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Overview - Inguinal Hernia

Written and reviewed by
Dr. Gaurav Bansal 91% (2282 ratings)
MBBS, MS-General Surgery , FMAS, FIAGES
General Surgeon, Gurgaon  •  18 years experience

Overview - INGUINAL HERNIA

An inguinal hernia occurs when tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles. The resulting bulge can be painful, especially when you cough, bend over or lift a heavy object.An inguinal hernia isn't necessarily dangerous, however, it can lead to life-threatening complications. Inguinal hernia repair is a common surgical procedure.    

Symptoms

  • A bulge in the area on either side of your pubic bone, which becomes more obvious when you're upright, especially if you cough or strain .
  • A burning or aching sensation at the bulge   
  • Pain or discomfort in your groin, especially when bending over, coughing or lifting    
  • A heavy or dragging sensation in your groin    
  • Occasionally, pain and swelling around the testicles when the protruding intestine descends into the scrotum
  • You should be able to gently push the hernia back into your abdomen when you're lying down.

Incarcerated hernia

If you aren't able to push the hernia in, the contents of the hernia can be trapped (incarcerated) in the abdominal wall. An incarcerated hernia can become strangulated, which cuts off the blood flow to the tissue that's trapped. A strangulated hernia can be life-threatening if it isn't treated.

Signs and symptoms of a strangulated hernia 

  • Nausea, vomiting 
  • Fever    
  • Sudden pain that quickly intensifies    
  • A hernia bulge that turns red, purple or dark
  • Inability to move your bowels or pass gas

Signs and symptoms in children

  • Inguinal hernias in newborns and children result from a weakness in the abdominal wall that's present at birth. Sometimes the hernia will be visible only when an infant is crying, coughing or straining. 
  • 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.
  • Seek immediate medical care if a hernia bulge turns red, purple or dark.

Causes

  • Some inguinal hernias have no apparent cause. 
  • Increased pressure within the abdomen    
  • A pre-existing weak spot in the abdominal wall
  • Straining during bowel movements or urination    
  • Strenuous activity    
  • Pregnancy    
  • Smoking
  • Inguinal hernias develop later in life when muscles weaken or deteriorate due to aging, strenuous physical activity or coughing that accompanies smoking.

Risk factors

  • Male. Men are eight times more likely to develop an inguinal hernia than are women.   
  • Old age
  • Family history.
  • Chronic cough, such as from smoking.    
  • Chronic constipation.
  • Pregnancy.

Complications

1. Pressure on surrounding tissues

Most inguinal hernias enlarge over time if not repaired surgically. In men, large hernias can extend into the scrotum, causing pain and swelling.    

2. Incarcerated hernia

If the contents of the hernia become trapped in the weak point in the abdominal wall, it can obstruct the bowel, leading to severe pain, nausea, vomiting, and the inability to have a bowel movement or pass gas.    

3. Strangulation

An incarcerated hernia can cut off blood flow to part of your intestine. Strangulation can lead to the death of the affected bowel tissue. A strangulated hernia is life-threatening and requires immediate surgery.           

Diagnosis

A physical exam is usually all that's needed to diagnose an inguinal hernia. Your doctor will check for a bulge in the groin area. 

.If the diagnosis isn't readily apparent, your doctor might order an imaging test, such as an abdominal ultrasound, CT scan or MRI.                                

Treatment

If your hernia is small and isn't bothering you, your doctor might recommend watchful waiting. 

Enlarging or painful hernias usually require surgery to relieve discomfort and prevent serious complications.

There are two general types of hernia operations — open hernia repair and laparoscopic repair.                Open hernia repair - In this procedure, which might be done with spinal anesthesia or general anesthesia, the surgeon makes an incision in your groin and pushes the protruding tissue back into your abdomen. The surgeon then sews the weakened area, often reinforcing it with a synthetic mesh (hernioplasty). The opening is then closed with stitches, staples or surgical glue.After the surgery, you'll be encouraged to move about as soon as possible, but it might be several weeks before you're able to resume normal activities.  

COMPARISON OF OPEN AND LAPAROSCOPIC SURGERY

Laparoscopy

In this minimally invasive procedure, which requires general anesthesia, the surgeon operates through several small incisions in your abdomen. Gas is used to inflate your abdomen to make the internal organs easier to see.A tiny camera (laparoscope) is inserted into one incision. Guided by the camera, the surgeon inserts tiny instruments through other incisions to repair the hernia using synthetic mesh.People who have laparoscopic repair might have less discomfort and scarring after surgery and a quicker return to normal activities.

It also might be a good choice for people with hernias on both sides of the body (bilateral).

 

 

 

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