Inguinal hernia
Treatment
The aim of the treatment is a gentle, successful, low-stress operation with elimination of the defect in the inguinal canal and elimination of the cause of the pain (isolated cutaneous nerve entrapment). While laparoscopic operations always close the defect in the abdominal wall (hernia gap) with a large mesh in the abdominal cavity (TAPP) or immediately above the peritoneum (TEP), eliminating the cause of the pain (isolated cutaneous nerve branch entrapment in the anterior wall (external aponeurosis)) is usually the domain of open treatment. The open treatment makes it possible to decide intraoperatively whether a mesh should be avoided (fascioplasty; Shouldice) or whether the defect (hernia gap, changes in the inguinal canal) should be eliminated with mesh (Lichtenstein)/fascioplasty with mesh to avoid a recurrence under the mesh. In the event of intolerance, the open approach to removing mesh is more beneficial than the abdominal approach. New studies (DÄbl 2020) of complications of herniotomy in hospital (peritonitis, injury to the intestine and large vessels) reveal a 10-fold increase in mortality (lethality) compared to outpatient treatment in Sweden.
Symptoms
The symptoms of an inguinal hernia are usually minor – pulling, a feeling of pressure. Stabbing (neuropathic) pain may also occur
(Nerve entrapment). Depending on the findings, a neurological examination may be useful. The hernial sac can usually be reduced (pushed back) without pain. If this is not possible and/or there is unbearable pain, there may be an incarcerated (intestinal entrapment with the risk of necrosis (death) of the intestine) hernia, which should be treated in hospital immediately. In any case, an ultrasound examination, or better color duplex sonography, of the groin and the surrounding structures should be carried out in order not to overlook other causes of groin problems.
Causes
An inguinal hernia occurs due to hereditary weakness of the connective tissue in connection with overload (lifting, coughing, sneezing). This causes the hernial sac to bulge, which may contain preperitoneal fatty tissue and/or intestine. The hernia can occur without any symptoms. If pain occurs, the cause of the pain should be looked for independently of the hernia. This may be an isolated cutaneous branch nerve entrapment in the external aponeurosis (anterior wall).