dressings and surgical linen are sterilized in an autoclave.

Suture material: catgut is sterilized according to the Pokatilo method (for 72 hours in a 4% formalin solution).

We sterilize kapron threads by boiling and store in 96% alcohol.

Sterilization of gloves. All existing methods of hand treatment do not provide their absolute sterility. This can be achieved by using sterile rubber surgical gloves.

Sterilization in an autoclave. Each glove is carefully sprinkled with talcum powder inside and out, wrapped in gauze and sterilized in an autoclave along with the dressing.

e) Preparing the animal for surgery

The animal must be prepared for the operation. The set of measures to prepare the animal for surgery includes:

1) a comprehensive study of a sick animal and familiarization with the epizootic situation of the farm from which the animal was delivered for treatment;

2) elimination of concomitant diseases that make it difficult to perform the operation, and the use of drugs that increase the body's defenses;

3) the appointment of a diet, an appropriate regime for keeping and zoohygienic care for animals (cleaning the skin, partial or complete washing of the animal, etc.).

2. TECHNIQUE OPERATIONS P UPOCHNOY HERNIAS At PIGS

Piglets are fixed in the dorsal position on the operating table or in the trough. Several methods of operation have been proposed. They are selected taking into account the type of hernia (reduced, irreducible) and the size of the hernial rings.

Abdominal wall defects in the form of abdominal hernias of a congenital or acquired nature, as well as those resulting from injuries, are a common pathology in the animal kingdom. Surgical treatment is generally accepted, and today there is no alternative when it comes to large defects in the musculoaponeurotic layer of the abdominal wall. In surgical practice, large defects of the abdominal wall are also observed after laparotomies complicated by peritonitis, suppuration of the postoperative wound, and eventration. The cause of large congenital defects is usually the initial underdevelopment of the umbilical ring and the midline of the abdomen, which, with the age of the animal, turn into even larger defects than at birth. layer to intra-abdominal pressure, which at certain moments of the animal's life can reach significant values. Naturally, pregnancy and childbirth, powerful attempts, obesity and other factors that increase intra-abdominal pressure and reduce tissue density and strength of the aponeurosis and other retaining layers of the abdominal wall play an unfavorable role. Unpredictably large defects in the muscular-aponeurotic layer of the abdominal wall occur with direct trauma to the abdomen with sharp and blunt injuring objects, including after animal bites. Open and closed (that is, with the preservation of the skin) injuries, depending on the degree of rupture of the abdominal wall, lead to its defects, sometimes of a rather large size. In practice, the observation of penetrating traumatic injuries of the lateral wall of the abdomen with the formation of a defect in the musculoaponeurotic layer up to 15 cm in diameter has been noted. Attempts to get by with conservative measures and maintain the status quo with pressure bandages, bandages, etc. lead only to complications in the form of infringements, intestinal obstruction and traumatization of the internal organs of the abdominal cavity. The experience of surgery and the comparative frequency of failures indicate that the solution to the problem of surgical treatment of large abdominal wall defects is not as obvious as with hernias of small size and easy for surgical access. The problem becomes complicated when the usual ligature method causes significant tension (tension) of the edges of the sutured defect of the aponeurosis and the muscles of the abdominal wall. The surgeon must fully appreciate the significance of this factor, since after the operation, as the physical activity of the animal increases, the load on the tissues and sutures increases many times over. This circumstance sharply limits the possibility of autoplasty at the expense of local tissues, the "quality" of which in case of large defects is always highly questionable. That is why the search for ways to close abdominal wall defects continues and is continuously improved.

General information about hernias and their classification

Hernias in animals are very common. For their treatment, they are mainly used surgical methods. Complications are possible with hernias.

Sick animals - young and not fattened - have to be culled, which brings significant economic damage to farms.

When describing various hernias of farm animals and the methods of their operations, which are performed in the conditions of industrial livestock complexes, the authors summarized the experience of their research and practical work, as well as data from other researchers.

A hernia is the displacement of internal organs (intestinal shock, omentum, uterus, bladder, etc.) into adjacent cavities or under the skin through a natural or artificial opening.

Hernia (hernia) consists of the following elements: hernial orifice, hernial sac and hernial contents.

The hernial opening can be natural gaps - the umbilical ring, the inguinal canal, the femoral canal, or artificial ones - a rupture of the wall of the anatomical cavity. The hernial opening is also called the hernial ring - when it is narrow, or the hernial orifice - with a wide gap, or the hernial canal - when

Rice. 1. Scheme of an umbilical hernia with preserved umbilical-hepatic and umbilical-vesical ligaments (according to Zadvirny): 1 - peritoneum; 2 - transverse fascia; 3 - muscular-aponeurotic layer; 4 - yellow abdominal fascia; 5 - skin; 6 - liver; 7 - bladder; 8 - umbilical-hepatic ligament; 9 - umbilical-vesical ligament.

The hernial sac consists of a parietal abdominal sheet with adjacent fascia.

