A hernia is a bulge formed when the internal organs of your abdominal cavity are pushed through a weakened spot in your abdominal wall. Hernias most commonly occur between the area of your rib cage and the groin.
An inguinal hernia is a bulge that forms when a part of your small intestine or fatty tissue protrudes through a weak spot in the groin (area between the upper thigh and lower abdomen) or scrotum (muscular sac containing male testes). Inguinal hernias occur more commonly in men than women. There are two types of inguinal hernia:
- Indirect inguinal hernia
Most inguinal hernias are caused when the walls of the abdominal muscles fail to close before birth. It commonly occurs in males because of the way the reproductive system develops. Before birth, the testicles are formed within the abdomen and slowly descend into the scrotum through the inguinal canal. The inguinal canal is closed after birth, preventing the testicles from moving back into the abdomen, but leaving enough space for the spermatic cord to pass through. Weakness in this region can lead to the formation of a hernia. The risk of indirect inguinal hernia is higher in premature infants as the baby does not get enough time in the womb for the closing of the inguinal canal.
- Direct inguinal hernia
The abdominal wall may become weaker in later life due to tissue degeneration and result in an inguinal hernia. Pressure on the weak spot due to coughing, straining, or lifting heavy objects can cause a bulge in the groin. Being overweight or undergoing a prior surgery is also a risk factor for inguinal hernia.
Inguinal hernias generally do not cause any symptoms, but may be revealed when your doctor conducts a routine medical exam. The bulge formed is more prominent when you stand, cough or strain, and may disappear while lying down as it slips back into the abdomen. Other symptoms include:
- Pain or discomfort in the groin
- Heavy sensation in the groin
- Burning or aching bulge
- Pain and swelling around the testicles in men
The hernia can be easily pushed into the abdomen while lying down. Inability to push the hernia back into the abdomen may cause the hernia to become incarcerated (trapped). An incarcerated hernia may strangulate thereby disconnecting blood supply to the trapped part of your intestine. This is a dangerous situation and may require emergency medical help. Symptoms of a strangulated inguinal hernia include:
- Increased heart rate
- Sudden quick intensifying pain
- Reddish or bluish discoloration of the bulge
- Nausea and vomiting
In children, inguinal hernia is visible only when the child stands for a long time, while coughing, crying or straining during bowel movements.
Screening & diagnosis
A physical examination is generally required for the diagnosis of an inguinal hernia. Your doctor will enquire about your symptoms and examine the bulge in your groin. A cough test may be ordered to check for protrusion when pressure is applied, which can confirm presence of direct or indirect inguinal hernia.
Imaging tests such as X-rays, magnetic resonance imaging (MRI) or computer tomography (CT) scan may be ordered to determine if the intestine or other internal organs has protruded into the bulge.
Pre/Post operative Instruction
Inguinal Hernia Surgery
The aim of this information sheet is to provide an answer the most frequently asked question about Anal Hernia Surgery.
Anal Hernia Surgery is aimed to re-establish the integrity of the abdominal wall at the inguinal/groin level where the hernia developed.
The principle of surgical procedure we offer is to repair the defect using a tension-free technique with the addition of light mesh which is going to remain in the area re-enforcing the abdominal wall. Tension free surgery for preparing inguinal hernia means that there is no stitching in any form which is joining fascial, tendons or muscular structure that are not by the normal anatomy linked together. Such a procedure is achieved through a very small incision usually 5 cm, which allows access to the inguinal area where the hernia has developed. Such repair is completed with the insertion of a very light mesh which is going to remain in the inguinal region to promote the development of fibrous tissue which make the areas stronger and therefore reduces the possibility of future hernias recurrences. Such a technique has been widely demonstrated to have a very low recurrence rate, well below 5% and therefore assuring optimal results on the long-term.
What to expect after the procedure?
Inguinal hernia procedure is performed under general anesthesia as a day case procedure. There is no need for the patient to undertake bowel preparation before surgery. The duration of surgery is usually between 30 to 45 minutes. Once the procedure is completed your doctor will inject some local anesthetic in the area in order to numb the region of the operation. The patient will be able to walk immediately after surgery and will leave the hospital premises within 3 to 4 hours after the surgical procedure as been completed. Pain medication will be given to the patient at the time of discharge with the appropriate instruction. No antibiotic is required after surgery while a single dose of intravenous antibiotics is administered just before surgery starts in order to reduce the chances of postoperative infection. The patient at the time of discharge will receive Operation note, Discharge summary and Sick note when required.
What activity would I be able to perform immediately after surgery?
Light physical activity can be sustained immediately after surgery and full physical activity can generally be resumed after 4-5 weeks. The effects of local anesthetic injection usually lasts for a few hours after surgery and the patient will be instructed to regularly take pain medication as indicated in the discharge summary. The patient will be seen in the clinic as follow-up usually one week after surgery. The recommended off work period is between 1 and 2 weeks according to the clinical conditions. No external stitches will be present after surgery and the wound dressing will only consist in a feeding layer film of glue. Shower will be possible the day after surgery without indulging a long time under the water.
What are the complications of this surgery?
Tension-free technique repair for inguinal hernia are usually very safe procedures well tolerated by the patient. Infection at the level of the surgical incision it is a possible complication although pretty rare as well as the infection which may arise at the level of the mesh. More commonly minor collection of serous fluid can be observed after surgery in the area and your doctor may decide to drain those collections in the office according to the clinical condition. Such a procedure is completely painless and he is usually done in a couple of minutes. Some induration and stiffness of the area can be a condition after surgery any generally resolve with then 2 months from the operation. Your doctor will see you regularly in clinic for the first few weeks making sure that the progress happens as expected after the surgery.
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Miss Hannah Giron
Medical Secretary to Dr. M Cristaldi