A hernia is a lump that occurs when part of the small bowel, or other abdominal tissue protrudes through an area of weakness in the wall of the abdomen. When this occurs in the groin, it is described as an inguinal hernia.
Over 70% of all hernias occur in the inguinal region. They are much more common in boys and men (98%). They may be present at birth or develop later in life, when straining, heavy lifting, coughing or obesity increases the pressure within the abdomen, applying strain on the muscles in the groin area. When an abnormal opening or defect occurs on both sides of the groin, it is called a bilateral inguinal hernia.
The only treatment for a hernia is surgical repair. The operation is most commonly performed either as an “open” surgery, involving an incision to the lower abdomen. This is usually a “tension-free” technique that uses a mesh of inert, sterile material (usually includes polypropylene plastic) to cover the affected area. Alternatively, the operation may be performed as “keyhole” surgery (laparoscopic), through small incisions in the skin using special instruments.
Hernia repair is usually carried out as a day case, with no overnight stay in hospital. The open operation can be done using local anaesthetic which involves using an “inguinal block” i.e. injection of local anaesthetic to completely block feeling from the groin region for the duration of the operation. A general anaesthetic may also be used.
Keyhole (laparoscopic) surgery and the “tension-free” open procedures lead to quicker recoveries compared to the older traditional darn repairs which are now rarely used. However, keyhole surgery is associated with different risks, such as a slightly higher risk than the open procedure of damage to neighbouring organs.
People are typically required not to eat or drink for about six hours before a general anaesthetic. Some anaesthetists allow a few sips of water until two hours beforehand.
Both open and keyhole procedures take about 30-60 minutes. An open hernia repair is performed through a cut about 7cm (3”) long in the groin. The hernia is replaced back through the gap into its proper place inside the abdomen and the gap is then closed with stitches. A synthetic mesh is inserted in order to reinforce the wall of the abdomen. Finally, the abdomen is closed in layers with further stitches.
Keyhole hernia surgery involves making a small cut near the umbilicus (belly button) and inserting a tube-like telescope called a laparoscope. Gas is inflated to separate the tissues to allow the surgeon to get better view of the interior spaces. Instruments are then inserted through the laparoscope or via further small cuts to perform the repair.
On clinical and cost-effectiveness grounds, the National Institute of Clinical Effectiveness, which advises the NHS, recommends an open repair for a first inguinal hernia. It suggests that the laparoscopic method may be better for hernias that occur on both sides of the groin (bilateral hernias) and for recurrences.