The bottleneck of the hernial sac is called the mouth, and the expanded part is called the bottom (Fig. 1). A pathological phenomenon, when the abdominal wall and peritoneum are torn, and the insides are displaced under the skin, is called prolapsus. In practice, this disease is often also referred to as abdominal hernias. The prolapse of internal organs from the anatomical cavity to the outside, without all the coverings (peritoneum, fascia, muscles), is called eventration (eventratio). The hernial content is more often a loop of the intestines, an omentum, less often the uterine horn, bladder (this is the main hernial content). In chronic hernia carriers, the cavity of the hernial sac also has a transudate - “hernial water”.

Hernias are classified depending on which anatomical region they are located in: umbilical, inguinal-scrotal, abdominal, white line hernias, perineum, femoral, diaphragmatic.

Some of them have their own varieties. In addition, hernias are acquired and congenital.

According to the state of hernial contents, they are divided into reducible, irreducible and restrained.

Reducible hernia (hernia Libera) - the hernial contents are freely and painlessly reduced through the hernial opening into the natural cavity. The swelling of the hernia is soft, elastic, and when the hernial contents are reduced, the hernial opening is palpated.

Irreducible hernia (herniairreponibilis), sometimes it is called fixed (hernia fixata), - the hernial content fuses with the hernial sac. This usually happens as a consequence of secondary bruises and; inflammatory processes. Primary fibrinous adhesions appear, and later fibrinous adhesion develops. Such a hernia becomes elastic. Depending on the size of the hernia and the width of the adhesions, digestion may be periodically disturbed, and the promotion of the contents of the intestines may be delayed. The animal is gradually losing weight.

Incarcerated hernia (hernia incarcerata) - the hernial contents are incarcerated in the hernial ring or squeezed in the hernial sac in different ways. This depends on a number of factors: the diameter of the hernial opening, the elasticity of the surrounding tissue, the size of the intestinal loop, and the amount of mesentery penetrating into the hernial sac, etc. According to the mechanism of development, there are three infringements - fecal, elastic, retrograde.

Fecal infringement occurs gradually, when the fallen intestine is overfilled with contents to such an extent that it cannot be pushed back into the abdominal cavity.

Elastic infringement (strangulation) appears quickly and unexpectedly, which usually happens during work, with increased intra-abdominal pressure. In this case, the hernial opening is greatly stretched for a short time, and the intestinal loop penetrates into it. And when, as a result of contraction of the surrounding tissues, the hernial opening is weakened and narrowed, located in it. the loop of the intestine is infringed.

Retrograde infringement occurs when a loop of intestine and part of the mesentery penetrates into the hernial sac. In this case, digestion is disturbed not only in the strangulated loop of the intestine, but also in the intestine, which lies freely in the abdominal cavity.

With strangulated hernias, there is always pain in the form of colic; the swelling increases in volume, becomes dense and tense. In the cavity of the strangulated intestine, the microflora rapidly multiplies, penetrating from the walls of the intestine, where the gangrenous process develops. It passes to the mesentery, and purulent peritonitis develops.

Strangulated hernias are serious diseases. At the first signs of their manifestation, an urgent operation is necessary to prevent peritonitis, in which the animal often dies.

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Indications. These methods can be used if the diameter of the umbilical opening is not more than 3 cm. So, F. A. Sunagatullin (1982) suggested closing the ring with a U-shaped suture. Animals are fixed in the dorsal position.

Anesthetic protection. Local infiltration anesthesia with 0.5% novocaine solution.

Operation technique. The contents of the hernial sac are pushed into the abdominal cavity. Then, under the control of the finger, at a distance of 0.5 ... 1 cm from the edge of the hernial ring, a needle is inserted through all layers, after which it is withdrawn on the opposite side. Then, stepping back 0.5 ... 1 cm from the place where the needle was removed, this operation is carried out in the reverse order.

If it is impossible to perform this manipulation in one step, it is done in two steps.

The scheme of imposing a loop-shaped horizontal suture on the hernial ring according to R.A. Sunagatullin: 1 - skin; 2 - superficial fascia; 3 - muscular-aponeurotic layer; 4 - transverse fascia; 5 - peritoneum

The needle is removed for the first time not on the opposite side, but in the middle of the hernial sac. The needle is again inserted into the same place and taken out on the opposite side. They are also stitched in the opposite direction, retreating 0.5 ... 1 cm to the side from the exit point of the needle of the already made seam. The ends of the ligature are tightened and tied.

Tissue edema develops at the site of the operation. The swelling then becomes tense, painful, and hot. After 3-4 days after the operation, it thickens, decreases and the pain reaction disappears.

If with an umbilical hernia the hernial orifice is wider (their diameter is more than 3 cm), one of the described bloody methods of operation should be used.

