Inguinal Hernia
WHAT IS AN INGUINAL HERNIA?
A hernia is the protrusion of an internal organ from a weak point in the body. If the protrusion in the form of a lump occurs in the groin region, we call it an inguinal hernia. Abdominal hernias occur in approximately 2-5% of the population. Inguinal hernias occur 7-8 times more frequently in men than in women. Approximately 10% are bilateral hernias.
WHY DOES IT DEVELOP?
Inguinal hernias occur for two reasons. The first is congenital causes. In the male, the testes are located in the abdomen in the intrauterine period. They move down to the scrotum by the time of delivery. During this movement, a hernia may occur if the area has defected. Secondly, the groin canal is already a weak area in this region. Ruptures may occur due to strain, allowing for herniation of the internal organs. Any strain in the groin area may be caused by constipation, chronic cough, sudden movements, heavy lifting, obesity, and fluid accumulation in the abdomen (ascites). All of these can put a strain on the anatomical structure of the inguinal region and cause hernias.
WHAT ARE THE SYMPTOMS OF INGUINAL HERNIA?
The most common symptom is swelling in the groin area. Swelling usually occurs during standing or walking. The swelling disappears in the lying position because the internal organs move back into the abdominal cavity. Pain is another complaint that occurs due to strain in the groin area. The pain increases in severity over time. Difficulties may develop later during movements, leaning, and walking.
HOW IS IT DIAGNOSED?
The diagnosis of inguinal hernias is usually made by physical examination. Ultrasound or MRI may sometimes be needed if pain occurs before swelling.
HOW ARE INGUINAL HERNIAS TREATED?
Inguinal hernias can be treated with surgery. Surgery can be performed by laparoscopy or using the open method. Non-operative treatment methods result in treatment failures. Non-surgical treatment methods for inguinal hernias will not provide a cure for the patient even if they reduce the patient’s complaints. Long-term use may impair the anatomical integrity of the anatomical structures and reduce the success of surgical treatment.
WHAT KIND OF TREATMENT IS PERFORMED AT WHICH STAGE?
Inguinal hernias should be operated at the time of diagnosis. Delays in surgery may cause hernias to grow and may result in hernia strangulation, complicating the treatment of the patient.
IF LEFT UNTREATED, WHAT TYPES OF HEALTH PROBLEMS MAY OCCUR?
Patients with inguinal hernias mostly present with the complaint of having a lump in the groin. If the patient neglects the lump and delays seeing a physician, the hernia may progress, grow, and may wrap around the testicles. This may complicate the treatment. The most feared complication of abdominal wall hernias is “strangulated hernia”. A strangulated hernia is an emergency indicating the impaired blood supply to the intestines. If the patient is still left untreated, gangrene may develop in the area and then it ruptures leading to diffuse peritonitis in the abdomen. The patient’s body temperature rises, his/her general condition deteriorates, and sepsis develops eventually leading to death. To avoid such a threat, hernia surgery should be performed as soon as possible. The complications may be so severe that removal of the intestinal loops may be necessary, resulting in long hospital stays and even death.
WHEN SHOULD OPEN AND CLOSED SURGERY BE PREFERRED?
It depends on the preferences of the patient and the physician. When the patient needs to return to daily life and work early, we prefer the laparoscopic method for bilateral, previously operated, and recurrent hernias. In unilateral hernias, open surgery may be preferred if the patient does not mind absenteeism. Laparoscopic surgery is performed under general anesthesia. Open surgery can be performed under general anesthesia, spinal anesthesia, and local anesthesia. High-risk patients for general anesthesia (patients with advanced heart failure, lung diseases, etc.) can be treated with open surgery under local anesthesia for the treatment of an inguinal hernia. We prefer laparoscopic methods for athletes to enable them to return to their sports life more quickly. In very large hernias, the laparoscopic method may be technically more difficult. In such cases, the surgeon may prefer open surgery.
After the operation, the patient stays in the hospital for a maximum of one day. He/she starts walking on the same day and can return to daily life in an average of 7-10 days. Running exercises can be started at a slow pace in the second week. Athletes can resume their former lives in 3 to 4 weeks. After a few days following the surgery (an average of 4-5 days), the patients can start driving. We advise the patients not to lift heavy objects after the surgery, not to bend or stand up suddenly, and to avoid engaging in heavy physical activities. Patients engaged in Islamic praying (namaz) are recommended to sit down for about 7-10 days.
Today, synthetic patches are used in hernia operations. In cases where the groin is exposed to a heavy strain, the hernia may recur. However, the recurrence rate in the patch method is 1 percent. Whether hernia surgery is performed using the open or closed method, patches should definitely be used.
WHAT ARE THE SYMPTOMS OF INGUINAL HERNIA?
- Swelling in the groin area.
- Pain occurs when the groin is strained.
- Difficulties in moving, bending, or straightening.
- Later difficulties in walking.
HOW IS A HERNIA DIAGNOSED?
- The diagnosis of inguinal hernias is usually made by physical examination. Ultrasound or MRI may sometimes be needed if pain occurs before swelling.
WHAT ARE THE TREATMENT OPTIONS FOR INGUINAL HERNIAS?
- Inguinal hernias can be treated with surgery. Surgery can be performed by laparoscopy or using the open method. Non-operative treatment methods result in treatment failures. Binders or corsets used for the treatment of inguinal hernia will not provide a cure for the patient even if they reduce the patient’s complaints. Long-term use may impair the anatomical integrity of the anatomical structures and reduce the treatment success with surgery.
