What is an inguinal hernia repair?

An inguinal hernia is a bulge of soft tissue through a weak spot in the abdominal wall in the groin area. Inguinal hernias can occur in one or both sides of the groin at the same time or at different times. The bulge usually contains tissue lining the inside of the abdomen (peritoneum) and may include fatty tissue from inside the abdomen, a loop of intestine, or fluid (ascites). There are two types of inguinal hernias: direct and indirect. An indirect inguinal hernia is caused by an opening that does not close as it should before birth. The cause of a direct inguinal hernia often is unknown. It’s believed to be caused by the wear and tear of daily life and aging. However, lifting a heavy object or doing other activities that put pressure on the abdominal muscles, such as frequent coughing or straining when urinating or having a bowel movement, are thought to cause a hernia. Excessive weight gain, pregnancy, and constipation also are possible causes.

Older adults and people who are overweight are at a higher risk for direct inguinal hernias than are other people because of increased stress on the lower abdominal muscles. Hernias also may develop in other areas of the body. This topic is limited mainly to inguinal hernias. A femoral hernia sometimes is confused with an inguinal hernia. A femoral hernia bulges from the lower abdomen into the upper thigh, just below the groin crease. It pushes down through the femoral canal, a narrow passage that carries major blood vessels to the leg. Athletes sometimes develop what is called a sports hernia — a chronic pain in the groin but with no obvious sign of a hernia. This hernia occurs mainly in sports that involve a lot of repetitive twisting while moving, such as ice hockey, soccer, and tennis. Over time, a bulge may develop in the groin. Several other types of abdominal hernias also exist, including:

• Spigelian hernia: a rare type of abdominal hernia that can occur in middle age.
• Incisional hernia: which can develop after previous abdominal surgery.
• Umbilical hernia: occurring in the navel. Periumbilical hernias are around the navel.
• Epigastric hernia: which can occur in the middle of the abdomen.

Signs of hernia

The main sign of an inguinal hernia is a tender bulge in the groin or scrotum. The bulge may appear gradually over a period of several weeks, or it may form suddenly after you have been lifting heavy weights or coughing, bending, straining, or laughing. In some cases, you may feel groin pain or other discomfort, especially when bending or lifting. The discomfort may be felt in the scrotum. Some hernias cause a bulge but no pain. Other possible symptoms include heaviness, swelling, and a tugging or burning sensation in the area of the hernia, scrotum, or inner thigh. Sometimes only lying down relieves the discomfort. You may have nausea and vomiting if part of the intestine bulges outside the abdomen and becomes trapped, or incarcerated, in the hernia. The diagnosis of inguinal hernia is usually based on a medical history and a physical examination. A health professional will ask about your symptoms and will examine your groin area for a bulge. You may be examined while standing and coughing or straining (as if trying to have a bowel movement). Imaging tests such as abdominal ultrasound and computed tomography (CT scan also may be done; a CT scan can confirm the type of hernia).

Surgical Treatment

Surgery is necessary to repair an inguinal hernia. Two surgical approaches are available:

• Open surgery: The surgeon repairs the hernia through an incision in the groin. A piece of mesh is sewn over the weakened area of the abdominal wall to reduce the risk of the hernia recurring. This is a common method of repairing a hernia. In some cases, the tissue of the abdominal wall can be repaired without using a mesh.

• Laparoscopic surgery: The surgeon inserts a thin, lighted scope into a small incision in the abdomen; instruments to repair the hernia are inserted into another small incision. Mesh also is used in this surgery to reinforce the abdominal wall. Laparoscopic surgery is relatively new. Studies show that people have less pain after this type of surgery and return to work and other activities more quickly than after open repair.