INGUINAL HERNIA

Introduction

Hernia is a common condition in which organs of the body move to an area where they should not be physiologically. In inguinal hernia, the contents of the abdominal cavity (mainly preperitoneal fat, mesentery or the entire intestinal loops) are displaced into the inguinal canal. With large, long-developing hernias in men, the intestinal loops may move along the inguinal canal to the scrotum, causing it to significantly enlarge.

Causes

The causes of inguinal hernia can be divided into dependent and independent of the patient. The reasons beyond the patient’s control include genetic predisposition, the quality of collagen, the main component of the connective tissue which gives strength to the abdominal wall, the ratio of type I to type III collagen. Patient-dependent causes include chronically increased abdominal pressure due to, for instance, hard physical work, lifting weights or persistent coughing (hernias are more common in asthmatics). Sometimes, hernia develops in patients not burdened with the above risk factors.

Symptoms

A lump, prominence or bulge, that comes and goes and is located in the groin area, is often the first symptom of inguinal hernia. Additionally, hernia may be accompanied by pain or discomfort, such as burning, pulling or gentle pricking. Pain usually occurs with exertion, standing or walking for a long time. Incarceration, or a situation in which the contents of hernia become blocked in the canal and immobile, is a dangerous complication of inguinal hernia. It causes swelling, blood circulation disorders, and in the worst case, necrosis and perforation of the intestinal wall inside hernia. It is a life-threatening condition requiring emergency surgical intervention. This is why a surgery performed at an early stage of hernia development is the preferred method of treatment to prevent serious and dangerous complications.

Diagnosis

In order to diagnose inguinal hernia, it is necessary to take detailed medical history and perform a thorough physical examination. Sometimes, additional examinations, for example, ultrasound is needed.

Treatment

The treatment is based on a surgical reduction of hernia back into the abdominal cavity and strengthening the abdominal wall to prevent hernia from recurring. The strengthening is possible not only by suturing the defect, but also by implanting a special mesh that makes the wall stronger and reduces the possibility of recurrence. The mesh is made of a fully biocompatible material to avoid rejection by the patient’s body.

Type of operation

The procedure can be performed using the classic method (the so-called Lichtenstein repair) with a small, about 8 cm incision made in the groin – this place is very easy to hide under underwear – practically invisible. Laparoscopic surgery is an alternative method, which is a bit more technically complicated. It is the method of choice for patients who have previously undergone the Lichtenstein repair. Here, instead of a scar in the groin, the patient has 3 or 4 small (about 1 cm) incisions made on the abdominal integument through which laparoscopic instruments are inserted.

Postoperative period

In most cases, inguinal hernia surgery is a one-day procedure. This means that the patient is admitted to the Ward in the early morning, on the day of the procedure, operated on the same day, and discharged home in the evening. The patient leaves the hospital on his/her own, being practically fully functional. In some cases, there is a need to stay in the hospital for one night for observation.

The recovery period takes about a month. It is important to avoid strenuous exercises. Lifting heavy objects is also contraindicated. During this period, the patient is fully fit and, apart from avoiding heavy physical exertion, can perform normal daily activities.

In the Szpital Zakonu Bonifratrów, inguinal hernia operations are performed by doctors from the Department of General and Oncological Surgery.