Inguinal Hernia

With the term inguinal hernia we mean the projection of the contents of the abdomen (most commonly omentum or bowel) through a gap in the abdominal wall in the inguinal region. An inguinal hernia can occur in only one groin (unilateral) or in both at the same time (bilateral). It accounts for 90% of all hernias and is the most common cause of surgical treatment in the field of General surgery. Globally more than 20 million operations are performed annually for inguinal hernia repair. It occurs in 90% of men and only 10% of women.

It is estimated that 27% of men will experience an inguinal hernia at some point in their lives, while in women this percentage is only 3%. The inguinal hernia is divided into direct and indirect depending on the way the contents of the abdomen protrude through the gap in the abdominal wall. Direct inguinal hernia is more common in older people, while indirect in younger people.

A different type of inguinal hernia is the sports hernia . It is a separate category that occurs in exactly the same area, with similar symptoms, but there is actually no hernia. In highly trained individuals, the muscles of the area are particularly strained and give symptoms similar to inguinal hernia.

Inguinal hernia – Causes
-Hereditary predisposition
-Obesity
-Weight lifting
-Constipation
-Disturbance in the synthesis-degradation balance of collagen
-Chronic cough
-Previous surgeries in the area
-Smoking
-Pregnancy
-Chronic respiratory lung disease

• Male gender
• Old age

Inguinal hernia – DIAGNOSIS
In the majority of cases, a clinical examination by a General Surgeon is sufficient to establish the diagnosis of inguinal hernia. In case of doubt, we proceed with a soft tissue ultrasound scan of the inguinal region, which is pretty accurate for this specific condition. If an additional check is needed, we perform CT and magnetic scan of the area. In case of sports hernia, then the only test that gives a diagnosis is the MRI scan.

Inguinal hernia – SYMPTOMS
The symptoms of an inguinal hernia vary. In the initial stages it can be asymptomatic for a long time. Often the patient notices a mass in the area, which comes in and out at regular intervals and causes discomfort and a burning sensation several times. In more advanced stages, the hernia causes pain in the area, while in the stage where the intestine has been strangled (strangulated inguinal hernia), then we have vomiting and inability to open bowels. The latter case is a particularly dangerous situation for human life and must be treated immediately.

Inguinal Hernia – TREATMENT
There is no conservative treatment for inguinal hernia. The only treatment is surgical repair. Special bands used to prevent hernia prolapse should not be used. Once the diagnosis of inguinal hernia is made, then the indicated treatment is elective surgical repair. Delaying surgery can cause the hernia to swell and have higher rates of recurrence when it is surgically repaired. At the same time, if the inguinal hernia turns into a strangulated, then the surgery becomes more dangerous for the patient and the recurrence rates are higher.

The operation of the of repair the inguinal hernia can be done in two ways:

1) With an incision in the groin area , reduction of the hernia and placement of mesh above the muscles. It is the operation that has been performed for decades and the patient leaves the clinic the next day of the operation.
2) Surgery of choice is the laparoscopic repair. In all specialized centers , the laparoscopic treatment of inguinal hernia has been established and has replaced the classic open approach. Laparoscopic repair is performed either intraperitoneally (TAP) or extraperitoneally (TEPP). Through three small holes with a diameter of 0.3-1 cm, the operation is carried out, where the hernia is first reduced and then a special mesh is placed in the abdominal wall to prevent recurrence. In this way, the mesh is placed behind the muscles, unlike the open method, and thus shows better results. It must be emphasized that in sports hernia only laparoscopic repair is indicated, as the open method is considered ineffective. The operation is painless, bloodless and the patient leaves the clinic the same or the next day. It should be noted that even in the case of bilateral inguinal hernia , the operation is again carried out through the same three small holes, which is a significant advantage over the open method.

ADVANTAGES OF LAPAROSCOPIC TREATMENT

• Significantly less postoperative pain
• Lower rates of chronic pain compared to the open method
• Faster recovery and immediate return to work and daily activities
• Better aesthetic result as large incisions are avoided
• Lower recurrence rates compared to the open method according to international literature
  For more information on inguinal hernia repair, contact Surgeon General, Dr. Alexandros Kyritsis. The doctor has extensive experience in treating hernias with the most liess invasive methods, as he has been retrained in the field of minimally invasive surgery at the world-renowned New York hospital “Memorial Sloan Kettering Cancer Center”.

FREQUENT QUESTIONS

What is an inguinal hernia?

It is the most common type of hernia and appears in the inguinal area.

My groin hurts. Do I have an inguinal hernia?
Not necessarily. There are other diseases (musculoskeletal pains, urinary diseases, lymphadenopathy) that can cause pain in the specific area, therefore every pain in the groin area does not always mean an inguinal hernia.

Which doctor should I see if I suspect that I have an inguinal hernia?
The appropriate physician is the General Surgeon

I have an inguinal hernia and was told I have to wear a special abdominal belt. It’s correct?
The abdominal belt for inguinal hernia does not repair the hernia while at the same time can cause adhesions in the area making subsequent surgery more difficult. Its use is not recommended.

I have an inguinal hernia but since it is small and doesn’t cause me much trouble they told me not to have surgery yet. It’s correct?
This perception is wrong. A small inguinal hernia due to the small gap can more easily end up strangulated. At the same time, the larger the hernia , the more difficult the surgery becomes and the greater the chances of future recurrence. Once the diagnosis of inguinal hernia is made, the correct treatment is surgical repair.

I have an inguinal hernia. Is it better to have open or laparoscopic surgery?
Here the answer is clear. Laparoscopic repair has significant advantages. Especially in cases of bilateral inguinal hernia or sports hernia, laparoscopy is the only way.

How long do I have stop working if I have surgery?
In the case of laparoscopic reconstruction, if our work does not require weight lifting, the return is a matter of 2-3 days. If intense weight lifting is required then we should refrain for 15-30 days to avoid the risk of relapse.

How much does inguinal hernia surgery cost?
The cost depends on the type of patient insurance as well as the type of mesh to be used. Laparoscopic repair has a higher cost than the open approach.

How long does it take to book an inguinal hernia surgery?
The booking is immediate and the operation can be done even the day after the clinical examination.

What causes inguinal hernia?
Inguinal hernia can be caused by:

Smoking
Obesity and poor nutrition
Family history
Manual work, heavy lifting or chronic cough
Multiple pregnancies etc.

What are the symptoms of an inguinal hernia?
Abdominal pain
Feeling of heaviness and discomfort
Appearance of a bulge

How is the diagnosis made?
Clinical examination is the first step if further testing is needed, an ultrasound or MRI scan .

What is the treatment for inguinal hernia?
The treatment is carried out only with surgery and not conservatively. As for the surgery, it can be done either with an incision in the groin, reduction of the hernia and placement of the mesh or laparoscopically.

Which method is preferred and why?
Most patients now choose the laparoscopic technique. This is due to the following advantages: reduction of postoperative pain, faster return to everyday life, aesthetic result, minimal chances of recurrence.