When tissue protrudes through a defect in the encapsulating walls, a hernia occurs. Hernia repair surgeries are a general option for such deformity. But even before undertaking a surgical repair, a manual reduction of the hernia usually pushes it back into its compartment. This mitigates any associated symptoms and helps avoid adverse outcomes of strangulation and any event of elective surgical repair.
The Reducible Hernia
If a hernia can be reduced manually, then it means that the contents can be returned back into their original chamber. With this procedure the patient achieves symptomatic relief and averts any future risks of strangulation. Long term management may always warrant a surgical repair. Treatment varies from patient to patient and sometimes a non-operative treatment may produce results similar to minimally symptomatic individuals who may even undergo surgical repair.
A manual reduction is indicated when there is a presence of a non-strangulated hernia. Most incarcerated hernias require a reduction even if there is no clinical evidence of strangulation. Strangulated hernias cannot be repaired with manual reduction. Fluid replacement and naso-gastric suctions are the viable options. It is extremely essential that a strangulated hernia is not missed. Otherwise it may result in the necrotic bowel being introduced into the abdomen and in consequence, a clinical deterioration that requires urgent reduction.
Manual reduction of hernias is an outpatient procedure. A cold compress or ice is applied for several minutes to reduce the swelling. All through the process, the patient is laid supine for an abdominal hernia and at a 20 deg. Trendelenburg position for a groin hernia as the gravity automatically helps the hernia to retract. Analgesia and sedation may be advised through the proceedings to reduce pain.
After this there is a 20 to 30 minutes’ wait. Most hernias reduced due to the application of a cold compress. It relaxes the muscles, reduces edema and due the gravity, the surrounding hernia retracts.
Pressure is slowly applied distal to the hernia. The proximal position is guided into the abdomen and both hands are used for guidance through the fascial defect with gentle pressure applied simultaneously. This takes about 15 minutes.
A truss may be recommended for closure of the fascial defect temporarily after successfully reducing the hernia.
An ultrasonography may be done to diagnose the presence of a hernia and determine its contents. It may also be used to aid in hernia reduction. For an ultrasound aided reduction a pair of high-frequency linear probes may be used in two-dimensional mode. A color Doppler helps in distinguishing between strangulation and incarceration. The point of maximal aperture of the inguinal canal is identified. The tissue is held perpendicular to the plane of maximal aperture. It is then guide through it and compressed from a distal point. The proximal end is directed through the aperture.