Hernias

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Inguinal hernias, which occur in the groin area, are much more common in men than women, although they can occur in women. The reason for this is that men have an opening in both sides of the lower abdomen, or groin area, through which the spermatic cords pass on their way to the testicles. The spermatic cord contains a vein, artery, vas deferens (this carries sperm from the testicle), and the ilioinguinal nerve. Obviously, women do not have this opening in the abdominal wall. The contents of the abdomen, which are under pressure, can cause this opening to tear, thereby allowing the inner abdominal wall to bulge, or herniate, out. The hernia can be detected by the presence of a bulge in the groin. By placing a hand over the area and asking the patient to cough, which increases intra-abdominal pressure, a bulge can be felt. The bulge should be soft and should be able to be pushed in. If the bulge is hard and cannot be pushed back in, the hernia may be incarcerated, which is a surgical emergency. If a loop of bowel is stuck inside an incarcerated hernia, it may lose its blood supply and die, which can cause peritonitis.

Once a hernia is detected, it should be repaired. As a rule, small hernias can be easily repaired, whereas large hernias may be technically difficult to repair, and the repair is more likely to fail. Most small hernias will become large ones over time if they are not repaired. The repair may be performed as an open procedure or done with a laparoscope. In either case, the surgeon usually covers the opening in the abdominal wall with a prosthetic mesh, commonly made of nylon. The mesh is inserted and secured to the muscles of the abdominal wall. Using mesh will usually make the hernia repair less likely to fail. In general, laparoscopic surgeries heal faster than open surgeries with less post-operative pain and bruising. Whether the repair is done open or laparoscopically, pain at the surgical site is common and often lasts a few days to a week. Bruising, medically known as ecchymosis, is also common and may be extensive in some cases, particularly if the repair was an open one. Bruising and swelling of the penis and scrotum can occur, and while its appearance can be alarming, it is usually not dangerous, however the surgeon should be informed.

Post-operative recovery is normally fast, especially for repairs of small hernias. Patients are often encouraged to walk every day, but strenuous activity like running and lifting anything more than five to 10 pounds (for example nothing heavier than a gallon of milk) is not permitted until the patient has a follow-up visit with the surgeon, usually about one to two weeks after the procedure. Constipation and straining during bowel movements put pressure on the repair and should be avoided. Often a stool softener is prescribed. Lastly, if the patient has a fever, shaking chills, worsening pain, inability to eat without feeling nauseous, or redness or pus draining from the wound, the surgeon or primary care doctor should be immediately contacted as the wound may be infected, which will often lead to the need for hospitalization.

For more information go to www.mayoclinic.org/diseases-conditions/inguinal-hernia/home

 

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