Inguinal hernia is a condition observed in individuals of all ages and genders, stemming from the weakening of the abdominal wall. It occurs when abdominal organs protrude through the weakened part of the abdominal wall in the groin area. In inguinal hernia, the hernia content can involve almost any organ.
A hernia is the term used when abdominal organs move through a defect in the abdominal wall and protrude onto the abdominal wall due to the formation of the defect. In the case of inguinal hernia, this occurs in the groin area due to a defect in the abdominal wall, and abdominal organs move outward, causing herniation.
It is commonly found in the groin area, often associated with situations that increase intra-abdominal pressure. The swelling diminishes when lying down but reappears when standing, particularly with increased intra-abdominal pressure. However, if left untreated, the swelling and appearance gradually worsen. It does not resolve on its own, and surgical intervention is the only treatment.
Inguinal hernias are more prevalent in males and constitute the majority of all hernias. It is a frequently encountered condition with a comfortable and effective treatment and postoperative period.
Inguinal hernia refers to hernias located in the groin area. Normally, there is anatomical weakness in this region even in the absence of increased intra-abdominal pressure. However, when intra-abdominal pressure rises, the abdominal muscles support this area, preventing hernia formation.
Several factors contribute to the development of inguinal hernia. These include chronic conditions such as persistent cough, chronic constipation, heavy lifting, trauma, advanced age (weakening and inadequacy of muscle tissue),and other factors that increase intra-abdominal pressure. The main mechanism here involves the increase in intra-abdominal pressure, causing the abdominal organs to exert pressure (strain) on the groin area.
Inguinal hernia can manifest as swelling in the groin area, often accompanied by pain. In some cases, depending on the size of the hernia, organs entering the hernia may become trapped even after abdominal pressure returns to normal, causing them to remain in the groin area.
In such situations, it leads to localized severe pain in the groin region. If a significant amount of time elapses without intervention, there may be a need for more serious surgical procedures due to compromised blood supply to the trapped organs. Urgent surgical intervention is typically required in both scenarios.
In cases where such complications are absent, patients often complain of localized pain in the hernia area. This pain is especially noticeable during prolonged standing and exertion, accompanied by a sense of pressure in the groin area and pain radiating down the leg. Patients frequently describe the hernia disappearing and the pain subsiding when lying down.
Direct Inguinal Hernia: This form of hernia occurs when there is a direct protrusion of the weakened abdominal wall towards the groin.
Indirect Inguinal Hernia: In males, this type involves the passage of blood vessels, nerves, and reproductive channels that extend to the testicle, exiting through the canal and progressing to the testicle. It then emerges from the opening, leading to the expansion of the space from where it exits into the abdominal cavity. The hernia is formed as abdominal organs follow this pathway onto the abdominal wall.
Femoral Inguinal Hernia: These hernias emerge from the edge of the structure formed by nerves and vessels going to the leg.
Surgical treatment is the primary option for addressing these hernias, and the surgical approach is generally similar. One widely accepted method for the surgical treatment of inguinal hernias involves the use of synthetic materials known as patches to reinforce the hernia area. The aim is to reduce the risk of recurrence (reappearance) of the hernia with the use of these materials.
Some hernias may be asymptomatic and are detected during routine check-ups. They are characterized by swelling in the groin area, and there may be pain and burning sensations. Any condition that increases intra-abdominal pressure can exacerbate the pain. While the diagnosis is typically made through physical examination, ultrasound of the area can also aid in diagnosis.
Factors such as hereditary causes, connective tissue weakness, aging, excessive weight gain, heavy lifting, constipation, chronic cough, pregnancy, and familial predisposition can contribute to the development of inguinal hernia. The entry and entrapment of organs into the hernia sac in the formation of inguinal hernia can create serious problems, necessitating urgent surgery. The goal here should be to repair the hernia without the need for advanced surgical intervention before it becomes an emergency situation.
The treatment for inguinal hernia is surgical. Inguinal hernia surgery aims to place the herniated organs back into the abdominal cavity, eliminate the formed hernia sac, repair the gap causing the hernia, and prevent recurrence by using a patch. The surgery can be performed using either open or laparoscopic methods. The likelihood of recurrence is lower when the surgery is performed by experienced hands.
The procedure is carried out under general or local anesthesia and typically lasts around 30-40 minutes. Patients are usually discharged on the same day or the day after the surgery. Stitch removal is generally not required, and patients can take a shower the day after discharge. The return to social activities is rapid.
Inguinal hernia surgery can be conducted under general anesthesia, spinal anesthesia, or even local anesthesia. The surgical approach may be either open or laparoscopic, with the goal in both cases being hernia repair and reinforcement using a patch.
The duration of inguinal hernia surgery typically lasts around 40-60 minutes. Patients are usually discharged on the same day or, at the latest, the day after the surgery. After discharge, patients are encouraged to take a shower the next day, and there is no need for stitch removal as all stitches are closed aesthetically.
Patients are advised to avoid activities that increase abdominal pressure and exertion for about 2-3 months after the surgery. However, there are no restrictions on walking, driving, or traveling. The return to social activities is rapid.
Inguinal hernia surgery, like any surgery, carries certain risks similar to other surgical procedures. The risks of inguinal hernia surgery include:
It's important to note that with experienced medical professionals and well-prepared patients, the occurrence of these risks is very low.
Inguinal hernia surgery is one of the most commonly performed types of surgery within the field of general surgery. Consequently, there are numerous experienced surgeons who specialize in this type of operation. While the surgery may present some challenges for the patient, it typically lasts an average of 40-50 minutes, and the return to social and work activities takes around 5-6 weeks.
Pain experiences can vary based on the individual pain threshold of the patient, with most pain occurring in the early postoperative period. Pain medication is generally effective, and the discomfort diminishes over time. In summary, inguinal hernia surgery is considered a relatively easy and comfortable procedure for the patient.
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Prof. Dr. Sezai AydınGeneral Surgery Turkey
PROF. DR. SEZAI AYDIN
