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Inguinal Hernia

Definition


Disease: Inguinal Hernia Inguinal Hernia
Category: Surgical diseases
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Disease Definition:

Inguinal hernias occur when soft tissue — usually part of the intestine — protrudes through a weak point or tear in the lower abdominal wall. The resulting bulge can be painful — especially when the patient coughs, bends over or lifts a heavy object.

Not necessarily dangerous in themselves, inguinal hernias can lead to life-threatening complications. For this reason, the doctor is likely to recommend surgical repair of an inguinal hernia that’s painful or becoming larger.
Today’s hernia surgery isn’t the same that our fathers may have had — with a large abdominal incision, a long hospital stay and weeks of immobility. Instead, many inguinal hernias now can be successfully repaired with a technique that uses several small incisions, leading to a faster, less painful recovery.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Some inguinal hernias don’t cause any symptoms, and one may not know they have one until the doctor discovers it during a routine medical exam. Often, however, one can see and feel the bulge created by the protruding intestine. The bulge is usually more obvious when the patient stands upright, especially if they cough or strain.
Inguinal hernia signs and symptoms include:

 

  • A bulge in the area on either side of the pubic bone
  • Pain or discomfort in the groin, especially when bending over, coughing or lifting
  • A heavy or dragging sensation in the groin
  • Occasionally, in men, pain and swelling in the scrotum around the testicles when the protruding intestine descends into the scrotum

 

Signs and symptoms in children
About five in every 100 children have inguinal hernias. Inguinal hernias in newborns and children result from a weakness in the abdominal wall that’s present at birth. Sometimes the hernia may be visible only when an infant is crying, coughing or straining during a bowel movement. In an older child, a hernia is likely to be more apparent when the child coughs, strains during a bowel movement or stands for a long period of time.
Someone should see a doctor if they have a painful or noticeable bulge in the area on either side of the pubic bone. The bulge is likely to be more noticeable when they’re standing upright, and the patient usually can feel it if they put their hand directly over the affected area.


One should be able to gently and easily push the hernia back into the abdomen when they’re lying down. If not, applying an ice pack to the area may reduce the swelling enough so that the hernia slides in easily. Lying with the pelvis higher than the head also may help.
If the patient is still not able to push the hernia in, the herniated intestine may have become trapped (incarcerated) in the abdominal wall — a serious condition that may require immediate medical attention. This condition may be accompanied by nausea, vomiting or a fever, and a hernia bulge that turns red, purple or dark. If any of these signs or symptoms occur, call the doctor right away.

Causes:

Some inguinal hernias have no apparent cause. But many occur as a result of:

 

  • Increased pressure within the abdomen
  • A pre-existing weak spot in the abdominal wall
  • A combination of the two

 

In many people, the abdominal wall weakness that leads to an inguinal hernia occurs at birth when the abdominal lining (peritoneum) doesn’t close properly. Other inguinal hernias develop later in life when muscles weaken or deteriorate due to factors such as aging, strenuous physical activity or coughing that accompanies smoking.
In men, the weak spot usually occurs along the inguinal canal. This is the area where the spermatic cord, which contains the vas deferens, the tube that carries sperm, enters the scrotum.
In women, the inguinal canal carries a ligament that helps hold the uterus in place, and hernias sometimes occur where connective tissue from the uterus attaches to tissue surrounding the pubic bone.


More common in men
Men are more likely to have an inherent weakness along the inguinal canal because of the way males develop in the womb. In the male fetus, the testicles form within the abdomen and then move down the inguinal canal into the scrotum. Shortly after birth, the inguinal canal closes almost completely, leaving just enough room for the spermatic cord to pass through, but not large enough to allow the testicles to move back into the abdomen.
Sometimes, however, the canal doesn’t close properly, leaving a weakened area. There’s less chance that the inguinal canal won’t close after birth in female babies. In fact, women are more likely to develop hernias in the femoral canal, an opening near the inguinal canal where the femoral artery, vein and nerve pass through.
Weaknesses can also occur in the abdominal wall later in life, especially after an injury or certain operations in the abdominal cavity.
Whether or not someone has a pre-existing weakness, extra pressure in the abdomen can cause a hernia. This pressure may result from:

 

  • Straining during bowel movements or urination
  • Heavy lifting
  • Fluid in the abdomen (ascites)
  • Pregnancy
  • Excess weight


Even chronic coughing or sneezing can cause abdominal muscles to tear.

Complications

Complications:

Most inguinal hernias enlarge over time if they’re not repaired surgically. Large hernias can put pressure on surrounding tissues — in men they may extend into the scrotum, causing pain and swelling.
But the most serious complication of an inguinal hernia occurs when a loop of intestine becomes trapped in the weak point in the abdominal wall (incarcerated hernia). This may obstruct the bowel, leading to severe pain, nausea, vomiting and the inability to have a bowel movement or pass gas.
It can also diminish blood flow to the trapped portion of the intestine — a condition called strangulation — that may lead to the death of the affected bowel tissues. A strangulated hernia is life-threatening and requires immediate surgery.

Treatments:

If the hernia is small and isn't bothering, the doctor may recommend a watch-and-wait approach. But enlarging or painful hernias usually require surgical repair to relieve discomfort and prevent serious complications. There are two general types of hernia operations:


Herniorrhaphy: In this procedure, the surgeon makes an incision in the groin and pushes the protruding intestine back into the abdomen, then repairs the weakened or torn muscle by sewing it together. After the operation, the patient will be encouraged to move about as soon as possible, but it may be as long as four to six weeks before they are able to fully resume normal activities.


Hernioplasty: In this procedure, which is something like patching a tire, the surgeon inserts a piece of synthetic mesh to cover the entire inguinal area, including all potential hernia openings. The patch is usually secured with sutures, clips or staples. Hernioplasty can be performed conventionally, with a single long incision over the hernia. But it's often done laparoscopically, using several small incisions rather than one large one. A fiber-optic tube with a tiny camera is inserted into the abdomen through one incision, and miniature instruments are inserted through the other incisions. The surgeon then performs the operation using the video camera as a guide.


Advantages of laparoscopic repair include less discomfort and scarring after surgery and a quicker return to normal activities — most people are back to work within a few days. The procedure is a good choice for people whose hernias recur following traditional hernia surgery because laparoscopic methods allow surgeons to work around scar tissue from earlier repair. It's also good for people who have hernias on both sides of the body (bilateral inguinal hernias).


Disadvantages of laparoscopic repair include an increased risk of complications and of recurrence following surgery. These risks are reduced if the procedure is performed by a surgeon with extensive experience in these kinds of repairs.
One may not be a candidate for laparoscopic hernia repair if they have a very large hernia, if the intestine is pushed down into the scrotum or if they've had previous pelvic surgery such as a prostatectomy.

Prognosis:

Not Available

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