Inguinal Hernia

Introduction
Hernia is a very common surgical problem seen in general population. Yet it is one of the most neglected disease. It is estimated that nearly 27 percent of men and nearly 3 percent of women will develop hernia in their lifetime. In India alone nearly 10 million people ( one crore people ) develop this disease every year.

What is an inguinal hernia ?

An inguinal hernia is a bulging of the contents of the abdomen through a weak area in the lower abdomen. This mostly consists of fat ( omentum ) or parts of small or large intestines. In women they may even have parts of female reproductive system.

These come out through a potentially weak space of the body called inguinal canal. In males the testes come out of the body through this passage at birth and thereafter the canal closes. But a potentially weak spot remains. In females this area is present but not as weak. That’s why males are ten times more prone to  develop inguinal hernia.

CAUSES OF INGUINAL HERNIA

  1. Congenital : seen in newborns and young children
  2. Increasing age : as person gets old the muscles become weak. And this associated with chronic diseases like cough or constipation can lead to hernia formation
  3. Heavy exertion : nowadays we are seeing a lot of hernias in young adults due to over exertion in gyms. Especially when they are doing unsupervised gymming or the gym instructors are themselves poorly trained.
  4. Family history of hernias makes a person more prone to developing inguinal hernia
  5. Difficult child birth : in women this contributes as a major cause of hernia formation.
  6. Last of all people with connective tissue disorders , low BMI , excessive smokers have also been seen to develop hernias more often.

SYMPTOMS OF INGUINAL HERNIA

mild hernias are normally asymptomatic.

  1. It consists of mild bulge in the inguinal fold which becomes more prominent on standing , coughing , sneezing or exercise. It normally goes back on lying down and rest.
  2. Feeling of discomfort, pain , heaviness or burning in groin are very common.
  3. In complicated cases the pain may be very severe especially if intestines get entrapped in the hernia. It is usually associated with a large inflamed swelling and intractable vomiting and difficulty in passing flatus. This condition requires urgent surgical intervention to save the intestines and also persons life at times.

WHEN TO SEEK EMERGENCY MEDICAL HELP

A stragulated hernia needs to be attended to immediately as it is a life threatening situation.

Symptoms of strangulated hernia may include

  1. A hernia bulge that increases suddenly in size
  2. A hernia bulge that used to go back inside but no longer does so
  3. Fever
  4. Redness at the hernia site
  5. Sudden or severe pain or tenderness at the hernia site
  6. Symptoms of intestinal obstruction such as abdominal pain, bloating , nausea,vomiting and non passage of gas ( flatus )

TESTS USED TO DIAGNOSE INGUINAL HERNIAS

Almost all the inguinal hernias are diagnosed by clinical examination alone. However tests like ultrasound, CT scan or MR Imaging of the lower abdomen may be required in certain cases of complicated hernias.

TREATMENT OF INGUINAL HERNIAS

There’s only one treatment for inguinal hernia and that is SURGERY. Broadly surgery can be of three types

  1. Laparoscopic
  2. Conventional ( open )
  3. Robotic

LAPAROSCOPIC HERNIA REPAIR

This has become the treatment of choice for inguinal hernias especially at places where good equipment and trained surgeons are available. Skill set required to perform a laparoscopic hernia repair is far more so select your centre and surgeon carefully. Mastering of laparoscopic hernia repair technique is a long process so please check for the experience of your surgeon in performing this.

Laparoscopic surgery, including that of hernia , should always be done at higher well equipped centres as they have latest and best technology.

Other advantages of a laparoscopic repair are

  1. Small scars
  2. Quicker recovery
  3. Both sides inguinal hernia can be operated at the same time through same incisions.
  4. Even rare hernia sites like femoral etc are also covered as mesh size is big.

Disadvantages

  1. Slightly more expensive than conventional surgery
  2. Requires use of general anesthesia
  3. Slightly longer operative time.
  4. Not suitable for very large hernias as operating time increases a lot.

CONVENTIONAL / OPEN INGUINAL HERNIA REPAIR

This is an age old technique more than a century old. Most surgeons are proficient in doing this. However it involves a bigger cut. Recovery is consequently little slow. Nevertheless even in todays age it has certain advantages.

  1. Much more economical
  2. Can be performed under local or regional anesthesia. No need to subject the patient to general anesthesia and its related risks.
  3. Relatively better for very large or irreducible hernias.
  4. Can be safely performed even at relatively smaller centres.

 

ROBOTIC LAPAROSCOPIC HERNIA

This a relatively new technique. It involves use of robots instead of human. Though the robot is controlled by a laparoscopic surgeon only. It is more precise. But the primary disadvantage is the huge cost involved in the procedure. As the cost of procurement and maintenance of robot is phenomenal. Robotic facilities are available at very limited centres though gradually its use is becoming more widespread. So at the present time in my opinion use of robot should be limited to very complex cases only.

 

HOSPITAL STAY & FOLLOW UP

More than 90 percent of cases require only one day of hospital stay. All the patients are made mobile the same evening. Very rarely a patient needs to stay in hospital for a second day as usually seen in elderly patients for better care. Stitches are removed in a weeks time ( unless absorbable stitches have been put ). Most patients return to their office after 4-5 days and work from home is permitted after 24 hours itself.

However hernia patients need to be little careful for subsequent weeks.

Precautions in post operative cases

  1. Strict avoidance of lifting of heavy weights ( say more than 7-10 kg ) for 6 weeks
  2. Avoiding unnecessary use of stairs. However in case someone lives on upper floors he should be climbing stairs slowly , one step at a time. And avoid unnecessary movement up and down
  3. Avoid sitting on floor / squatting position. So use of English toilet seat is preferred.
  4. Driving a two wheeler is not advisable for three weeks atleast
  5. Driving a car especially with manual gear box in heavy start stop traffic is not advisable for 2-3 weeks
  6. A scrotal support should be worn for around 2 weeks as this reduces the post operative swelling around testis
  7. Smoking is a strict NO
  8. However a walk in the garden is not prohibited but brisk walk or jogging should be avoided
  9. Use of gym or doing yoga should be avoided especially the heavy abdominal exercises for atleast 6 months. But light exercise and breathing exercises are not an issue
  10. Patients should avoid constipation and should take high fibre healthy food. If needed a laxative may also be required for sometime to avoid undue exertion while passing stools.

 

If you have any more doubts regarding hernia or it’s surgery please feel free to contact us anytime.