Find information on thousands of medical conditions and prescription drugs.

Inguinal hernia

Inguinal hernias are protrusions of abdominal cavity contents through an area of the abdominal wall, commonly referred to as the groin, and known in anatomic language as the inguinal area or the myopectineal orifice. They are very common and their repair is one of the most frequently performed surgical operations. They usually arise as a consequence of the descent of the testis from the abdomen into the scrotum during early fetal life, and are therefore far more commonly seen in men than women. They present as painless bulges in the groin area that can become more prominent when coughing, straining, or standing up. The bulge commonly disappears on lying down. more...

ICF syndrome
Ichthyosis vulgaris
Imperforate anus
Inborn error of metabolism
Incontinentia pigmenti
Infant respiratory...
Infantile spinal muscular...
Infective endocarditis
Inflammatory breast cancer
Inguinal hernia
Interstitial cystitis
Iodine deficiency
Irritable bowel syndrome

The presence of pain, or the inability to "reduce" the bulge back into the abdomen, usually indicates the onset of complications.

As the hernia progresses, contents of the abdominal cavity, such as the intestine, can descend into the hernia and run the risk of being strangulated within the hernia, causing an intestinal obstruction. If the blood supply of the portion of the intestine that is caught in the hernia is compromised, gut ischemia and gangrene can result, with serious consequences. The time of occurrence of complications is not predictable; some hernias can remain static for years, others can progress rapidly from the time of onset. Therefore, provided there are no serious co-existing medical problems, patients are advised to get the hernia repaired surgically at the earliest convenience after a diagnosis is made. Emergency surgery for complications such as obstruction and strangulation carry much higher risk than planned, "elective" procedures.

Despite the profusion of medical technology that is now available, the diagnosis of inguinal hernia rests on the history given by the patient and the physician's findings on examination of the groin. No tests are needed to confirm the problem.

Surgical correction of inguinal hernia is a simple operation that is now done in most places as an ambulatory or "day surgery" procedure. A workable technique of repairing hernia was first described by Bassini in the 1800s; the Bassini technique was a "tension" repair, one in which the edges of the defect are simply sewn back together without any reinforcement or prosthesis. Although tension repairs are no longer the standard of care due to their high recurrence rates, long recovery period and severe post-operative pain, a few tension repairs are still in use today; these include the Shouldice and the Cooper's/McVay repair.

Almost all repairs done today are open "tension-free" repairs that involve the placement of a synthetic mesh to strengthen the inguinal region; some popular techniques include the Lichtenstein repair (flat mesh patch placed on top of the defect), Plug and Patch (mesh plug placed in the defect and covered by a Lichtenstein-type patch), Kugel (mesh device placed behind the defect), and Prolene Hernia System (2-layer mesh device placed over and behind the defect). The meshes used are typically made from polypropylene or polyester, although some companies market Teflon meshes and partially absorbable meshes. The operation is typically performed under local anesthesia, and patients go home within a few hours of surgery, often requiring no medication beyond over-the-counter pain relievers such as aspirin or acetaminophen. Patients are encouraged to walk and move around immediately post-operatively, and can usually resume all their normal activities within a week or two of operation. Recurrence rates are very low - one percent or less compared with over 10% for a tension repair.


[List your site here Free!]

Laparoscopic surgery vs. open mesh repair of hernia
From American Family Physician, 1/15/05 by Bill Zepf

Recurrence of an inguinal hernia after surgical repair is fairly common. Tension-free repair of hernias using prosthetic mesh has been shown to reduce rates of recurrence compared with traditional tension-producing operative techniques. Laparoscopy is used increasingly for hernia repair and is associated with less postoperative pain and earlier return to normal activities. Laparoscopic repair requires the use of general anesthesia, however, and has higher reported rates of serious complications compared with the local anesthesia technique used for open repair. Neumayer and colleagues report on outcomes from a comparison trial of laparascopic and open mesh repair for inguinal hernias.

Patients with primary or recurrent inguinal hernias were recruited from general surgery clinics at various Veterans Affairs medical centers. Open and laparoscopic repair techniques were standardized across the participating centers and performed by surgeons with at least 25 prior repair experiences. A total of 3,518 patients with hernias initially were screened, and 2,164 consented to randomization. Of the patients randomized to laparoscopic repair, 9.8 percent were converted to open repair. Two-year follow-up data were available for 85.5 percent of the 1,983 patients who successfully underwent surgical repair. The average age of trial participants was 58 years, and more than 20 percent were from minority ethnic groups. Intraoperative complications (e.g., problems with anesthesia, injuries to spermatic cords or blood vessels) were significantly more common in the group that underwent laparoscopic repair (4.8 versus 1.9 percent in the open mesh group). Life-threatening complications (e.g., myocardial infarction, ischemia, arrhythmia) were uncommon but occurred significantly more often with laparoscopic repair (1.1 versus 0.1 percent). Two deaths occurred within 30 days of surgery in the laparoscopic group, both of which were attributed to the operation. No deaths occurred in the open mesh group within 30 days of surgery. Immediate postoperative complications (e.g., hematoma, pain) were slightly more common with laparoscopic repair. Recurrence of a primary hernia during the two-year follow-up period was more than twice as common with laparoscopic repair than with the open mesh technique (10.1 versus 4.9 percent). Mesh repair of recurrent hernias did not show a significant difference in recurrence rates between laparoscopic and open approaches.

Pain scores in the immediate postoperative period and at the two-week follow-up visit were higher in patients undergoing open repair. The median time for return to normal activities was shorter after laparoscopy than open repair (four versus five days). Post-trial data analysis showed that highly experienced surgeons (i.e., those who had performed more than 250 procedures) had a lower rate of hernia recurrence with laparoscopic repair than less experienced surgeons, but there was no significant difference in recurrence rates after open technique surgeries based on the surgeon's experience level.

The authors conclude that laparoscopic repair of inguinal hernias is associated with less pain and quicker return to activity than an open technique, but it has a higher rate of operative complications and a significantly higher recurrence rate of primary hernias.

Neumayer L, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med April 29, 2004;350:1819-27.

COPYRIGHT 2005 American Academy of Family Physicians
COPYRIGHT 2005 Gale Group

Return to Inguinal hernia
Home Contact Resources Exchange Links ebay