Inguinal hernias: A brief overview

Diagnosis

Patients often diagnose that they have a hernia as the lump or swelling is usually obvious. Your GP will usually be able to confirm the diagnosis. The lump may be more obvious when standing and coughing.

If the diagnosis isn’t obvious, investigations such as an abdominal ultrasound, CT scan or MRI may be helpful to confirm the diagnosis.

Treatment

Small hernias that are not causing any symptoms do not always require treatment. In part the decision to treat or not will depend on your symptoms from the hernia, where it is located and other factors such as your general health. A watchful waiting approach may be best for some people.

Enlarging or painful hernias usually require surgery to relieve discomfort and prevent serious complications.

There are two general types of hernia operations — open hernia repair and laparoscopic repair.

Open hernia repair

Open hernia repair (also called a tension-free mesh repair) is perhaps the most commonly performed hernia operation and can usually be done with local anesthesia and sedation or general anesthesia. An incision in made in your groin and the surgeon pushes the protruding tissue back into your abdomen. The surgeon then sews the weakened area, often reinforcing it with a synthetic mesh. The opening is then closed with stitches, staples or surgical glue.

After the surgery, you’ll be encouraged to move about as soon as possible, but it might be several weeks before you’re able to resume normal activities.

Laparoscopy

In this minimally invasive procedure, which requires general anesthesia, the surgeon operates through several small incisions in your abdomen. Gas is used to inflate your abdomen to make the internal organs easier to see.

A small tube equipped with a tiny camera (laparoscope) is inserted into one incision. Guided by the camera, the surgeon inserts tiny instruments through other incisions to repair the hernia using synthetic mesh.

Many patients who have had a keyhole or laparoscopic repair have less discomfort and scarring after surgery and perhaps, a quicker return to normal activities. However, some studies indicate that the risk of the hernia coming back is a little more likely with laparoscopic repair compared to an open tension-free repair.

Laparoscopy allows the surgeon to avoid scar tissue from an earlier hernia repair, so we usually recommend this approach for people whose hernias recur after traditional hernia surgery. It also might be a good choice for people with hernias on both sides of the body (bilateral).

Some studies indicate that a laparoscopic repair can increase the risk of complications and of recurrence. Having the procedure performed by a surgeon with extensive experience in laparoscopic hernia repairs can reduce the risks.

Open vs. Laparoscopic repair of inguinal hernias: Lap. repair may be better.

A recent study published in the March issue of Archives of Surgery 2012 suggests that patients who undergo a laparoscopic inguinal hernia repair (Total extraperitoneal inguinal hernia repair (TEP)), report higher patient satisfaction, less chronic pain and less impairment of inguinal (groin) sensation compared to those who undergo a tension-free the open Lichtenstein repair.
Hernia Surgery. Two surgeons performing an operation