A bloodless method of surgery for reducible umbilical hernia in piglets was proposed by A. F. Burdenyuk. This method is used only in recent cases, when the diameter of the hernial ring is not more than 2 ... 3 cm. Without dissecting the tissues, the hernial contents are inserted through the skin into the abdominal cavity and the hernial opening is palpated, which usually includes one finger. After reduction of the hernial contents, the hernial sac is twisted and pulled away from the abdominal wall as much as possible. Then they take a large surgical needle prepared in advance with a needle holder and a double silk ligature (No. 8).

Under the control of the index finger of the left hand, the skin and the hernial ring are pierced with a needle, stepping back from its edge 1 ... 2 cm. Then the opposite edge of the hernial ring is pierced with a needle, and it is removed at the base of the hernial sac. The hernial ring is closed with 2 ... 3 stitches of a seam with rollers.

Bloodless operation of an umbilical hernia in a piglet (according to A.F. Burdenyuk): 1 - peritoneum; 2 - transverse fascia; 3 - muscular-aponeurotic layer; 4 - serous-hernial sac; 5 - ligature

In the first days after the operation, edema of the hernial sac develops and purulent exudate appears in place of the ridges at the sutures. The sutures are removed after 10-12 days. The skin hernial sac gradually straightens out and disappears as the animal grows. The umbilical ring (hernial ring) is well closed by connective tissue.

With irreducible hernias, there is a risk of stitching intestinal loops together with the hernial sac and the occurrence of complications.

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MINISTRY OF AGRICULTURE AND FOOD OF THE RUSSIAN FEDERATION

ULYANOVSK STATE AGRICULTURAL ACADEMY

Department of Surgery and organization of veterinary business.

COURSE WORK

by discipline: Operative surgery with the basics of topographic anatomy

on the topic: Operation of umbilical hernia in piglets

ULYANOVSK 2008

PLAN

1. Introduction

a) Brief description of the disease

b) Overalls of a veterinarian

c) Preparing the surgeon's hands for surgery

d) Sterilization of instruments, suture and dressing materials

e) Preparing the animal for surgery

2. Technique of operation of umbilical hernia in piglets

a) Preparation of the surgical field

b) Technique of infiltration linear anesthesia

c) Operation technique according to the Gutman method

Conclusion

List of used literature

Appendix

1. INTRODUCTION

a) Brief description of the disease

An umbilical hernia is a protrusion of the peritoneum and the exit of the internal organs of the abdominal cavity (intestine, omentum, etc.) through the expanded umbilical ring.

Forecast. With reducible hernias, the prognosis is favorable, with strangulated hernias with intestinal necrosis - from doubtful to unfavorable (especially in foals).

Prevention. Comply with zoohygienic and veterinary rules for feeding and keeping animals and caring for them. Take steps to prevent injury.

b) Overalls of a veterinarian

c) Preparation of the operating field and the surgeon's hands for the operation

The most common hand sanitizers are: .

Spasokukotsky-Kochergin method. It is based on the property of ammonia solution to dissolve fats with which bacteria are washed away. Handwashing with soap and water is not required.

Hands can also be washed under a weak stream of 0.5% ammonia solution for 5 minutes.

In conclusion, fingertips, subungual spaces, nail beds are lubricated with a 5% alcohol solution of iodine.

d) Sterilization of instruments, suture and dressing materials

We sterilize glass instruments separately from metal instruments in distilled water. Syringes are boiled disassembled, previously wrapped in gauze. Sterilize glassware for 15 minutes.

Dressings and surgical linen are sterilized in an autoclave.

Suture material: catgut is sterilized according to the Pokatilo method (for 72 hours in a 4% formalin solution).

We sterilize kapron threads by boiling and store in 96% alcohol.

Sterilization of gloves. All existing methods of hand treatment do not provide their absolute sterility. This can be achieved by using sterile rubber surgical gloves.

Sterilization in an autoclave. Each glove is carefully sprinkled with talcum powder inside and out, wrapped in gauze and sterilized in an autoclave along with the dressing.

e) Preparing the animal for surgery

The animal must be prepared for the operation. The set of measures to prepare the animal for surgery includes:

1) a comprehensive study of a sick animal and familiarization with the epizootic situation of the farm from which the animal was delivered for treatment;

2) elimination of concomitant diseases that make it difficult to perform the operation, and the use of drugs that increase the body's defenses;

3) the appointment of a diet, an appropriate regime for keeping and zoohygienic care for animals (cleaning the skin, partial or complete washing of the animal, etc.).

2. TECHNIQUE OF UMBILICAL HERNIA IN PIGLETS

Inguinal hernia in a piglet

Inguinal hernia - Hernia scrotiinguinalis - displacement of organs together with the parietal sheet of the peritoneum outside the cavity, under the skin or other tissues and cavities.

Classification

The classification of hernias provides for their anatomical definition: umbilical, inguinal, perineal, etc. In each of these groups there are formations with characteristic anatomical features.

In separate groups of hernias, according to etiology, congenital ones are distinguished. These include not only those with which they are born, but in general hernias that occur at any age, for the formation of which congenital anomalies are needed in the development of the area of the body where the hernia appears.

