What is an Inguinal Hernia?
An inguinal hernia can develop in the area between the trunk and thigh and can be on the right or left side, but it can also appear bilaterally. Inguinal hernias occurs when an intra-abdominal viscera, most commonly intra-abdominal fat but it can also be bowel, protrudes through a weak point of the lower abdominal wall. This projection can cause discomfort and pain, especially when the person coughs or bends down to lift a heavy object. On some occasions it can be asymptomatic for a long time.
In which people can an inguinal hernia occur?
Inguinal hernia is created due to an increase in pressure in the abdomen. More typical examples of people with an increased likelihood of developing inguinal hernia:
- People engaged in heavy manual work
- People who lift heavy weights
- Women during pregnancy
- People with excess body weight (obesity)
- Chronic smokers
- Chronic cough due to a chest condition i.e. Asthma
- People with chronic constipation
Of course, there are also cases when people with inguinal hernia do not belong to any of the above categories. Here, an important factor is the genetic predisposition of the individual, i.e. a genetically determined weakness in their abdominal walls.
Modern Surgical treatment of inguinal hernias
We are in the era of minimally invasive surgery. Of course, the development could not fail to extend to the surgical treatment of hernias. This operation, although technically demanding, is considered the most harmonious minimally invasive surgical approach to the treatment of inguinal hernia.
What is the Laparoscopic surgical technique? Why not the classic open technique?
Laparoscopic surgical repair is an ideal choice in cases of inguinal hernia, as it is associated with a minimal rate of postoperative morbidity and recurrence. The operation requires 3 microincisions. The surgeon carefully inserts the laparoscope (microcamera), which is connected to a high-definition screen to have a detailed and enlarged image of the affected area. The hernia is reduced and a biocompatible, non-absorbable mesh is placed in the area, thus creating a “new”, strong wall.
All open techniques, without exception, fall short of laparoscopy as they are associated with postoperative and chronic pain, while hernia repair, with mesh placement, is performed essentially “blindly”, through an incision.
Why choose the Laparoscopic technique?
- It is carried out through minimal holes, so damage to tissues is negligible.
- Minimal blood loss.
- It is the only technique that allows the placement of a large mesh area (usually 12×15 cm), which based on the literature minimizes the risk of recurrence.
- It allows the insertion and anatomical integration of three-dimensional grids (3D) so that the restoration is completely harmonious.
- Due to the narrow space where the surgery is performed, there is no need to fix the mesh with materials or sutures that can cause chronic discomfort (in no other technique can this be done), so it is completely painless.
- It allows the complete restoration of normal anatomy, strengthening the gap and weak abdominal walls from the inside.
- It allows the repair of double inguinal hernias (both) through the same small holes.
- It allows synchronous correction with the same mesh of hernias that may coexist but were not recognized preoperatively (eg femoral hernia).
- It avoids injury to nerves and sensitive vessels in the area, especially in relation to testicular perfusion in male patients.
- The postoperative pain is significantly reduced and recovery is rapid.
- It has an excellent aesthetic result.
Revised International Guidelines for Hernia Repair Surgery
The recent revised international guidelines on the modern treatment of hernias of the inguinal region (inguinal hernia and femoral hernia), answer clearly about the surgical methods to be used and dispel many myths circulating online about alternative techniques. At the same time, they confirm the need for significant experience on the part of the surgeon for the definitive treatment of hernia, with a small percentage of complications. According to the instructions:
- Inguinal hernia repair requires mesh placement.
- Laparoscopic inguinal hernia repair has faster recovery, less postoperative and chronic pain and is less expensive than the classic open technique.
- Open techniques that have been developed in recent years, saying that they resemble the endoscopic technique, such as ONSTEP. TIPP, TREPP, Ugahary, Wantz, etc., are not acceptable options and should only be carried out within the framework of research protocols.
- Inguinal hernias (on both sides) should be treated with the laparoscopic technique.
- If open surgery is necessary, the use of local anaesthesia is contraindicated.
- In women with a hernia in the groin, the indicated technique is always laparoscopic as it can simultaneously correct the femoral hernia if it coexists.