The most widespread hernia type is the inguinal hernia that appears in the area of the groin. This medical condition appears when an intestine’s section pushes through an inguinal canal’s weak spot.
Some common characteristics of inguinal hernias are:
• Inguinal hernias present typically as a bulge that is painful and appears in the region of the groin. They can also extend in males into the scrotum.
• Groin hernias are rare in women and for this reason their diagnosis is often misdiagnosed as gynaecologic pain or missed. In order to provide a clear diagnosis in case of inguinal hernias in women are often necessary imaging studies.
• It is not necessary to repair all inguinal hernias. However, surgery is necessary in all hernia repairs. Not strangulated small hernias do not necessarily need emergency surgical repair or surgery in general. These small hernias are just blocking the supply of blood to the intestine, but they are not causing significant pain or bowel obstruction.
Inguinal hernia can be repaired by performing a surgery operation in order to fix the damage in your groin. The bulging tissue will be pushed back in during the surgical procedure. The abdominal wall is supported with stitches (sutures), and sometimes with mesh, in order to strengthen it. This repair procedure can be done with either laparoscopic surgery or open surgery. The surgeon will discuss with you the best suitable type of surgery in your case.
Your surgeon will also decide the type of anesthesia you will need:
• Medicine to relax you and local anesthesia
• Regional anesthesia will numb you from the waist to feet
• General anesthesia will keep you pain free and asleep
In case of an open surgery procedure to repair your inguinal hernia:
• A cut near the hernia is made by the surgeon.
• The hernia is separated from the surrounding tissues. The hernia is gently pushed back into your abdomen or the hernia sac is removed.
• Your weakened abdominal muscles will be closed by the surgeon with stitches.
• In order to strengthen your abdominal wall, a piece of mesh is often sewn into place. This strengthens the wall of your abdomen.
• The cuts are stitched closed at the end of the hernia repair.
In case of the laparoscopic surgical procedure:
• Three to five small cuts are made by the surgeon in your lower belly.
• A laparoscope medical device is inserted into your abdomen through one of the cuts. This is a lighten and thin tube that features a camera on the end. It has the role to help seeing inside your abdomen.
• Through the other cuts are inserted some other tools. These tools are used by the surgeon to fix the inguinal hernia.
• The surgeon performs the same repair as in open surgery.
• The tools and laparoscope are removed at the end of the repair. The cuts are closed with stitches.
The hernia surgery procedure is performed if your hernia bothers you or if you have pain during everyday activities. In case that your hernia is not causing many problems, the surgery may not be necessary. Usually, the outcome of the hernia repair surgery is very good.
How Do I Know If I Have An Inguinal Hernia?
- The common areas where hernias occur are in the groin (inguinal), belly button (umbilical), and the site of a previous operation (incisional).
- It is usually easy to recognise a hernia. You may notice a bulge under the skin. You may feel pain or discomfort when you lift heavy objects, cough, strain during urination or bowel movements, or during prolonged standing or sitting. Other times a hernia may be detected by your doctor on a routine physical examination.
- The pain may be sharp and immediate or a dull ache that gets worse toward the end of the day.
- Severe, continuous pain, redness, and tenderness are signs that the hernia may be entrapped or strangulated. Another sign of this is if the bulge used to come and go, but now is stuck out. These symptoms are cause for concern and you should immediately contact your physician or surgeon.
What Causes an Inguinal Hernia?
The wall of the abdomen has natural areas of potential weakness. Hernias can develop at these or other areas due to heavy strain on the abdominal wall, aging, injury, an old incision or a weakness present from birth. Anyone can develop a hernia at any age. Most hernias in children are congenital. In adults, a natural weakness or strain from heavy lifting, persistent coughing, difficulty with bowel movements or urination can cause the abdominal wall to weaken or separate.
What are the Advantages of Laparoscopic Inguinal Hernia Repair?
