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.
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
Question: What is Inguinal Hernia Repair: What Does It Entail, What are the Benefits and Expected Outcomes?
1. **Overview of Inguinal Hernia:**
Inguinal hernia repair, generally performed by a surgeon, focuses on rectifying a weakness within the abdominal wall, specifically in the lower abdomen’s groin area. Typically affecting males, an inguinal hernia materializes when a portion of the intestines (small or rarely, the colon) or an organ protrudes through a tear or natural area of weakness in this abdominal wall. The outcome is a noticeable bulge on either side of the pubic bone.
2. **Underlying Causes & Risk Factors:**
Male anatomy poses a higher risk of inguinal hernias due to an inherent weakness in the groin region. Excessive pressure on the abdominal wall can intensify this weak spot and catalyze a hernia. Strenuous physical activities, straining during bowel movements, prolonged coughing, previous abdominal surgery, and even genetics contribute to this condition.
3. **Different Herniation Types:**
a) **Direct Inguinal Hernia:** It occurs when a protrusion pushes against the weak groin area. Typical in older adults, the herniated material bulges directly through this weak abdominal wall.
b) **Indirect Inguinal Hernia:** More common, especially in infants and young children, this occurs when the protrusion takes a different pathway, following the path taken by the spermatic cord (in males) or round ligament (in females) as they reach the scrotum or labia, respectively.
4. **Benefits of Inguinal Hernia Repair:**
Immediate advantages of undergoing an inguinal hernia repair include:
a) **Hernia Reduction:** The protruding organ or tissue is safely repositioned back into its original abdominal cavity.
b) **Reinforced Abdominal Wall:** By restoring the weakened abdominal wall to its former strength, the risk of further hernia formation is significantly reduced.
c) **Eradication of Pain:** Discomfort and pain stemming from the hernia are typically alleviated post-surgery.
d) **Prevention of Future Complications:** Addressing the hernia proactively can prevent serious consequences like bowel obstruction or strangulation, which can lead to severe pain, tissue damage, and increased risk of infection.
e) **Restored Quality of Life:** A successful repair facilitates daily activities without discomfort or the persistent fear of hernia worsening.
5. **Additional Considerations:**
a) **Elective Surgery:** An inguinal hernia repair is considered an elective procedure and, therefore, not immediately life-threatening. After consultation with your healthcare provider, a surgery date is scheduled at your convenience.
b) **Anesthesia:** Your surgeon will determine if general anesthesia (where you’re asleep during the surgery) or a local anesthetic (numbing just the area of the hernia repair) is appropriate for your case.
c) **Surgical Options:** Techniques vary according to individual patient factors. Open surgery typically involves a larger incision, whereas laparoscopic surgery opts for multiple smaller ones.
d) **Post-Surgery Recovery:** After surgery, recovery typically involves avoiding strenuous activities and lifting heavy objects. Discomfort is managed with medications, and sutures are usually removed within a week. Resuming work and regular routine may take a few days to a few weeks, depending on your overall health and the severity of the hernia.
6. **Expected Outcomes:**
a) **Minimized Risk of Further Hernias:** A proficient surgical repair practically eliminates the risk of hernia recurrence.
b) **Restored Comfort and Activity Level:** After healing, engaging in everyday tasks and even recreational activities is once again possible without experiencing pain or discomfort.
c) **Confidence Enhancement:** Many patients report an increase in self-assurance and confidence, facilitated by the repair’s successful correction of their hernia condition.