INGUINAL HERNIA MOSTLY CASES

Inguinal Hernia
A hernia is the protrusion of abdominal contents, usually intestines outside the abdominal cavity through a natural or acquired defect. Among all types of hernias, an inguinal hernia is the commonest form and is found in 1-2% of children and 5-15% of adults. The male to female ratio is 4:1 in children and 12:1 in adults. Older people or adults who regularly do heavy manual work are more likely to develop hernias. Other less common hernias are paraumbilical hernia, incisional hernia, femoral hernia and diagphragmatic hernia.
Caused by weakened groin muscles and tissue
An inguinal hernia may be present at birth or develop later in life due to weakened groin muscles and tissue. The formation of an inguinal hernia may be from factors that cause raised pressure in the abdomen such as intra-abdominal tumour, ascites, chronic cough, constipation and straining on urination.
Patients may feel mild pain or discomfort in the groin area and find that their groin or scrotum bulge or swell especially during coughing or prolonged standing. Swelling disappears while lying down, however, intense pain is a sign that the intestine has become trapped.
Fortunately, an inguinal hernia can usually be accurately diagnosed by clinical examination. If in doubt, doctors will use an ultrasound examination to aid the diagnosis.
Return to normal activities within a week after surgery
An operation is always necessary to treat an inguinal hernia. The symptoms may last for several months or even years without immediate danger, however, if the intestine becomes stuck in the inguinal canal the blood supply to the intestine can be jeopardized. This complication is known as a strangulated hernia and is life threatening. Emergency surgery will be required. Hence, it is better to proactively treat an inguinal hernia through surgical means before any damage occurs.
There are two types of inguinal hernia repair: open surgery and laparoscopic surgery and the surgeon will recommend which type is suitable.
If patients require an open inguinal hernia repair, an incision (~8cm) is made in the groin region under general anaesthesia. The hernia content is placed back into the abdominal cavity, the hernia sac removed and the hernia defect is closed. A piece of meshed synthetic material is used to strengthen the weakened groin muscles and reduce the recurrence rate to as low as 1-2%. Patients only need to stay in hospital for 1-2 days after surgery and full recovery takes around 7-14 days.
For laparoscopic inguinal hernia repair, three small incisions (0.5-1cm) are made in the lower abdomen and the abdomen inflated with air to provide a clear view under general anaesthesia. The hernia content is placed back into the abdominal cavity, hernia defect closed with stitches and the air released. Like open surgery, a piece of meshed synthetic material will be placed underneath the abdominal wall to strengthen the weakened groin muscles. Patients need to stay in hospital for 1-2 days after surgery and full recovery takes around 5-7 days. The recurrence rate is similar to that of open surgery at 1-2%.
Generally speaking, a laparoscopic repair leads to less wound pain, less scaring and the patient enjoys a shorter recovery time. It is particularly suitable for bilateral inguinal hernias as the same access incisions can be used to operate on both sides. It is also convenient for recurrent hernias.
Normally, patients can return to normal daily activities within a week but are advised to avoid physical activities for at least 4 weeks.
Quitting smoking reduces the chance of developing hernias
Possible complications include wound infection, bleeding, scrotal haematoma and retention of urine. Injury to the vas deferens is a rare complication which may happen in very large and difficult inguinal hernia repairs.
There are several ways to prevent a hernia, for instance, people can avoid lifting heavy objects and avoid straining during bowel motion. Quitting smoking can also reduce the chance of developing a hernia as smoking can cause a chronic cough and results in the weakening of groin muscles.
Source: Dr Alex Kwok, Specialist in General Surgery, Matilda International Hospital
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