Inguinal hernia

An inguinal hernia is the leakage or protrusion of the contents of the abdominal cavity (generally the bowel loops) through a defect in the muscular wall of the inguinal area. It is the most common type of hernia (approximately 75% of all hernias in the abdomen).

There is talk of indirect inguinal hernia when the abdominal content moves towards the scrotum (more frequent in children or young people) or of direct inguinal hernia when it protrudes in the groin (in more advanced ages).

How is it produced?

The appearance of an inguinal hernia is associated with congenital factors (that is, from birth) such as the weakness of the muscular wall or the persistence of a closure defect that facilitates the exit of the bowel loops through the inguinal region and predisposing acquired factors. Among the latter have been described: obesity, pregnancy, physical overexertion involving overload of the abdominal muscles (lifting of weights, constipation and chronic cough), advanced age.

Symptoms

The patient notices a bulge in the groin area, which is especially evident with exertion, and which decreases or disappears with rest or when lying down. May appear local pain and if the hernia is very large cause discomfort and discomfort. The discomfort caused by hernias is always greatest at the end of the day and is relieved at night when the patient lies down and the hernia is reduced.

When the contents of the hernia can be easily reintroduce into the abdomen we speak of a reducible hernia. If this is not possible, we speak of a non-reducible hernia. In these cases there is a risk that the hernia becomes strangulated, that is, that the hernia becomes trapped in the muscular wall, causing a compromise of the vascularization and consequently an injury to the abdominal content.

This causes a very important pain picture and is a medical emergency. The groin lump appears hard and tight to the touch, and cannot be reintroduced into the abdomen. nausea and vomiting generally also appear, and there may be distention of the abdomen. If urgent medical attention is not received within a few hours, the intestine can become perforated due to lack of blood supply, causing a generalized abdominal infection (peritonitis).

Diagnosis

The diagnosis is based on the direct scan that allows you to see the size of the hernia and whether or not it is reducible.

Treatment

The definitive treatment for hernia is surgery. In general it is indicated tsurgical treatment for most patients except in those cases of great surgical risk or in elderly people who do not have any symptoms.

The surgery consists of reintroduction of hernial content within the abdominal cavity and the repair or strengthening of the wall musculature. This procedure is known as herniorrhaphy. The surgery can be performed open, that is, making an incision in the groin or laparoscopically. In laparoscopic surgery, a series of small cuts are made in the lower abdomen through which a small camera (laparoscope) and surgical instruments are inserted and the hernia is repaired.

There are different techniques for hernia repair, in some cases it is necessary put on an artificial mesh or body tissues (as muscles) to restore the defect in the abdominal wall area. Mesh repair is especially indicated in large hernias, bilateral direct hernias, and reproduced hernias. On the contrary, there is a small risk of infection or rejection of the mesh.

Surgery is usually outpatient or do not require hospitalization for more than 24 hours. After this, a feeling of tightness, pain and groin bruises may appear, which generally resolve in the following weeks. Return to normal activities occurs between 2 and 4 weeks, although it is advisable to avoid great efforts for 8 weeks. It is important to consider the.

In a small percentage of cases the hernia can reproduce again, especially in elderly patients.

Prevention

Avoiding the factors described as obesity and excessive efforts for the abdominal muscles can help prevent the development of the hernia.