Inguinal hernia

What is an inguinal hernia ?

An inguinal hernia is a weakness of the lower abdominal wall in the groin.

As a result of the weakening of the abdominal wall, intra-abdominal structures (abdominal fatty tissue, bowel, bladder…) may migrate outside the abdomen into the groin or scrotum. Depending on which intra-abdominal structure migrates, different symptoms may occur. Not all hernias are accompanied by symptoms.

Symptoms

• Non-painful inguinal swelling.
• Painful inguinal swelling with or without vomiting: obstruction, trapped small or large intestine with or without necrosis (death of the intestine).
• Internal pain: pinched intra-abdominal fat in groin opening.
• Discomfort with walking or physical exertion.

– Avoid forceful physical activities.

– If you are overweight, you are advised to lose weight.

– An inguinal belt can sometimes relieve discomfort temporarily.

• If painful swelling develops in the groin area, which does not subside spontaneously. We recommend that, in a lying position, you try to relax and try to reduce the hernia with gentle but constant backward pressure on the swelling towards the abdomen.
• If you succeed in reducing the hernia, you should contact your surgeon as soon as possible.
• If you fail to reduce the hernia, you should go to the emergency room or contact your surgeon.

There is no single explanation for the development of a hernia, but there are many factors, which are not all known nor understood :

• Smoking: This weakens the molecules (collagen) that gives strength to all tissues.
• Genetics: Some families have weaker tissues.
• Rare genetic disease: Marfan syndrome, Ehlers-Danlos syndrome.

No.

• No, the opening will not close on its own.

Whenever the pressure in the abdomen is increased (coughing, lifting a heavy weight or physical exertion), the pressure will try to escape through the opening, the point with the least resistance. As a result the opening will more often widen over time.

If the hernia is symptomatic, surgery is suggested. Unless the patient’s general condition does not allow surgery.

If the hernia is asymptomatic, the decision depends on the patient’s age, general health and physical activity.

• To a young, active patient, surgery will be suggested.
• To an older, sedentary (not very active) patient, a non surgical approach will be recommended as long as there are no symptoms.

No.

• The nerves that enable erections are not located in the surgical area during inguinal hernia repair.

No.

• During inguinal hernia repair, the woman’s reproductive organs are not in the surgical area.

Open inguinal hernia repair with a mesh according to “Lichtenstein”

Surgery with a classic skin incision. The mesh is placed behind the first superficial muscle (external oblique abdominal muscle) in the inguinal canal. The prosthesis is attached to the inguinal ligament in the groin.

The main advantage of this technique is the possibility of performing this operation under regional anesthesia or epidural anesthesia.

See surgery: “Lichtenstein”

The operation is performed with small incisions (less painful). A gas (CO2) is blown through these small holes and a space is created between the peritoneum and the back of the abdominal muscles. In this space, inguinal hernias can be repaired by covering the inguinal holes with a mesh which rests against the back of the abdominal wall.

The advantage of this technique is that it is less painful and therefore  the postoperative recovery is faster than with open surgery. The scars are smaller. The operation is always performed under general anesthesia.

See surgical procedure: “Laparoscopy”