Inguinal Hernia Surgery
What is an inguinal hernia?
Swellings that occur as a result of intra-abdominal organs (especially the intestines) trying to come out through weak points in the groin area are called inguinal hernia. Herniation of intra-abdominal organs is most commonly seen in the groin area, and approximately 70-75% of abdominal wall hernias are inguinal hernias. 20 million inguinal hernia surgeries are performed every year around the world.
Inguinal hernias are 8 times more common in men than in women and can be unilateral or present in both groins at the same time.
Why does inguinal hernia occur?
The groin area is one of the weakest points of the abdominal wall. In men, the testicles pass through the canal in this region (inguinal canal-inguinal canal) before birth and migrate to where they should be, and within the canal are the vessels leading to the testicles and the structure that carries the sperm (spermatic cord). In women, the ligament that suspends the uterus passes through this canal. If the canal that needs to close after birth does not close or closes poorly, herniation may occur over time. Additionally, there are two other weak points in the groin area, apart from the canal. One of these is the femoral canal at the edge of the leg vein, and the other is the posterior wall of the inguinal canal on these structures.
Are all inguinal hernias similar?
There are three types of inguinal hernias, the most common of which arise from different weak points in the groin area. These are indirect inguinal hernia passing through the inguinal canal, direct inguinal hernia arising from its inner edge without passing through the canal, and femoral hernia arising from the edge of the femoral vessels, which are the leg veins.
More than 90% of hernias in the groin area are direct and indirect. Femoral hernia occurs in approximately 5-7% and is frequently seen in women.
While inguinal hernias are usually seen unilaterally, herniation can be detected on both sides at the same time, although at a lower rate. Therefore, in unilateral inguinal hernias, the opposite side must be examined.
How is laparoscopic surgery performed?
The patient is usually put to sleep under general anesthesia. First, the abdomen is entered through a small incision below or above the navel, and the abdomen is inflated by administering carbon dioxide gas. A medical device (trocar) that allows the passage of a camera (telescope) is placed through the same hole and the organs are made visible on the screen.
After the camera is inserted, other trocars suitable for the organ to be operated on are inserted and the surgery is performed with cutting and holding tools such as scissors and forceps with rod-shaped ends.
What conditions cause inguinal hernia?
Since the abdomen is a closed environment, in all cases that increase intra-abdominal pressure, it occurs as a result of the organs trying to come out from the groin area, which is the weakest point.
Causes of increased intra-abdominal pressure;
- Constipation
- Difficulty urinating (due to prostate enlargement)
- Habit of straining to urinate
- Pregnancy in women
- Chronic (persistent) cough Weight gain (obesity) S
- portive activity (weight training)
What symptoms does an inguinal hernia cause?
Pain and swelling in the groin area are the main complaints of patients. However, from time to time, it may cause only pain or swelling without pain.
The characteristic of swelling in inguinal hernias is that the swelling grows in situations that increase intra-abdominal pressure, such as straining and coughing. Sometimes the swelling grows too much and descends into the skin of the testicle, called the scrotum in men, and disappears only when lying down or pressing with a hand. In some cases, if it does not go back when lying on your back or with manual pressure and causes severe pain, this is called hernia strangulation.
How is inguinal hernia diagnosed?
Although patients can often self-diagnose inguinal hernias by noticing pain and accompanying swelling in the groin area, the actual diagnosis is made as a result of a general surgical examination.
In some cases, in patients who cause pain but no swelling can be detected, diagnosis is made using imaging methods such as ultrasonography or MRI.
How is inguinal hernia treated?
A. Surgical Treatment:
The main treatment for patients with inguinal hernia and related complaints is to surgically close the opening causing the hernia. Inguinal hernia should not be treated with medication or corset. With surgical treatment, the weak points in the groin area are strengthened with stitches and patches to prevent the organs from coming out of this opening.
Surgeries that were performed openly in the past are now performed closed, that is, laparoscopically.
B. Close Observation:
Some inguinal hernias that do not cause complaints and do not disrupt the daily activities of the individual with advanced age and high risk of surgery can be followed up with a joint decision between the surgeon and the patient, provided that they are observed closely.
How should anesthesia be chosen for patients undergoing surgery?
Surgery for inguinal hernias can be performed under general anesthesia or spinal, or regional, anesthesia. Which type of anesthesia will be determined primarily by the patient's preference, the type of surgery (open-closed) and the evaluation of the anesthesiologist. Spinal anesthesia is preferred in high-risk patients for general anesthesia.
How are closed surgeries performed?
While in the past, hernia surgeries were performed only openly, that is, with an approximately 8-10 cm incision on the inguinal canal, today they are performed closed (laparoscopically) with the help of special devices and video entered through 3 0.5-1 cm long incisions. The herniation reflected on the screen by the camera is removed with hand tools suitable for the procedure and patch reinforcement is applied.
Which surgery should I choose: Open repair? Laparoscopic repair?
In current surgical practice, laparoscopic surgeries are being performed at increasing rates. Laparoscopic surgeries have many advantages such as smaller incisions, less pain and early return to work. It is the ideal method for athletes and bilateral hernia patients.
Considering its long-term results, it has been shown in clinical studies that it is as effective as the open method and is considered superior to the open method due to its advantages.
Are there any risks to inguinal hernia surgery?
When evaluated together with the advances in surgical technique and anesthesia science, these surgeries (open-closed) are performed very safely. Risk assessment is made by looking at the condition of the hernia, the patient's current illnesses, medications used and previous surgeries.
Is emergency surgery required for inguinal hernias?
Emergency surgery for inguinal hernias is required when there is strangulation (compression) of the hernia. Hernia strangulation; It means that the intra-abdominal organ protruding from the weak point does not disappear by pressing with hand or lying down. If this condition is accompanied by abdominal pain, inability to defecate, nausea and vomiting, it is understood that there is an intestinal obstruction and it must be corrected with urgent surgery.
When can I return to normal life after surgery?
Although it varies depending on the method of surgery, you will be discharged from the hospital on the first day after the surgery. Although it varies depending on individual differences and the type of work performed (desk-requiring work), 5-7 days after surgery. You can return to your pre-operative working routine daily.