Inguinal Groin Hernia

Inguinal Groin Hernia?

An inguinal groin hernia is a defect (space) in the groin in which in inner lining of the abdomen in it’s contents bulges through.  This may cause pain.  The blood supply can get choked off resulting in death and perforation if the intestinal contents which may be life threatening.

What Causes a Hernia?

The groin has natural areas of potential weakness.  These include the area where the testes pass down into the scrotum during development or where the round ligament passes into the abdomen.  Heavy straining from lifting, coughing, difficulty with bowel movements, and urinary retention may lead to hernia formation.

Inguinal Hernia Repair

Many hernias are still performed through a traditional, open incision. This is mainly due to the technical difficulty of the laparoscopic repair and the increased cost.  Most insurances actually try to dissuade surgeons from performing laparoscopic inguinal hernia repair by reimbursing them less.  The benefits, however, are greater for the patient.  These include faster return to normal activities, less post operative pain, and much less chronic pain which sometimes happens after the open repair.  This may be debilitating due to suture entrapment, mesh adherence, or division of the nerves.

During a laparoscopic inguinal hernia repair, the layers of the abdominal wall are dissected around the defect.  The contents of the hernia (often small intestine) are reduced back into the abdominal cavity, and the lining is reduced as well or ligated.  A thin mesh (screen) is placed in between the abdominal wall layers keeping them from returning.

Many surgeons use tacks to hold the mesh in place.  This has possible complications of beeding or pain however.  I was taught, however, to widely dissect the hernia sac so there is a large amount of overlap of mesh eliminating the need for tacks.  Recurrence with this technique is <1%.

Large RIH

large RIH

Left Inguinal Hernia

left inguinal hernia

Mesh Placement Left Inguinal Hernia

mesh placement left inguinal hernia

Placement of Mesh Outside of Sac Right Inguinal Hernia

placement of mesh outside of sac right inguinal hernia

Repaired Right Inguinal Hernia

Repaired right inguinal hernia

Strangulated Left Inguinal Hernia

strangulated left inguinal hernia