Congenital hernias (H. congenitae) are usually caused by abnormalities in the formation of natural fissures, for example, the inguinal canal, when it remains shortened, excessively wide. This condition is often seen in boars.

Acquired hernias (H. acquisitae) are formed due to damage to the abdominal wall by a horn, stake, hoof, etc., with excessive stress (difficult childbirth, falling into pits, under a feeder, hard work). In newborn animals, an increase in intra-abdominal pressure is the most important factor in stretching the weak points of the abdominal wall (umbilical ring, inguinal canal) and the formation of hernias, when the restoration of the abdominal wall is performed without proper successive closure of its tissue layers.

According to the state of the contents, hernias are distinguished as reducible, irreducible, and restrained.

Reducible hernia (H. reponibilis) is characterized by free mobility of the contents. Filling the bag is not accompanied by pain. The tissues of its wall are only somewhat stretched, but remain as elastic as after the reposition of the contents.

Hernia irreducible (H. incarcerate) is a life-threatening complication. It is due to compression of the contents at the level of the hernial ring. There are elastic and fecal infringements.

Elastic infringement occurs due to the contraction of the tissues of the hernial opening and adjacent areas of the abdominal wall. The elastic ring circularly compresses the intestinal loop or other organ.

Fecal infringement is due to the mechanism of squeezing the efferent knee of the intestine with increasing filling of the adductor.

The supervised animal has a left-sided reducible inguinal-scrotal hernia. A hernia with a sac lies next to the vaginal canal, such a protrusion of the peritoneum gradually descends, exfoliating the fibrous sheet of the common vaginal membrane from the Cooper fascia. A hernia is formed due to rupture of the tissue layers of the abdominal wall directly at the inguinal canal. Their stratification is promoted by edema in this area. More often, inguinal hernias are left-sided, which is due to some anatomical features, in particular, the larger size of the left testis, the length of its spermatic cord, the left-sided location of the loops of the small intestine, which are more widely displaced and easily penetrate into the gap of the vaginal ring.

Brief anatomical and topographic data of the area of localization of the pathological process

Operative access was carried out in the abdomen.

The anterior border of the abdomen is the thoracic part of the body along the line of attachment and the dome of the diaphragm; back - the entrance to the pelvis, corresponding to the level of the inguinal ligament; upper - lumbar vertebrae with adjacent muscles; below - the ventral part of the soft abdominal wall and the xiphoid cartilage; from the sides - the lateral part of the soft abdominal wall.

The abdominal cavity is divided into 3 sections: anterior, middle and posterior.

The anterior border of the anterior section is the diaphragm, the posterior border is a segmental plane drawn tangent to the last rib. The anterior section is divided into 3 regions: the right and left hypochondrium and the region of the xiphoid cartilage. The anterior border of the middle section is a segmental plane drawn tangent to the last rib, the posterior border is a segmental plane drawn tangent to the maklok. The middle section is divided into 4 regions: the right and left iliac, umbilical and renal regions. The posterior section continues from the middle to the entrance to the pelvic cavity. The back section is divided into the right groin, left groin and pubic region.

Fig.1. Areas of the abdomen: 1, 2 - right and left hypochondria; 3 - xiphoid cartilage; 4, 5 - right and left iliac; 6 - umbilical; 7, 8 - right and left inguinal; 9 - pubic.

The following are involved in the formation of a soft abdominal wall: the external and internal oblique abdominal muscles, the rectus and transverse abdominal muscles, the transverse and yellow abdominal fascia, and the white line of the abdomen.

In layers, the wall of the abdominal region is represented by skin, subcutaneous tissue, superficial two-layered fascia, with the subcutaneous muscle of the abdomen passing through it, subfascial space, deep fascia (yellow abdominal fascia), muscle layer (external oblique abdominal muscle, internal oblique abdominal muscle, transverse abdominal muscle, rectus abdominis muscle), transverse abdominal fascia, retroperitoneal fat, peritoneum.

The abdominal muscles end in aponeuroses on the white line of the abdomen.

Rice. 2. Layered structure of the abdomen at the level of the 3rd lumbar vertebra: a - skin; b,f - superficial fascia with skin muscle; c,d - lumbar-dorsal fascia; e - yellow abdominal fascia; g, h, i, i - external and internal oblique; transverse and rectus abdominis muscles; v - transverse abdominal fascia; k - peritoneum; m - preputial muscle; n - white line of the abdomen; o, p, g — longissimus and iliocostalis muscles, 1 — aorta and posterior vena cava; 2 - cranial branches of the deep circumferential iliac artery and vein; 3 - epigastric and cranial arteries and veins; 4- saphenous vein of the abdomen.

The bony skeleton of the abdominal cavity is represented by the sternal ends of the abdominal ribs, cartilaginous ribs, xiphoid cartilage, lumbar vertebrae, ilium and pubis.

