An inguinal hernia is a bulging of the peritoneum through a hole in the abdominal wall in the groin area. At the same time, parts of internal organs (parts of the intestines and fat) protrude out through the so-called inguinal canal or close to it from the abdominal cavity. The inguinal canal passes diagonally through the abdominal wall and includes in men a system of the spermatic cord (vas deferens, blood vessels, nerves), and in women the ligament of the uterus holding it.
How often is an inguinal hernia?
Inguinal hernias are very common. This applies to approximately 2-3% of the population, men and boys more often than women and girls.
What causes an inguinal hernia?
An inguinal hernia can be a congenital hole in the abdominal wall. Or occurs during life due to the progressive weakening of the connective tissues and muscles of the abdominal wall in the groin area. An increase in pressure in the abdominal cavity, for example, due to:
- Chronic constipation (straining during bowel movements)
- Chronic cough
- Excess weight
- Constant lifting of heavy loads
The abdomen is largely closed and lined by a fine skin, the peritoneum. It houses organs such as the stomach, liver and intestine. Gravity pulls the organs down. The abdominal wall holds her in position. But especially in the lower abdominal area there is still a certain pressure.
This pressure is also felt by the inguinal canal. Especially when lifting heavy loads, sneezing, coughing or pressing (such as during bowel movements), the abdominal organs press on the inguinal canal. Normally, it can withstand the strain - thanks to the powerful muscles, ligaments, and tight connective tissue that surround it.
However, if the pressure becomes too great, there will be a gap in the inguinal tissue (hernia): the peritoneum will bulge outward at this point. Therefore one speaks also of break bag. Sometimes also entrails occur (usually parts of the intestine) - enclosed by the fracture bag - through the gap and out of the abdominal cavity (fraction content).
Even if the term suggests something else: In a hernia (inguinal hernia) no bone is broken, but it is pierced tissue in the groin - the so-called inguinal canal. This tubular connection between the abdominal cavity and the outer pubic region draws obliquely from back to front. In this channel run blood and lymph vessels and the spermatic cord in the man and one of the mother tapes in the woman.
If this inguinal canal is punctured by a hernia, this is recognized by a visible and / or palpable swelling in the groin area, which can often be pushed inwards. Sometimes the genital region is also affected by the inguinal hernia labia occur in the man on the scrotum. In most cases, the inguinal hernia symptoms (woman & man) are on the right side.
In many cases, the inguinal hernia causes no pain. Those affected report more of an indefinite feeling of pressure or a pulling, sometimes of abdominal pain or a foreign body sensation in the groin.
If inguinal hernias occur, they can drag into the testicles or labia. Increases the abdominal pressure, for example, when coughing or lifting loads, the complaints increase. At rest and while lying down, the inguinal hernia symptoms disappear. So if someone is more in pain lying down / at night, it is usually not a hernia. Instead, for example, a hip joint or muscle disease behind it. Both pain and swelling increase during exercise. In the case of particularly intense inguinal hernia signs, tissue may already be trapped. Then you should go to the doctor immediately!
Inguinal hernia symptoms in children
Recognizing a hernia in children is not always easy. Often, parents accidentally discover the visible swelling in the groin or genital area when bathing, dressing or undressing their child. When pressed, the child reacts sensitively. Other signs of hernia in children may be:
- Tearfulness or seemingly groundless crying (especially baby and toddler);
- refusal to eat;
- great restlessness.
Pinched hernia: warning symptoms!
In rare cases, inguinal hernias (such as bowel loops) are trapped in a hernia. These are then no longer sufficiently supplied with blood and can die off. The symptoms of inguinal hernia with entrapment are much more intense, for example:
- Strong pain;
- redness of the site;
- nausea and vomiting.
If someone shows such symptoms, one must immediately alert a doctor. It threatens a bowel obstruction and a life-threatening peritonitis!
Severe pain in a hernia is a symptom that there are (dangerous) complications. Go to the doctor immediately!
If it has come to a hernia, experts recommend surgery in almost all cases. There are different methods that are suitable for patients.
