Inguinal (Groin) Hernia
An inguinal hernia is a defect (space) in the groin in which the inner lining of the abdomen in its contents bulges through. This may cause pain. The blood supply can get choked off, resulting in death and perforation of 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 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 the 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 bleeding 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%.
Left Inguinal Hernia
Mesh Placement Left Inguinal Hernia
Placement of Mesh Outside of Sac Right Inguinal Hernia
Repaired Right Inguinal Hernia
Strangulated Left Inguinal Hernia