The blood supply to the internal organs of the abdominal cavity is carried out by arteries extending from the abdominal aorta. The blood supply to the abdominal wall is provided by: branches of the saphenous abdominal artery, branches of the external thoracic artery, intercostal arteries, lumbar arteries, girdle deep iliac artery, cranial and caudal epigastric arteries.

Lymph outflow occurs through superficial and deep lymphatic vessels embedded in the subcutaneous tissue and in the muscles; they flow into the patella lymph node, into the lateral iliac nodes and into the superficial and deep inguinal lymph nodes.

The innervation of the internal organs is carried out by the nerves of the sympathetic and parasympathetic nervous systems. All layers of the abdominal wall are innervated by the thoracic nerves, mainly by their ventral branches, as well as the dorsal and ventral branches of the lumbar nerves (ilio-hypogastric, ilio-inguinal, ilio-seminal).

Etiology

It was not possible to establish specific etiological factors in the supervised animal. Presumably, the reason for the formation of a hernia was deficiencies in maintenance and feeding, in combination with anatomical predispositions conducive to hernia formation (a vaginal canal open into the abdominal cavity).

In the etiology of hernias, congenital malformations with intrauterine formation of a wide umbilical ring are of great importance, considering such a defect to be hereditary. An element of congenital predisposition should be considered a delayed reduction of the umbilical vein and umbilical artery with urachus. The most important anatomical element that predetermines the development of a hernia is the formation of inguinal hernias through the natural communication of the cavity of the common vaginal membrane with the abdominal cavity through the vaginal canal, which remains in animals after the testicles are lowered.

With the start of additional feeding at 2-3 weeks of age, young animals often experience constipation, diarrhea, and sometimes vomiting, which is accompanied by tenesmus with an increase in intra-abdominal pressure, which also contributes to the occurrence of a hernia.

In addition to the above deficiencies in feeding and the noted anatomical features of the abdominal wall in the inguinal region (the vaginal canal open into the abdominal cavity), the tension of the abdominal wall during hard work and weak filling of the loops of the small intestines are important in the occurrence of hernias; rearing, rapid changes in body position with enteralgia, kicking, etc.

Pathogenesis

In the genesis of inguinal hernias, the role of congenital malformations in the development of the vaginal and inguinal canals is reasonably asserted, which follows from the data of A. V. Dubrovsky devoted to the study of hernia formation in boars. His research allows us to understand the essence of the mechanism of hernia formation:

1) Due to the peculiarities of the attachment of the rectus abdominis muscle and the aponeurosis of the external oblique muscle (at the level of the anterior and middle third of the fusion line of slender muscles, and not at the anterior edge of the pubic bones, as in other animal species), a space of the non-muscle layer is formed in the caudal region of the inguinal region (inguinal gap in topographic and anatomical definition). In the event that this space is triangular rather than oval, a wider internal inguinal ring is formed.

2) The triangular shape of the inguinal gap is combined with the formation of a more massive external cremaster due to the splitting off of a relatively wide plate of the internal oblique muscle of the abdomen, which is also associated with a widening of the internal inguinal ring, which is characteristic of boars with an intravaginal hernia.

3) Significant in this structure of the inguinal gap is a change in the relative position of the rings of the inguinal canal and the position of the peritoneal ring of the vaginal canal, with smoothing of its protrusion into the abdominal cavity, resulting in a short straight path to the scrotal section of the common vaginal membrane.

The inguinal canal remains wider during the period of descent of the testis. After that, it tapers strongly on its inner ring. Hence there are reasons to interpret the significance of congenital malformations that predetermine the development of hernias before birth, at the time of childbirth and in the first days of the extrauterine life of the animal. Subsequently, only a strong simultaneous increase in intra-abdominal pressure or a stubbornly existing weaker tension of the abdominal press with a weakening of tissue tone is sufficient to cause an inguinal hernia.

Clinical signs

On examination in the left inguinal region, a swelling of a soft consistency, oval in shape, in the form of a strand, 13 centimeters long and 4 centimeters wide, was found. The hernial sac had smooth walls, no fluctuation was detected on palpation. Local temperature was not elevated, pain was not observed

In the process of treatment, the hernia was reduced. Clinical signs of a hernia were not subsequently observed.

Rice. 3. Scheme of the structure of a hernia: 1 - hernial sac; 2 - excised area of the peritoneum; 3 - hernial contents; 4 - hernial ring.

Diagnosis and its rationale

The diagnosis of reducible inguinal hernia was made according to the anamnesis and clinical signs of the manifestation of the disease in the supervised animal.

In the anamnesis of the disease of the supervised animal, a swelling in the area of the soft abdominal wall was described. In a clinical study, a painless, soft swelling of 13 × 4 centimeters in size was also observed in the left groin area.

Differential Diagnosis

In the differential diagnostic respect, it is necessary to take into account the formation of an abscess in the inguinal region in the absence of a hernia. Strictly contoured swelling in this case outwardly resembles a hernia in many ways. But with an abscess, the hernial ring is not detected, the puncture helps to understand the features of the process.

