Definition & Overview

Hernia is a common medical issue that occurs when an internal part of the body pushes through its surrounding wall due to the development of weak spots in the surrounding muscles.

There are different types of hernias that are named based on the body part where they developed, and these include umbilical, femoral, and hiatus hernias. An inguinal hernia refers to the one that causes a painful lump or swelling in the groin area. The lump becomes more visible and painful when the patient lifts something up.

Who Should Undergo and Expected Results

It is important to note that not all inguinal hernias require surgical intervention. However, if the condition causes pain, other severe and persistent symptoms, and other serious complications, a surgical repair is usually recommended.

The procedure is mainly performed on men, as they are the ones who are particularly vulnerable to inguinal hernias. The problem is supposedly linked with ageing, as the muscles in the abdomen tend to lose their strength and tautness as a person gets older. Complicated inguinal hernias are also more likely to affect men who often place a lot of pressure on the abdomen, such as those who suffer from persistent or chronic cough problems and who usually push or carry heavy loads.

An inguinal hernia, when left untreated, can lead to:

  • Obstruction, or when a part of the bowel becomes stuck in the inguinal canal

  • Strangulation, or when a part of the bowel becomes trapped in the canal, causing blood supply to be cut off

Obstructed bowels can cause nausea, vomiting, stomach pain, and a painful lump in the groin area. Strangulation, on the other hand, is a more serious problem that requires emergency surgery.

A surgical inguinal hernia repair can remove the hernia and fix the weak spot in the muscle wall. This effectively relieves pain and other symptoms, as well as prevents serious complications from occurring.

How is the Procedure Performed?

An inguinal hernia repair can be performed either through traditional open surgery or the use of laparoscopy.

A traditional open surgery involves making one large incision down the abdomen to gain access to the hernia so the surgeon can easily push the lump back into its proper place.

A laparoscopic surgery, on the other hand, is a minimally invasive option that eliminates the need for a large incision. Although safer and associated with fewer risks, this option is deemed more difficult to perform and thus requires expertise from the surgeon. During the procedure, the surgeon makes several smaller cuts in various selected spots in the abdomen. The cuts are just big enough to accommodate a thin hollow tube through which the surgeon passes special surgical instruments needed to perform the procedure. The laparoscopic option minimises bleeding and scarring and also shortens the recovery time.

After a laparoscopic inguinal hernia repair, the patient can go home on the same day or the day after the procedure. To prevent post-surgical complications, patients are advised to eat a healthy diet to prevent constipation and to avoid straining the abdominal region.

The recovery period lasts for around six weeks, but most patients are able to return to light activities within just 2 weeks following the surgery.

Possible Risks and Complications

Due to the large number of people who suffer from an inguinal hernia, its corresponding surgical repair procedure is considered as a common routine surgery. It is ruled as relatively safe with few associated risks. These risks, which rarely occur, include:

  • Blood or fluid buildup in the space vacated by the hernia

  • Residual swelling and bruising in the groin

  • Nerve damage or trapped nerve, causing numbness in the groin

  • Damage to the testicle blood supply

  • Damage to the vas deferens

  • Recurrence of hernia

Studies show that as many as 15 percent of patients who undergo treatment for inguinal hernia experience recurrence after the surgery, and in about 4% of these patients, the hernia comes back within three years after the procedure. However, according to some reports, the use of tension-free surgical repair involving a prosthetic mesh helps reduce the risk of recurrence down to just 5 percent.

References:

  • Neumayer L., Giobbie-Hurder A., Jonasson O., et al. “Open mesh vs. laparoscopic mesh repair of inguinal hernia.” N Engl J Med 2004; 350:1819-1827. http://www.nejm.org/doi/full/10.1056/NEJMoa040093#t=article

  • Forbes J., Fry N., Hwang H., Karimuddin A. “Timing of return to work after hernia repair: Recommendations based on a literature review.” BCMJ 2012; 54(7):341-345. http://www.bcmj.org/articles/timing-return-work-after-hernia-repair-recommendations-based-literature-review

  • Panchoii M., Sharma P., Patel GR. “Retrospective study of repair of inguinal hernia by various methods of surgery, comparing their results and rate of complications in the teaching institute of south Gujarat.” http://medind.nic.in/gaa/t12/i2/gaat12i2p22.pdf

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