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Inguinal Hernia


When intestinal or fatty tissues push through the inguinal canal in the groin area, the condition is called inguinal hernia. Both men and women can be affected by an inguinal hernia. There are two types of inguinal hernias:

Direct inguinal hernias: Occur only in adult males due to a weakness in the abdominal wall

Indirect inguinal hernias: When the hernial sac and contents traverse the inguinal canal (from the internal ring to the external ring)

Signs and symptoms

  • Burning sensations
  • Sharp pain during bending over, exercising or coughing
  • Fullness or heaviness of the groin
  • In men: swelling in the scrotum
  • Discomfort when standing, straining, lifting that improves with rest

Causes and risk factors

Commonly occurs in men

  • Heredity
  • Prematurity at birth
  • Cystic fibrosis
  • Pregnancy
  • Chronic cough
  • Obesity
  • Constipation or obstructive urination
  • Heavyweight lifting
  • Standing for prolonged periods of time

Complications of inguinal hernias

Incarceration: the fatty tissue or the intestine gets stuck in the groin or scrotum and does not go back into the abdomen

Strangulation: the incarcerated hernias are left untreated; there is obstruction of blood supply to the small intestine; strangulated hernias are an emergency situation and require immediate attention.

Diagnosis

Physical examination: the patient is asked to stand, cough and strain to see if a bulge forms

Imaging tests are not absolutely essential for the diagnosis of inguinal hernia.

Inguinal hernia is a clinical diagnosis

Ultrasound scan of the groin may be done if there is doubt in the diagnosis or if the clinical examination is inconclusive

CT scan is done in a complicated inguinal hernia if there is a doubt of obstruction or strangulation (in selected cases)

Treatment

Laparoscopic hernia repair is performed as a therapeutic option for inguinal hernias. Recovery times are shorter with patients feeling less pain and discomfort. As a preventive measure, surgical repair is the only option that will avert instances of incarceration or strangulation. Laparoscopic inguinal hernia repair has got definite advantage compared to open repair in cases of inguinal hernia on both sides and in hernias which has appeared for a second time after a previous open repair, even if it is on one side.

I have treated several early-stage and strangulated hernias very successfully. Our team has experienced laparoscopic surgeon who can treat simple and complicated inguinal hernias through keyhole surgery.

Authored by Dr. Deepak Varma, MBBS, MS (General Surgery)

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