An abscess often occurs simultaneously with a hernia (see Fig. 4), but is localized in the wall of the skin hernial sac. In this case, the hernia often remains reducible. An abscess is characterized by a dense limited, sometimes painful swelling, easily displaced along the plane of the hernial sac.

Rice. 4. Scheme of an umbilical hernia complicated by an abscess: 1 - peritoneum; 2 - transverse fascia; 3 - muscular-aponeurotic layer; 4 - yellow abdominal fascia; 5 - skin; 6 - abscess; 7 - intestinal loop.

A cyst in the umbilical region is characterized by a painless fluctuating, without fever, swelling ranging in size from a nut to a goose egg. (See Fig. 5)

Among the chronic inflammatory processes that complicate the differentiation of a hernia, one should keep in mind the formation of a nonspecific granuloma. It usually develops in connection with the prolonged growth of granulation tissue during the collapse of the restrained omentum. Its dense, elongated strand is covered on the outside with sclerotized folded skin; in areas of ulceration, purulent exudate is separated in a limited amount. (see fig. 5)

Figure 5. Diagram of a cyst in the umbilical region. Umbilical granuloma: 1 - peritoneum; 2 - transverse fascia; 3 - muscular-aponeurotic layer; 4 - yellow abdominal fascia; 5 - skin; 6 - liver; 7 - bladder; 8 — contents of a cyst; 9 - umbilical-hepatic ligament; 10 - umbilical-vesical ligament; 11 — union of an intestinal loop with a cyst; 12 - granuloma.

Irreducible hernias are differentiated from reducible ones by the presence of fusion of the stacks of the hernial sac with the abdominal cover of the contents. Strangulated hernias are accompanied by soreness, intestinal obstruction syndrome.

Disease prognosis

In this case, the prognosis is favorable, since the hernia is reducible, not infringed, and not complicated by septic processes. Treatment prevented infection. The animal has a high level of resistance.

Treatment and its rationale

An animal was admitted to the clinic, during the study of which a left-sided reducible inguinal and scrotal hernia was diagnosed. Surgical intervention was used to reduce it, since conservative methods of therapy (bandage, rubbing irritating ointments, injections of alcohol, hypertonic sodium chloride solution around the hernial opening, bringing the walls closer together with wooden or metal blades, etc.) are ineffective. Herniotomy is the only rational treatment in animals.

The animal was fixed in a split in the dorsal position. For anesthesia, intramuscular injection of a 2% solution of rometar was used. The mechanism of action of rometar is based on blocking the conduction of nerve impulses, which causes immobilization of the animal. Then they cut and shaved the wool around the future incision; the surgical field was treated with an aqueous solution of furacilin (1:5000), then with an alcoholic solution of furacilin (1:1500). Furacilin is an antibacterial substance that acts on various gram-positive and gram-negative bacteria (staphylococci, streptococci, dysentery bacillus, E. coli, paratyphoid salmonella, the causative agent of gas gangrene, etc.). Furacilin blocks cellular respiration by competing with flavin enzymes, as a result it blocks the structural DNA gene, reduces the activity of dehydrogenases.

Next, local infiltration anesthesia was performed with a short novocaine block with an antibiotic (20000 IU of streptomycin and penicillin 1:1 in a 0.5% solution of novocaine). Novocaine weakly inhibits the sensitivity of exteroreceptors, but completely suppresses the function of Na +, K + channels of the nerve pathways in the zone of direct action of novocaine. Blocking mechanism: suppression of redox enzymes inside the cells; termination of the function of potassium-sodium ATPase pumps and the formation of a potential on the surface of the membranes during resorption.

Penicillin (benzylpenicillin potassium salt). It has a bacteriostatic and bactericidal effect on gram-positive microorganisms. The essence of the mechanism of antimicrobial action is to suspend the biosynthesis of biochemical components of the cell wall of microorganisms, as a result of inhibition of transpeptidase.

Streptomycin has a wide spectrum of antimicrobial activity. The antibiotic is active against Mycobacterium tuberculosis, as well as most gram-negative (E. coli, Friedlander's bacillus, influenza bacillus, plague, tularemia, brucellosis and some gram-positive (staphylococcus) microorganisms; less active against streptococci, pneumococci. Does not affect anaerobes, rickettsia and viruses.

Streptomycin is bactericidal. The effect is associated with the suppression of protein synthesis by microorganisms at the level of ribosomes in a microbial cell.

Further along the hernial sac, a 9 cm long incision was made. Cut the skin, subcutaneous tissue, superficial deep fascia, common vaginal membrane. They found an inguinal ring with a diameter of 2 centimeters, the hernial sac was separated by a blunt method from nearby tissues. We made sure that the intestinal loops were not damaged. Pushed the intestines into the abdominal cavity. The ring was closed with interrupted knotted sutures. treated with tricillin. Tricillin is a complex drug that includes benzylpenicillin, streptomycin, streptocide. The antibacterial drug consists of compounds with different mechanisms of antimicrobial action (inhibition of the biosynthesis of wall components, protein and folic acid, respectively) provides it with a bactericidal effect with a wide spectrum. Pharmacodynamics is the sum of the effects caused by each component.

