A hernia occurs when an internal part of the body pushes through a weak place in the surrounding connective tissue or muscle wall. Hernias typically don’t get better by themselves, they get worse, which is why doctors usually recommend surgery.
What is an inguinal hernia?
A hernia occurs when an internal part of the body (fatty tissue or an organ) pushes through a weak place in the surrounding connective tissue or muscle wall. Most hernias aren’t immediately life threatening, but they don’t go away on their own. Surgery is usually recommended to prevent dangerous complications.
Hernias can occur in different parts of the body, usually between the chest and hips. Inguinal hernias are the most common type of hernia and mainly affect men. They occur when fatty tissue or a part of the intestines push through the lower abdominal wall and into the inguinal canal in the groin.
Causes and symptoms of inguinal hernia.
Hernias can be congenital (a person can be born with them) or acquired (developed throughout life). Inguinal hernias are the most common, and approximately 25% of men will suffer one at some point in their life. It is most often associated with ageing and repeated strain on the lower abdomen.
Symptoms vary, can come and go, and some hernias display no symptoms at all. Nevertheless, the most common symptom of inguinal hernias is the presence of a lump next to the pubic bone or inside the scrotum. This mass can be moved when prodded, or may disappear when the patient lies down. Other symptoms include pain or pressure in the groin.
Possible complications of an inguinal hernia include organ obstruction or strangulation, both of which are medical emergencies. Symptoms for this include the hernia becoming firm or tender, severe abdominal pain, the patient is vomiting or has difficulty passing wind or poo.
Types of inguinal hernia surgery.
As mentioned earlier, hernias typically don’t get better by themselves, and elective surgery is usually recommended. The underlying goal of the operation is to return the astray tissue or organ to its rightful place and prevent it from protruding again in the future.
Surgical repair of inguinal hernias is one of the most commonly performed operations in the world. Surgical techniques fall into two broad categories: open and laparoscopic.
- -Open surgery is the more “traditional” option. It involves a relatively large incision (between 7 and 10cm) so that the surgeons can gain easy access to the area. It can be performed under local anaesthesia.
- -By contrast, laparoscopic (also called keyhole) surgery is minimally invasive, involving a few 5-10mm incisions. A thin tube containing a light source and a camera (laparoscope) is inserted through one of these incisions and surgical instruments are inserted through the other ones. It requires general anaesthesia.
Laparoscopic hernia surgery can be subdivided into 2 types: TAPP (transabdominal preperitoneal) and TEP (total extraperitoneal). Totally extraperitoneal surgery is the newest keyhole technique and involves repairing a hernia without entering the peritoneal cavity.
Nowadays, laparoscopic techniques are gaining in popularity as they require smaller incisions. They also result in less bleeding, lower infection rates, faster recovery, shorter hospitalisation periods, and reduced pain. Nevertheless, while the benefits of laparoscopic surgery are clear, there is technically no “best” method as both open and laparoscopic approaches have their respective strengths, and every patient should be evaluated on a case-by-case basis.
According to recent 2019 medical publications by the Hernia Surge Group (Hernia. 2018 Feb;22(1):1-165. doi: 10.1007/s10029-017-1668-x), laparoscopic inguinal hernia surgery is recommended when the patient:
- -has endured past recurrent hernias and operations, and especially if these were performed via open surgery.
- -suffers from bilateral inguinal hernias (left and right simultaneously).
- -requires a quick post-operative recovery and return to work.