SURGERY FOR INGUINAL HERNIAS

What is an inguinal hernia?

An inguinal hernia is a weakness or a tear in the abdominal muscle which allows organs or fat from within the abdomen to protrude through the defect. There is usually a bulge in the groin which may or may not be reduced back into the abdomen. Most are congenital but some are due to progressive weakness of the muscle, giving way to increased pressures.

What are the risks of having an inguinal hernia?

A good majority of people with hernias do not experience any problems with them throughout their lifetime. However, there is a chance of incarceration (protruding intestines cannot be pushed back inside) and subsequent strangulation (the blood supply to the incarcerated portion of the intestine is cut off due to constricting pressures). Strangulation constitutes a surgical emergency and the patient ends up with a more complicated, potentially life-threatening, and risky procedure. Intestines may have to be removed usually requiring a long surgical incision in the abdomen instead of smaller, less morbid, and more cosmetically and functionally acceptable surgical scar.

How are inguinal hernias treated?

Hernias cannot get better or heal on their own. Likewise, there is no medication that can cure a hernia. Some medications, however, can be taken to prevent straining during passing motion and avoiding physical and social activities that cause straining may prevent worsening of the hernia but is in no means a cure. Treatment is surgical and hernia repair surgery is one of the most common operations done by surgeons today.

How is an inguinal hernia repaired?

Several decades ago, hernia surgery was done by simply stitching the edges of the defect together to close the gap or forcibly close the hole by stitching other tissues above it. However, the undue tension by bringing two distant tissues together has been a major problem and constitutes one of the main reasons why recurrence of the hernia through this technique is high. After years of evaluation, this has been proven to be very significantly inferior to today’s gold standard which is mesh repair.

A mesh is a synthetic material intended to bridge the gap acting as a scaffold for normal tissues to grow into and naturally reinforce the defect instead of serving as an immediate patch-up job.

What are the surgical options for hernias?

There are generally two ways by which mesh repair can be carried out - the conventional (open) technique or the Laparoscopic approach. In patients with first time hernias, both techniques are acceptable. However, in patients with recurrent hernias or hernias on both sides of the groin, the laparoscopic approach is strongly indicated.

Patients with unilateral hernias (hernias on only one side of the body) who are concerned about post-operative pain or who wish to return to their normal lifestyles and work quickly should also consider the laparoscopic approach.

What is the difference between the Open versus Laparoscopic approach?

The Open approach is done by making an incision approximately 3 inches in length along the side of the groin affected. The protruding tissue is returned into the abdomen and a mesh is stitched above and around the defect. It is presently the most common technique employed by surgeons worldwide.

The Laparoscopic approach is done by making 3 tiny incisions (5mm to 12mm) in the lower abdomen. The surgeon inflates the abdomen using a gas to create a working space and uses tiny instruments to operate while looking at a video screen. The hernia is reduced back into the abdomen and the mesh secured behind the hole. It is this reason why majority of laparoscopic surgeons believe in the integrity and strength of this repair technique.

Since Laparoscopic surgery is routinely carried out using general anesthesia and utilizes special instruments, cost is increased and appears to be the only significant disadvantage of the technique. However, most surgeons who advocate this technique believe that the proper point of comparison should be “cost effectiveness” of the procedure and not merely “cost” itself. Patients who would rather experience less pain, return to normal activities, work, and sports earlier, and have more cosmetically acceptable scars at a slightly higher cost can opt for laparoscopy.

What are the risks of surgery?

As with any surgery, there are risks of infection, bleeding, and damage to the surrounding tissues. However, their incidence is very low and even much lower in laparoscopic repairs if performed by a properly trained and experienced surgeon.

The information herein is only a guide and does not intend to replace proper consultation with your physician.