The edges of the surgical wound were brought together and sutured with a two-story suture. treated with tricillin.

Once every two days, the edges of the wound were treated with an alcohol tincture of brilliant green. Alcohol tincture of brilliant green is a highly effective and long-acting antimicrobial agent. Especially detrimental to streptococci and staphylococci. Gram-negative types of microorganisms are less effective in the presence of organic compounds (serum, blood, pus, necrotic tissue sites). Slight tissue irritation accelerates granulation processes. The mechanism of antimicrobial action is the denaturation of proteins by the drug itself and alcohol.

The stitches were removed eight days later.

As a result of the treatment, a hernia was reduced. The further prognosis is favorable.

The animal does not need further special diet, maintenance and can be used in agricultural production.

A set of measures for the prevention of diseases in the economy

In the prevention of hernias, congenital malformations with intrauterine formation of a wide umbilical ring are of great importance, considering such a defect to be hereditary. It is therefore possible to reduce the incidence of hernias in pigs by not breeding animals that have had hernias.

In piglets, it is possible to reduce the frequency of hernias by observing sanitary and hygienic standards of keeping, feeding norms.

It should be borne in mind that there are groups of animals more prone to hernias: pregnant females, animals with colic syndromes, flatulence, enteroalgia, animals undergoing physical exertion. Such groups of animals do not require impersonal special care.

Injuries are a predisposing and sometimes causing factor for hernias. Therefore, the prevention of injuries should also reduce the likelihood of hernias in animals.

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Multiparous animals, which include pigs, often suffer from congenital or acquired pathologies, so breeders often have a problem when a boar has a hernia in the testicle. What to do, in this case, will tell our article. In addition, we will help you deal with all other types of this pathology, because it can manifest itself in other parts of the body of pigs, regardless of gender and age.

The concept of hernia

A hernia most often appears in a young piglet; in adults, this ailment is recorded very rarely. Pathology is a displacement of internal organs under the skin or to other parts of the body. Attack can be congenital and acquired.

Congenital hernias in pigs appear due to abnormal intrauterine development of the fetus or in the case when the sows had a difficult birth. Acquired pathology can occur a few days after the birth of the baby.

The cause of the development of the disease is high intra-abdominal pressure. There are cases when the pressure in a pig normalizes by itself, and the hernia disappears. However, this phenomenon does not occur as often as we would like, so it is rare for breeders to hope for luck.

Classification of pathologies

Hernias in boars and pigs are classified according to several criteria and differ in certain indicators. They can be umbilical, perineal and inguinal.

The disease is classified into several groups. The most difficult is the lack of options for reducing the hernia. In other words, is it possible to treat the pathology or the boars need to be castrated, and the pigs should be put on meat at a certain age.

Congenital hernias appear in young individuals at birth or a few days after the start of life (2-3 days). Acquired pathologies are less common, and they are often caused by injuries that were inflicted on animals on purpose or involuntarily. Pig hits can receive:

stakes or other objects (most often the person is to blame for this);
when falling under a feeder or in a hole;
during a fight with relatives.

Hernias in piglets and adult pigs are also classified according to the state of the contents. Reducible hernias are mobile, that is, the formation can be displaced by palpation without causing pain to the animal. The breeder may notice a small pouch that is covered with skin, usually in the groin or abdomen.

Irreducible formations are considered very dangerous, hernias do not move, and when pressed on them, the pig experiences pain.

Pigs with an irreducible hernia are most often slaughtered as soon as the animal gains weight of 20-30 kg, because such an individual risks dying before reaching puberty. Piglets die due to the fact that relatives have an interest in sealing on the body of a sick animal. A strong blow is almost always fatal.

Umbilical hernia

Navel hernias appear, as a rule, in 2-3% of the total number of pigs. Animals suffering from this disease can be recognized by any experienced breeder, because the hernial sac is immediately visible on the body, in addition, such individuals do not gain weight well and often get sick. Often, these piglets are either rejected, or they themselves die due to infringement of the hernial contents.

Most often, umbilical hernia is fixed in boars, but pigs in some cases also suffer from this disease. This pathology is treated in a bloody and bloodless way.

The first method of getting rid of the disease involves surgery - the formation is removed. With bloodless treatment, the contents of the hernial sac are reduced. All actions can only be performed by a qualified veterinarian.

It is noted that in most cases, it is unprofitable to treat pigs with such a pathology, since the probability of recurrence is 50%.

Groin seals

Scrotal hernia occurs in male piglets and is considered the second most common. Most often, the disease is acquired and occurs when a certain muscle group of the animal is strongly compressed (for example, during a fight between young individuals).

