A hernia means that some part of the contents from within the abdominal cavity – some fat or sometimes a part of the intestine -- protrudes through an abnormal opening or weakness in the muscles of the abdominal wall. An inguinal hernia is a bulge that develops through a weakened area in the groin. The inguinal canal is a passage through the lower abdominal wall – there is such an opening on each side of the lower abdomen. In males, the spermatic cord from the testicle passes through the inguinal canal and contains blood vessels, nerves, and the spermatic duct, that carries sperm from the testicles to the penis. In females, the round ligaments, which support the uterus, pass through the inguinal canals. This inguinal canal provides a weak point in the abdominal wall which is why hernias often develop in the groin. They are more common in men than in women, can be present at birth, or developed at any time during your lifetime. Inguinal hernias can cause burning, pressure, a dragging sensation, a bulge, or pain. Most hernias can be diagnosed by physical examination. Usually your physician will ask you to cough or strain in order to make it more obvious on examination. If it is difficult to determine with certainty, then physicians will sometimes order an ultrasound exam or a CT scan.
A hernia does not get better over time, nor will it go away by itself. There are no exercises or physical therapy regimens that can make a hernia improve or heal. The hernia can be observed if you and your physician feel it is not an urgent problem, and there are minimal or no symptoms. An alternative to surgery includes wearing a truss or hernia belt.
There is a slight risk that abdominal contents could become incarcerated (trapped) or strangulated ( the tissue dies) which needs to be taken into consideration if surgical repair is not done. An incarcerated hernia happens when part of the fat or small intestine from inside the abdomen becomes stuck in the groin or scrotum and cannot go back into the abdomen. When an incarcerated hernia is not treated, the blood supply to the small intestine may become constricted, causing “strangulation” of the intestine or other contents. Hence most physicians encourage repair of inguinal hernias in patients who are medically able to undergo the procedure when feasible, even if there are no symptoms.
A hernia may not cause symptoms but they do tend to get larger over time. If symptomatic or enlarging, the hernia should be repaired. This requires a trip to the operating room, and the ability to tolerate some type of anesthesia. Most all hernia repairs involve implanting a mesh of woven material to strengthen the muscles and prevent hernia recurrence. Hernias can be repaired with a small incision in the groin (open technique) or using a laparoscope to enter the abdominal cavity and repair from the inside. Your surgeon will choose the technique which they feel is the most appropriate for your age, medical conditions, surgical risk, and potential outcome. Each type of repair has its advantages, risks, and benefits. There are certain patients in which only an open technique can be used, such as when the patient cannot tolerate general anesthesia.
In the hands of experienced surgeons who repair inguinal hernias on a regular basis, both the open and laparoscopic approaches have low rates of serious complications and very good outcomes. Complications include hematoma (bleeding into the tissue), superficial wound infection, testicular swelling, chronic pain in the groin, and hernia recurrence.
Most inguinal hernias can be repaired on an outpatient basis requiring only a short stay on the day of surgery. Higher risk patients may need hospital observation for their medical conditions. Recovery time is variable, but most patients can return to light activity within a few days. Timing for return to work or vigorous activity will be recommended by your surgeon.
Dr. Baker is a board certified general surgeon, a Fellow of the American College of Surgeons, and a retired US Navy Admiral. He is the Senior Partner of West Coast Surgical Associates (formerly Walnut Creek Surgical Associates) with offices in Walnut Creek, Concord, and San Ramon. For more information call 925-933-0984 or view the surgical team at www.wcsurgeons.com