Inguinal Hernia

What is inguinal hernia?

Inguinal hernias are the most common type of groin hernia and occur more frequently in men, as they follow the path of the blood vessels to the testicle (spermatic cord). If they become large they can pass into the scrotum. Inguinal hernia is also the most common hernia in women, as there is a ligament (round ligament) which mimics the spermatic cord.

What are the signs & symptoms of inguinal hernia?

Small groin hernias may not have any symptoms and can be observed rather than immediately repaired. In certain cases, even the bulge may not be visible with small hernias.

However, moderate and large groin hernias may manifest as a bulge and can be associated with some discomfort. The pain or bulge may get worse on coughing or straining. Large hernias may cause pain when you exert pressure, while standing up or lifting heavy objects.

If you experience severe abdominal and groin pain or the lump is reddish and tender, there may be a chance your intestine is obstructed (stuck in the inguinal or femoral canal) or strangulated (trapped). Strangulation may block blood flow to the part of your intestine that is stuck and cause tissue necrosis (death of tissue) which may endanger your life. A trapped or obstructed femoral hernia may cause the following symptoms:

• Groin pain
• Nausea or vomiting
• Abdominal pain or bloating

Presence of these symptoms requires an urgent hernia repair and you should attend the emergency department for assessment.

How is inguinal hernia diagnosed?

Physical examination is the first line of diagnosis to test the external groin bulge. The bulge will be examined for its texture, size and protrusion. However, your doctor may find it difficult to feel the bulge if it’s small. If the hernia cannot be detected with physical examination, your doctor may order ultrasound of the groin. Other imaging tests may be performed.

What are the treatment options of inguinal hernia?

Surgical hernia repair is the mainstay of treatment groin hernias causing symptoms.

Non-surgical treatments include close observation or the wearing of a truss (a type of belt that keeps the hernia from protruding).

Inguinal hernia rarely become strangulated, but are often symptomatic and will increase in size overtime. Surgical hernia repair is usually advisable, unless you have no symptoms or are unfit to undergo day surgery.

Your surgeon may perform either an open or a laparoscopic surgery to repair groin hernia.

Laparoscopic surgery for inguinal hernia

Laparoscopic hernia repair is now the most common chosen type of hernia repair. The exceptions are for very large hernias or hernias in people taking blood thinning medications, in which case open surgery may be safer. During laparoscopy, your surgeon will make 3 small incisions on the abdominal wall. A laparoscope (thin tube with a lighted device and a camera on its end) is inserted through one of the incisions and special surgical instruments are placed in through the other incisions. The peritoneal sac is pushed back in place and muscles of the abdominal wall are repaired by using a specially designed mesh.

Open surgery for inguinal hernia

During the procedure, a single 4 to 10 cm long incision (this scar will often not be seen while wearing underwear or swimwear) will be made over the bulge or in your lower abdomen and the bulge will be separated from the surrounding tissues. The part of your protruded peritoneal sac will be pushed back into the abdomen. The muscles of the weak abdominal wall may either be stitched or a piece of mesh may be sutured in place to repair the hernia.