The breeder is not able to treat such a disease on his own, so you always have to seek help from a veterinarian. The cost-effectiveness of performing manipulations is difficult to determine, since the doctor in most cases will suggest that the boar be castrated.

Castrated boars are also fattened and slaughtered at the appropriate time. They cannot cover pigs. At the same time, castration is considered a fairly fast process, the animal recovers within a few hours after the procedure and continues to lead a normal life.

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Indications. A hernia is a disease in which the entrails protrude through various openings along with the membrane lining them, with the integrity of the latter and the skin. Holes can be natural anatomical formations, such as the umbilical ring, inguinal canal, and also occur as a result of injuries, operations. In a hernia, there are: a gate, a bag and contents.

Hernial orifice is an opening through which, under the influence of various reasons, an organ or part of it (intestine, omentum) protrudes or exits. The size of the hernial orifice varies from a few centimeters to 20-30 cm or more (on the lateral abdominal wall). The edges of the hernial ring in the initial stage of their formation are elastic. Gradually they become coarse.

The hernial sac is the part of the lining that has come out through the hernial orifice.

Hernial contents are movable organs or parts of it located in the hernial sac.

Hernias are classified according to anatomical, etiological and clinical signs. Anatomical include inguinal, inguinal, scrotal, umbilical, lateral abdominal wall; etiological - congenital and acquired, the so-called postoperative, arising in various parts of the abdominal wall after laparotomy. Newly occurring after surgery in the same area of the hernia is called recurrent.

According to clinical signs, reducible and irreducible hernias are distinguished. The first group includes those whose contents of the hernial sac move freely from the abdominal cavity to the hernial sac and back; to the second - when, under the influence of various mechanical stimuli, aseptic inflammation occurs in the walls of the hernial sac and adhesions form. The latter fix the abdominal organs to the walls of the hernial sac, leading to a partial, and then to the occurrence of a completely irreducible hernia.

With complete irreducibility, the contents in the hernial sac are permanent and do not move into the abdominal cavity. This is most often observed with long-term and postoperative hernias.

A type of irreducible hernia is a strangulated hernia, when the organs that have entered the hernial sac are compressed in the neck of the hernial sac. At the same time, blood and lymph circulation is disturbed and there is a real threat of necrosis of the restrained organs. Any organs located in the hernial sac can be infringed: intestines, omentum, etc. The greatest danger is the infringement of intestinal loops.

When squeezing the vessels of the mesentery in the restrained loops, edema develops, then necrosis occurs. If timely assistance is not provided, the animal will die from intestinal obstruction and peritonitis.

Umbilical hernias, according to our data, are observed in 2-3% of piglets from the total number of animals. Piglets with such hernias lag behind in growth, often get sick and are prematurely culled. Sometimes they die from infringement of the hernial contents or prolapse of the intestine during ulceration and necrosis of the hernial sac.

It is noted that umbilical hernias in boars are recorded more often than in pigs. Both bloody and bloodless methods have been proposed for the treatment of these hernias. Bloody, in turn, are carried out without opening the hernial sac or it is opened and excised. Of particular interest in recent years is the bloodless method of surgery. So, F. A. Sunagatullin (1982) proposed to close the ring with a U-shaped seam. Animals are fixed in the dorsal position. The contents of the hernial sac are pushed into the abdominal cavity. Then, under the control of the finger, at a distance of 0.5-1 cm from the edge of the hernial ring, a needle is inserted through all layers, and it is withdrawn on the opposite side. Then, retreating 0.5-1 cm from the place of removal of the needle, this operation is carried out in the reverse order. If it is impossible to perform this manipulation in one step, it is done in two.

The umbilical opening with a diameter of 2-3 cm A. F. Burdenyuk (1986) also offers to close the bloodless method using a seam with rollers. After repositioning the contents into the abdominal cavity, the hernial sac is twisted and pulled away from the abdominal wall as much as possible. Then, stepping back from the edge of the hernial ring by 1-2 cm, all layers of the abdominal wall are pierced and the ligature is removed on the opposite edge. These methods, in our opinion, have a significant drawback, since it is very difficult to establish whether this hernia is reducible or irreducible by pressing on the hernial sac. With irreducible hernias, there is a risk of stitching intestinal loops together with the hernial sac and the occurrence of complications.

With bloody methods, a hernial opening with a small diameter is pulled together with a purse-string suture, which is passed through the abdominal wall without affecting the peritoneum. The desire to avoid opening the abdominal cavity underlies a number of other methods of herniotomy. For example, make a linear cut. The hernial sac is dissected and the contents are pushed into the abdominal cavity, twisted 2-3 times along the longitudinal axis, stitched with catgut and injected into the hernial ring. The edges of the hernial ring are brought together with interrupted sutures, imposed according to the type of Lambert's intestinal suture. The skin is sutured with knotted or looped sutures. These methods are relatively simple, but after their application, relapses often occur.