Introduction
- Groin or inguinal hernia is a distinct type of abdominal wall hernia.
- It has a unique repair, very different from the LVHR and so justifies an independent description.
- This hernia develops in the region of the groin fold and can extend into the scrotum in men and labia in females
- It occurs in both genders and any age, but is many fold commoner in men
- The treatment is surgical repair under local/ general anesthesia
- It is the one of the most common surgical procedures performed worldwide
Signs and symptoms
- The patient complains of a lump in the groin area, which appears on standing and straining and disappears on lying down
- In children the mother may notice the swelling when the child cries
- The swelling may become irreducible
- It may increase in size and extend down into the scrotum
Complications
- The swelling can become irreducible
- Pain, irreducibility, vomiting and constipation together are all ominous signs of an obstructed hernia.
- This is a surgical emergency
Diagnosis
- Inguinal hernias are diagnosed by examining the patient
- In case a swelling is not visible, but the patient has symptoms highly suggestive of hernia, then an ultrasound or an MRI of the groin area may help confirm the diagnosis.
Treatment
Endoscopic Groin hernia repair (Total Extraperitoneal mesh repair – TEP)
- The patient is advised to pass urine before surgery. In case the patient has difficulty passing urine or is known to have an enlarged prostate, a urinary catheter is inserted during surgery to ease out the post operative period. The catheter is removed the next day following surgery
- The surgical approach is from the midline below the umbilicus.
- The working area is between two tissue layers of the abdominal wall which defines the space where the hernia begins.
- The hernia is reduced back into the abdominal cavity and the entire groin area from the pubic bone in the midline to hip bone is covered by a large non absorbable mesh, which is fixed to the pubic bone in the midline.
- The same procedure can be performed on both groin regions simultaneously through the same access ports if required.
- This procedure improves the success rate of groin hernia repair as it allows the use of a very large mesh, which covers all potential weak spots of the groin.
- The recovery is quick, and hospitalisation is for 1 or 2 days only.
- Most patients are able to resume normal physical activities in a week to 10 days.
(Transabdominal pre peritoneal hernia repair – TAPP)
- This repair is similar to the endoscopic repair as described above.
- The difference is the route taken, which is through the abdominal cavity.
- The surgical access port are placed differently than in TEP (Fig)
Open groin hernia repair
- This was the standard repair performed for hernia before laparoscopy.
- It is performed through a cut over the hernia swelling
- The hernia is pushed back into the belly and the hernial opening is sutured close and covered with a mesh or simply covered with a mesh without suturing.
- The repair is done by cutting through multiple tissue layers which are re-sutured.
- The advantage of this approach is, it can be done under local anaesthesia and is a boon for high risk patients who may not tolerate general anaesthesia.
Post operative recovery
- Following TEP and TAPP patient is able to resume routine lifestyle after a week to ten days of surgery
- A small swelling may persist at the hernia site, which disappears gradually over a few weeks and should not be a cause of worry
- Following open repair it may take 4-6 weeks to resume routine physical activity