Every inguinal hernia should be operated on. Because he does not self-educate and grows with time. In addition, there is always the danger that intestinal or fatty tissue is caught in the protuberance and pinched off. This condition is life threatening and requires immediate surgery. Which surgical method is suitable for a harmless inguinal hernia depends on many factors. Thus, the age of the patient plays a role, as well as the location and size of the fracture. In addition, some methods are not suitable because they require general anesthesia. This is not an option for every patient. Important: An inguinal hernia surgery should be performed by a skilled surgeon who specializes in one of the procedures described below.
In principle, there are three different surgical methods: the operation according to Shouldice, the according to Lichtenstein and minimally invasive procedures. Which procedure is used, doctor and patient have to decide individually.
Operation in Case of Inguinal Hernia by Shouldice
Procedure: The surgeon makes a skin incision in the inguinal region and exposes the breakage. He then opens the fractured sac, which has formed through the inguinal hernia, and pushes back the contents of the hernia into the abdominal cavity. As a result, intestinal and / or fatty tissue return to their original positions. Finally, the surgeon sutures the gap created by the fracture with adjacent connective tissue and thus stabilizes the inguinal region.
Advantages: The procedure can take place under local anesthesia, general anesthesia is not necessary. There is little artificial material needed - just for sewing. Therefore, it hardly comes to allergic reactions or irritation.
Disadvantages: Patients have to spare themselves for a long time after the operation. It usually takes two months before they can strain themselves, lift something or do sports. After the procedure, there may be some pain in the groin for a while.
For whom? The Shouldice procedure is often recommended by doctors to young people and those who have had a small inguinal hernia.
Operation in Case of Inguinal Hernia by Lichtenstein
Procedure: The OP runs in principle like the method according to Shouldice. However, the surgeon stabilizes the fracture with a special plastic net. He lays it over the hole created by the breach and sews the net over it. In males, the net is positioned around the spermatic cord so that it can continue unhindered through the inguinal canal.
Benefits: This method does not require general anesthesia, local anesthesia is sufficient. The risk of another break is low. Patients may be recharged sooner than after the Shouldice procedure.
Disadvantages: The plastic net is used as foreign material in the body. In modern networks, however, it is very rare for the body to be sensitive to it.
For whom? The operation according to Lichtenstein is suitable for the elderly and for patients with a major inguinal hernia. Even if it is a repeated break or the person affected needs to be fit for work quickly, this method is recommended.
Minimally Invasive Technique in Case of Inguinal Hernia (TEP or TAPP operation)
Procedure: Minimally invasive means that it does not require a large skin incision, but only tiny cuts. Experts distinguish the so-called TEP (total extraperitoneal hernioplasty) procedure from the TAPP (transabdominal preperitoneal hernioplasty) method. In both cases, the surgeon uses the small abdominal incisions to insert an endoscope (tube device with built-in mini-camera) and the necessary instruments and pushes them to the inguinal hernia.
In the TEP technique, the doctor uses a fine tissue gap that is naturally between the skin and the peritoneum. There he cuts in the skin and injects the instruments. The surgeon presses the fractured bag back into the abdominal cavity and introduces a plastic net over the gap mentioned above, so that it attaches above the fracture. The net fixes itself, no metal clips or the like are necessary. In the TAPP procedure, the incisions are in the area of the navel and the middle abdomen. Subsequently, the belly must be inflated with the help of carbon dioxide. The surgeon also pushes the fractured sack back into the abdominal cavity. He pushes the plastic net from the abdomen - from the inside - to the inguinal hernia. He performs a laparoscopy for this. In this case, the net must be fixed with the help of staples or sutures. Occasionally, it is also glued. The staple or suture material in the body dissolves by itself.
Advantages: The risk of a new break is considered low. The patient is allowed to strain again soon after seven to ten days. The doctor places the plastic net without having to sew the break under tension. The operator is thus usually spared drawing pain and he is allowed to move quickly again.
Disadvantages: The operation is under general anesthesia, which can be problematic for the elderly, for example. Rarely, the surgeon injures the peritoneum during this procedure, resulting in pain after surgery.
For whom? According to experts, this procedure is recommended for all patients in whom there are no contraindications to the procedure. For example, if you have to be physically fit for a job, for example, you can opt for this surgery method.