An inguinal hernia is one of the commonest causes of a bulge in the groin.
It is a recurrent or permanent protrusion of the contents of the abdomen at an area of weakness of the muscle wall. The most common content will be intra-abdominal fat, though the small or large intestines are also possible contents in the case of a large hernia.
Patients with an inguinal hernia will notice that they have a bulge at the groin region (over the bony prominence at the frontal aspect of the pelvic bone) or an enlarged scrotum in males. The bulge may disappear on lying down, only to reappear upon standing or exercise.
Inguinal hernias are much 10 times more common in men than women. In longstanding cases in men, the hernia can enlarge sufficiently to extend down to the scrotum.
By and large, an inguinal hernia is unlikely to cause any immediate danger to life nor harbour any cancerous change. For most patients, the main issue is that of a sense of heaviness or a stretching pain over the groin lump. This occurs particularly during abdominal straining like coughing, sneezing, or lifting of a load. This is not life-threatening, but it prevents patients from carrying out their normal lifestyle which includes exercising or lifting of items.
In a minority of patients, the hernia may subsequently develop acute and severe pain. This is a surgical emergency as it suggests that the hernia contents have now become incarcerated (stuck) and potentially obstructed. Emergency surgery is needed to release the contents before they become dead and necrotic and to repair the weakness in the muscle wall (hernia repair).
There is no fixed timeline nor a size criterion to decide on the timing of surgery. A good guide is to avoid unnecessary delay on the surgery, given that there is always the unpredictable element of the development of an obstructed hernia and that surgery is always at a lower risk when performed at a younger age.
There are two approaches to the surgery – open (conventional) or laparoscopic (keyhole) approach. Both approaches adopt the same principle of repairs – reduction (pull back) of the hernia and repair of the abdominal muscle wall weakness.
Reduction of the hernia to its normal position then allows the actual repair to be carried out by placing a synthetic non-absorbable medical-grade mesh across the area of weakness. Fibrous (scar) tissue then forms across the mesh and hence further strengthens the area of weakness. This method of repair is the current standard of care with a low recurrence rate of 3-7%.
Single-sided (unilateral) inguinal hernias can be repaired through either an open (conventional) or laparoscopic (keyhole) surgery. Two-sided (bilateral) inguinal hernias are better repaired through the laparoscopic (keyhole) approach.
The other possible causes include:
1. Enlarged lymph nodes
2. Scrotal hydrocele (accumulation of fluid around the testes)
3. Varicocele (enlargement of the veins leading to the testes)
4. Undescended testes (congenital disorder from birth)
5. Femoral hernia
An assessment by a General Surgeon is needed to differentiate between these conditions.
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