Inguinal Hernia (Groin Hernia)

A hernia is the protrusion of an organ or part of an organ through an abnormal opening usually a defect in the walls of its cavity. The inguinal hernia is the result of the protrusion of the intestine into the inguinal canal and it is mainly seen in males because the inguinal canal is the path for testicular descent in the early years.

1. Inguinal Hernia: Causes, Types, and Surgical Management

It mainly results from congenital defects of the abdominal wall, anything that increases the intraabdominal pressure, or weakened abdominal musculature such as collagen deficiencies. The inguinal hernia can be of two types, direct (common in the old people) and indirect hernias (common in young people). Any hernia can strangulate.

Any hernia can strangulate. Treatment surgery is the treatment choice for hernias is surgery, which can either be open or laparoscopic. The operation entails opening the hernial sac and reducing the contents into the abdominal cavity then fixing the internal ring of the inguinal canal to prevent a repeat of the hernia occurrence. Herniorrhaphy can also be done to repair the defects of the abdominal wall. Often these two procedures are done together. Hernioplasty is an additional operation that can be done to the herniotomy to reinforce the internal inguinal ring with a mesh fiber.

2. Indications

Any person with the clinical signs of a bulging inguinal canal mass that can be symptomatic or not and confirmed by radiological investigations (abdominal ultrasound) to be an inguinal hernia.

3. How is this procedure done?

An adult can either be put under local anesthesia, general anesthesia or even the epidural for this operation. The three types of surgeries to correct the inguinal hernia strongly depend on the age status and the fitness of the patient

Herniotomy- this simply involves the opening the hernial sac and reducing the contents into the abdominal cavity. It is done in those whose musculature is intact such as small children. It is indicated for indirect hernias
Herniorraphy- this involves two-steps 1. Involves the opening the hernial sac and reducing the contents into the abdominal cavity (herniotomy) and Step2. Repairing of the posterior wall of the inguinal canal. It is indicated for small hernias.
Hernioplasty- This procedure is almost similar to the Herniorrhaphy, but instead of the repair of the posterior wall, it employs the use of a meshwork fiber to reinforce the wall. It is done in those whose musculature is sloppy especially the elderly and the debilitated. It is also indicated in large hernias.
A modern approach which is minimally invasive is through the laparoscope.

4. Risk of this procedure

Necrosis of the testicles.
If the appropriate procedure is not followed, the blood supply to the testis might get interfered with. The testicular involvement should be checked postoperatively to confirm the blood supply is still intact.
Chronic nerve pain
might result as a result of pinching of the nerves during suturing. Great care should be taken to avoid this.
Infection
of the surgical site, especially if aseptic conditions are not maintained during the procedure.

5. Getting ready for the procedure

The doctor should have assessed if you are fit for surgery. This would include the imaging studies carried out such as the ultrasound scan. Monitoring of the vital signs such as blood pressure and blood tests such as the full haemogram should also be doneFasting for at least 8-12 hours of no food or water before the surgery. This helps to minimize the complications of anesthesia. An intravenous line is inserted preoperatively as it is required to feed the required drugs into the body system of the patient. A water drip may or may not be employed.

6. Recovery after surgery

The recovery is normally smooth for the inguinal hernia, often with same-day discharge. The patient is encouraged to ambulate early to prevent complications such as clot formation and to encourage faster recovery process. Thromboprophylaxis can be given in patients who are expected to have prolonged immobility postoperatively. The dressings and the stitches on the patient are removed in a week. Advice should be given to avoid any strenuous activities before complete healing and a diet that is protein-laden to facilitate the healing process and repair of the body tissues. The patient should be fully well and return to normal functioning in about two months.

7. Outcomes

Inguinal repair surgery is one of the most common surgeries done in the world. The surgery normally goes through successfully and easily without any complications. Patients are advised to avoid strenuous activities post-surgery like lifting weights and heavy items for about 6 weeks post the surgery.

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