Inguinal Hernia

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What is an Inguinal Hernia?

A hernia develops when the internal layers of the abdominal wall become weakened, leading to the formation of a bulge or tear. Analogous to how an inner tube might protrude through a damaged tire, the abdominal cavity's inner lining protrudes through this weakened section of the abdominal wall, creating a sac-like structure. This may allow intestinal or abdominal tissue to slip into this tear. For some individuals, a hernia can lead to discomfort, pain, or other urgent complications that might necessitate emergency surgical intervention.

Hernias can affect both genders.

Some hernias are present from birth (congenital), while others develop gradually (acquired).

Hernias do not improve naturally with time and cannot heal by themselves. There are no specific exercises or physical therapy routines capable of curing a hernia. Managing certain risk factors might alleviate symptoms associated with the hernia. Without treatment, hernias have the potential to enlarge progressively.

How to Identify an Inguinal Hernia:

Inguinal hernias typically manifest as a noticeable bulge beneath the skin in the groin area. This bulge might cause pain or discomfort during certain activities, such as lifting heavy objects, coughing, straining during urination or bowel movements, or when sitting or standing for extended periods. The pain associated with a hernia can be sharp or dull and often intensifies as the day progresses.

Routine physical examinations by a doctor or diagnostic imaging may also reveal some hernias.

Hernia bulges might appear intermittently. However, if the bulge becomes fixed and protrudes permanently (incarcerated), or if you experience intense, continuous pain along with redness and tenderness in the hernia area (strangulation), these are urgent symptoms. Immediate medical attention is required in such cases, either by contacting a healthcare professional or visiting an emergency room.

What Leads to an Inguinal Hernia?

The abdominal wall has certain areas that are naturally weaker. Hernias can form in these areas due to factors like straining, aging, physical injury, a previous surgical cut, or inherent weakness from birth. Hernias can occur at any age, with most childhood hernias being congenital. For adults, factors such as heavy lifting, chronic coughing, or straining during bowel movements or urination can cause the abdominal wall to weaken or tear at these weak spots.

Is Surgery Always Necessary for Inguinal Hernias?

The need for repairing an inguinal hernia often depends on whether it causes symptoms that interfere with daily life. Hernias that are asymptomatic might be monitored, but many eventually become symptomatic over a few years. Based on individual medical conditions, your surgeon might advise against elective surgery and instead recommend a truss. A truss is a supportive external belt designed to keep the hernia contained, allowing you to maintain daily activities.

Types of Inguinal Hernia Repair Surgeries:

There are two main approaches for repairing inguinal hernias: open surgery and minimally invasive surgery.

Benefits of Minimally Invasive Inguinal Hernia Repair:

Minimally invasive techniques like laparoscopic and robotic hernia repair involve small incisions, use of specialized surgical tools, and often, mesh placement. Compared to open hernia repair, patients undergoing minimally invasive procedures generally experience an easier recovery, quicker return to work, and faster resumption of normal activities.

Who is a Suitable Candidate for Minimally Invasive Inguinal Hernia Repair?

Determining if you're a suitable candidate for minimally invasive hernia repair requires a comprehensive examination by your surgeon. This approach may not be the most appropriate for certain patients, especially those who have had major abdominal surgeries before or who have specific medical conditions.

Preparation for Inguinal Hernia Repair:

Before undergoing the operation, a complete physical examination is necessary. Additional tests may be required to ensure your fitness for surgery under anesthesia.

The surgeon performing your hernia repair will discuss the risks and benefits of the procedure with you. You will be required to sign a consent form, indicating your understanding and agreement to the planned operation.

Your surgeon's office will provide specific instructions on what you should do and avoid before the operation. While these instructions might vary, common pre-operative guidelines include:

- Hygiene: Bathing the night before or on the morning of your operation, potentially using an antibiotic soap as instructed by your surgeon. Please refrain from shaving the abdominal or groin areas.
- Fasting: Ceasing food and drink intake from a specific time as directed by your doctor before the surgery.
- Medications: On the morning of your operation, you may be allowed to take certain medications as prescribed by your doctor, but only with a minimal amount of water.
- Medication Adjustments: You might need to temporarily stop taking certain medications prior to your surgery, such as blood thinners, specific supplements, and medications that affect your immune system. It is important to consult your surgeon's staff to determine which of your usual medications are safe to continue.
- Lifestyle Adjustments: Smoking increases the risk of hernia recurrence and infection. In some cases, your surgeon may mandate quitting smoking at least 4-6 weeks before the surgery to improve your surgical outcomes.
- Transport: Arrange for someone to drive you home after the surgery. Discuss with your doctor or nurse about the level of assistance you might require once you return home.

How is the Surgery Performed?

Inguinal hernia repair surgery can be carried out using different types of anaesthesia, including sedation, spinal anaesthesia, or general anaesthesia. For minimally invasive inguinal hernia repairs, general anaesthesia is commonly used. On the day of your operation, you will have a meeting with the anaesthesia team.

The surgery itself can be conducted using one of two methods:

Open Approach: This traditional technique involves creating an incision either in the groin or the lower abdomen. The cut goes through the skin and fat layers, reaching the muscle or the area of the fascial defect, which is the actual hernia. The surgeon repairs the hernia at this level. It's common for the surgeon to use a piece of surgical mesh to reinforce the area and cover the defect. Your surgeon will provide information about different repair options and the potential incorporation of mesh. After the repair, the layers of skin and tissue are stitched back together.

2. Laparoscopic Approach: This method requires several small incisions in the abdomen. A laparoscope, which is a camera, is inserted through a cannula (a hollow tube) placed in one of these incisions. Additional cannulas are inserted into the other incisions, allowing the surgeon to operate "inside" using special instruments. The hernia is repaired from within. Surgical mesh is used to cover the hernia defect, and it may be secured in place with staples, tacks, adhesive sealant, or sutures. This type of operation is generally performed under general anaesthesia.

What is Next if the Surgery is Not Possible with the Laparoscopic Approach?

If the laparoscopic approach cannot be completed, your surgeon may need to switch to the traditional open method. This decision might be influenced by factors like obesity, the presence of extensive scar tissue from previous abdominal surgeries, difficulty in visualizing essential organs, bleeding, or other issues encountered during the surgery. The choice to convert to an open approach is based on the surgeon's professional judgement and can be made either prior to or during the operation.

Post-Surgery Expectations and Guidelines

Hernia surgeries are often outpatient procedures, meaning you will likely go home the same day.

After the surgery, you will be moved to a recovery area for observation until you are fully awake, your pain is under control, and you can move unassisted. The specific criteria for your discharge may depend on your surgeon and the facility where the surgery is performed.

Pain Levels and Medications:

It is normal to experience some discomfort for the first 48 hours after a hernia operation, and in some cases, this might last longer.

Post-Surgery:

You are encouraged to start walking the day after surgery. Discuss with your surgeon about what activities you can resume post-surgery, including showering, driving, climbing stairs, lifting, working, and sexual activity.

Follow-Up Appointment:

Be sure to arrange a follow-up appointment as directed by your surgeon.

Important Note: The above information is not a substitute for a thorough discussion with your surgeon regarding the necessity of laparoscopic inguinal hernia surgery.

If you have inquiries about the appropriateness of laparoscopic inguinal hernia surgery for your situation, alternative options, billing, insurance coverage, or your surgeon's qualifications and expertise, please feel free to contact us.

Should you have any questions pertaining to the surgical procedure or post-operative care, it is advisable to engage in discussions with your surgeon either prior to or following the operation.