Inguinal hernia

Inguinal hernia is a gap in the inguinal canal that often occurs in men and causes rather pulling discomfort in the groin area in addition to a bump. Incarceration of fatty tissue or intestine is very rare.

SUMMARIZED

• Inguinal hernias are the most common hernias in humans.
• Every 4 men develop an inguinal hernia in the course of their lives
• In young people the hernias are congenital, in older people it is a connective tissue weakness 
• Despite rather minor symptoms, surgery is recommended because the hernias often become larger.
• As a rule, the operation is performed under anesthesia. Minimally invasive surgery usually inpatient.
• Mesh insertion is recommended for men over 25 and always for women.

For experienced surgeons, a glance is enough for a diagnosis. When standing and pressing (coughing), a bulge appears in the groin area. The hernia usually recedes when the patient is lying down.

In the case of unclear findings or previously operated groins, an ultrasound examination (sonography) or magnetic resonance imaging (MRI) can be performed. The examination should be performed with the patient pressing (Valsalva).

Patients with a new hernia of the abdominal wall who are older than 50 years and who have not yet had a colonoscopy should definitely undergo this examination as a preventive examination before surgery in order to rule out an intestinal tumor.

IMPORTANT: Preventive colonoscopy is recommended for men over 50 years of age and for women 55 years of age, and the costs are covered in full by statutory and private health insurance companies.

Patients often have no complaints, i.e. they are asymptomatic. In addition to the incidental finding during a urological or general practitioner's examination, patients notice a painless protrusion on exertion or when standing. Many are not even aware that a hernia is present. 

In addition to the aesthetic problem, there is more often a pulling discomfort in the groin area, which is intensified during movement or sports activities. In this case, the bulging hernia sac presses into the inguinal canal and onto very fine nerves, which radiate into the testicles in men and into the labia in women. This causes the discomfort.

When an inguinal hernia becomes larger, this hernia can extend far into the scrotum in men, which is called a scrotal hernia. In this case, the hernia may become firmly fused to the scrotum, so that the hernia cannot be moved back when the patient is lying down.

Also, in larger hernias, bowel or parts of the urinary bladder may be present in the hernia sac, which can lead to digestive or bladder dysfunction.

There is a 2.7% chance of incarceration with an existing inguinal hernia over a lifetime. When bowel is incarcerated, it is always a life-threatening emergency that requires surgery within 6 hours. In this case the patient:s have very severe abdominal pain with nausea and vomiting.

Inguinal hernia operations are divided into 3 classical procedures. We present here only the procedures recommended in the guidelines. Overall, there are many variants of the operations. It is important to note that these operations should be performed by qualified hernia surgeons who perform more than 25 operations per year.

During follow-up treatment, the wounds are inspected in the following 5 days. In the case of dissolving sutures, we recommend a plaster dressing for up to 10 days. With shower plasters you can shower from the first day after surgery. Bathing only from the 14th day. 

Often a small bruise (hematoma) forms in the inguinal canal and wound fluid (seroma) collects. In men, wound secretion and blood may migrate to the testicle from day 2, resulting in a bruise in the scrotum and tenderness in the testicle. This usually goes away after 2-4 weeks. 

Rarely, bleeding and subsequent infection may occur in the umbilical area. This manifests itself as pain, swelling, hyperthermia, discharge, odor. 

In this case, an immediate medical presentation is required and can usually heal without problems after a small miracle opening and irrigation.

It has been shown in many studies that inguinal hernia has a very different dynamic in women than in men. Overall, it occurs less frequently and leads to significantly more problems, which is why surgical treatment should always be sought.

We have published extensively on this topic in the very prestigious surgical journal "Annals of Surgery" in 2019. more here...

• Emergency interventions in women with inguinal hernias are increased more than fourfold compared with men (men: 3%; women 14.5%).
• The approach of waiting ("watchful waiting") as in men cannot be recommended. 
• Early management is warranted when there is evidence of femoral hernia without symptoms (asymptomatic).  
• Women are at greater risk of hernia recurrence (recurrence). 
• Minimally invasive technique has lower risk of hernia recurrence (recurrence) in women than open Lichtenstein procedure. 

• The probability of inguinal hernia in pregnancy is only 0.12%. 
• Planned (selective) or emergency treatment of an inguinal hernia is a very rare event and has not occurred once in 0.12% patients with an inguinal hernia out of 20,714 pregnant patients, for example. 
• The ligamentum rotundum in the inguinal canal may have markedly enlarged vessels (varicosis), which may lead to a false diagnosis of inguinal hernia. 
• Watchful waiting for inguinal hernia in pregnancy (only here, otherwise surgery) 

You are welcome to book an appointment online in our appointment calendar DOCTOLIB under the specialty "Visceral surgeon and proctologist" with our doctors. We are looking forward to it.