In the medical field, “hernia” refers to the protrusion of organs through an anatomical opening. In the inguinal area, the abdominal musculature forms the inguinal canal, which runs through the abdominal wall at the groin level and connects the abdominal cavity with the subcutaneous space, leading to the male scrotal area.
- In men, this canal allows the passage of arteries, veins, nerves, and most importantly, the vas deferens, which carry sperm from the testicles to the penis.
- In women, it consists of the round ligament, which supports the uterus.
The inguinal canal is a weak point where the muscle and tendon structures are less restricted, allowing abdominal organs to protrude through this area and form a visible swelling beneath the skin.
Causes of inguinal hernia
Inguinal hernia can sometimes be present from birth and is therefore considered congenital, requiring correction by a pediatric surgeon during childhood. However, it is more commonly observed in adulthood, resulting from gradually weakening the muscular and tendon structures. This weakening can be attributed to factors such as:
- Physical exertion
- Natural tissue aging
- Individual predisposition
- Persistent coughing
- Activities that increase abdominal pressure
These factors contribute to the weakening of the inguinal area and increase the risk of developing an inguinal hernia in adulthood.
Symptoms and Signs
First and foremost, it should be noted that not all inguinal hernias cause symptoms. In some cases, small hernias can pass through the inguinal canal without causing discomfort and may not be visibly apparent as a swelling.
However, in general, hernias become symptomatic when there is visible swelling of the skin, especially during activities that involve:
- Standing for long periods
- Engaging in extended walks
Symptoms also tend to worsen during activities that put pressure on the abdominal area, such as:
- Bowel movements
In these situations, the swelling becomes more noticeable. On the other hand, the swelling may be less apparent when resting or lying down, as there is less pressure on the abdominal area.
What consequences can one face?
The most critical situation occurs when an inguinal hernia becomes incarcerated, which is an acute and unpredictable event. During this stage, the swelling becomes stiff and painful and cannot be reduced by applying pressure on the abdomen. This serves as a significant warning sign because the compression of blood vessels within the hernia can lead to:
- Tissue ischemia
- Subsequent necrosis – possibly resulting in peritonitis
- Intestinal obstruction – if the hernia involves a trapped section of the bowel
In case of intestinal obstruction, urgent surgical intervention is required.
Since hernias tend to worsen over time, it is advisable to consult a specialist to determine whether traditional or minimally invasive surgery is the most appropriate course of action.
The course of traditional surgery
Traditional surgery for inguinal hernia is known as anterior inguinal hernioplasty. The procedure involves:
- Making a small incision through which the hernia is located and repositioned within the abdomen
- Applying a mesh made of synthetic, biocompatible, and nonabsorbable material to the muscles and tendons to reinforce the weakened area of the muscle wall
This approach helps reduce postoperative pain as the muscle layer that is not stitched is not under tension, thereby reducing the risk of hernia recurrence.
Anterior inguinal hernioplasty is typically performed as a day surgery procedure with local anesthesia, and patients have a short recovery period. They can eat, stand up, and walk soon after the operation.
The surgery with the laparoscopic technique
Since the 1990s, it has been possible to perform inguinal hernioplasty using a laparoscopic technique, which is a form of minimally invasive surgery.
This approach involves creating three small incisions in the abdomen to allow for the passage of instruments and a camera. Like traditional surgery, the hernia is repositioned within the abdomen, and a mesh is applied to reinforce the muscle wall.
The laparoscopic technique provides excellent outcomes in terms of:
- Pain management
- Postoperative recovery
- Effectiveness of the mesh
However, it requires general anesthesia and differs from the traditional technique since it involves accessing the abdominal cavity and the superficial tissues.
When is laparoscopic surgery preferred?
There are certain situations where the laparoscopic technique offers significant advantages. For example, in the case of bilateral inguinal hernias, the traditional technique would require two separate inguinal incisions, whereas with laparoscopy, only three small incisions are needed.
Additionally, in cases of recurrent hernias that have been previously operated on using the anterior approach, laparoscopy allows the surgeon to avoid disturbing the tissues involved in the previous surgery. However, the choice of surgical technique ultimately depends on the surgeon, who will consider factors such as the patient’s age and overall health status.