Laparoscopic Hernia Repair is a technique to fix tears in the abdominal wall (muscle) using small incisions, telescopes and a patch (mesh). Laparoscopic repair offers a shorter return to work and normal activity for most patients.
Are You a Candidate for Laparoscopic Inguinal Hernia Repair?
Only after a thorough examination can your surgeon determine whether laparoscopic hernia repair is right for you. The procedure may not be best for some patients who have had previous abdominal surgery, prostate surgery, or underlying medical conditions.
How is the Procedure Performed?
There are few options available for a patient who has a hernia.
- Use of a truss (hernia belt) is rarely prescribed as it is usually ineffective. It may alleviate some discomfort, but will not prevent the possibility of bowel incarceration or strangulation.
- Most hernias require a surgical procedure.
Surgical procedures are done in one of two fashions:
- The open approach is done from the outside through a three to four inch incision in the groin or the area of the hernia. The incision will extend through the skin, subcutaneous fat, and allow the surgeon to get to the level of the defect. The surgeon may choose to use a small piece of surgical mesh to repair the defect or hole. This technique can be done with a local anaesthetic and sedation, using a spinal anaesthetic or a general anaesthetic.
- The laparoscopic hernia repair is done with the use of a laparoscope (a tiny telescope) connected to a special camera is inserted through a cannula, a small hollow tube, allowing the surgeon to view the hernia and surrounding tissue on a video screen.
Other cannulas are inserted which allow your surgeon to work “inside.” Three separate quarter inch incisions are usually necessary. The hernia is repaired from behind the abdominal wall. A small piece of surgical mesh is placed over the hernia defect, and it may be fixed in place using staples, adhesive sealant, or sutures. This operation is usually performed with general anaesthesia.
What Happens if the Operation Cannot Be Performed or Completed by the Laparoscopic Method?
In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the “open” procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualise organs or bleeding problems during the operation.
The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather good surgical judgment.
The decision to convert to an open procedure is strictly based on patient safety.
What Should I Expect after Surgery?
- Following the operation, you will be transferred to the recovery room where you will be monitored for 1-2 hours until you are fully awake.
- Once you are awake and able to walk, drink liquids, and urinate, you will be sent home.
- With any hernia operation, you can expect some soreness mostly during the first 24 to 48 hours.
- You are encouraged to be up and about the day after surgery.
- With laparoscopic hernia repair, you will probably be able to get back to your normal activities within a week. These activities include showering, driving, walking up stairs, lifting, working and engaging in sexual intercourse.
- Call and schedule a follow-up appointment within 2 weeks after you operation.
What Complications Can Occur?
- Any operation may be associated with complications. The primary complications of any operation are bleeding and infection, which are uncommon with laparoscopic hernia repair.
- There is a very low risk of injury to the urinary bladder, the intestines, blood vessels, nerves or the sperm tube going to the testicle.
- Difficulty urinating after surgery can occur and may require placement of a catheter, or tube to drain the bladder after surgery. You should ask your surgeon about ways to prevent this from occurring before your operation.
- Bruising and swelling of the scrotum, the base of the penis, and the testicles is not uncommon with open and laparoscopic repair. This will gradually resolve on its own in the vast majority of patients.
- Any time a hernia is repaired it can come back. This long-term recurrence rate is low in patients who undergo laparoscopic repair by an experienced surgeon. Your surgeon will help you decide if the risks of laparoscopic hernia repair are less than the risks of leaving the condition untreated.
- It is important to remember that before undergoing any type of surgery–whether laparoscopic or open–you should ask your surgeon about his/her training and experience with the operation.
When to Call Your Doctor
Be sure to call your physician or surgeon if you develop any of the following:
- Persistent fever over 39 C
- Increasing abdominal or groin swelling
- Pain that is not relieved by your medications
- Persistent nausea or vomiting
- Inability to urinate
- Persistent cough or shortness of breath
- Foul smelling drainage (pus) from any incision
- Redness surrounding any of your incisions that is worsening or getting bigger
- You are unable to eat or drink liquids