What is an inguinal hernia?
An inguinal hernia is the passage of an intra-abdominal organ (usually a portion of intestine or fat) through a weakness of the abdominal wall in the inguinal region (the groin). This pathology is among the most frequent in surgery, particularly in men.
The inguinal region is naturally a zone of weakness of the abdominal wall, in particular because of the inguinal canal, which contains the spermatic cord in men and the round ligament in women. With age, physical exertion, repeated coughing, or pregnancy, this zone may give way and allow the passage of an intra-abdominal element.
There are two main types of inguinal hernia:
- Indirect (or oblique external) inguinal hernia: most often congenital, it follows the path of the inguinal canal.
- Direct inguinal hernia: most often acquired; it passes directly through the abdominal wall.
Symptoms of inguinal hernia
The most frequent symptoms are:
- Bulge in the groin: soft, reducible swelling, increasing on standing or exertion (cough, lifting of weights), and disappearing in the lying position.
- Discomfort or pain of variable intensity, often accentuated by physical activity.
- Sensation of heaviness in the inguinal region.
In men, the hernia can extend to the scrotum (inguinoscrotal hernia), causing an increase in volume of the testicular bursa.
Complications
Although often well tolerated, an inguinal hernia can lead to serious complications:
- Incarceration: the herniated organ can no longer be reintroduced into the abdomen.
- Strangulation: the vascularization of the herniated organ is compromised, requiring emergency surgery.
These complications are accompanied by intense pain, vomiting, and a hard, non-reducible hernia. They constitute a surgical emergency.
Diagnosis
The diagnosis of inguinal hernia is clinical. The physical examination, in the standing and lying position, and during a coughing maneuver, makes it possible to confirm the presence of the hernia in the vast majority of cases.
Imaging tests (ultrasound, CT scan) are reserved for atypical or doubtful forms.
Treatment of inguinal hernia
The treatment of inguinal hernia is surgical. It consists of reintroducing the herniated content into the abdomen and reinforcing the weakness of the abdominal wall.
Surgical techniques
Two main techniques are used:
- Open surgery (Lichtenstein technique): a small incision in the groin allows direct access to the hernia. A synthetic prosthetic mesh is placed to reinforce the wall.
- Laparoscopic surgery: through small incisions in the abdomen, the surgeon places a prosthetic mesh from the inside. This technique is particularly indicated for bilateral hernias or recurrences.
The choice of technique depends on the type of hernia, the patient’s history, and the surgeon’s habits.
Course of the procedure
The procedure is performed under general or locoregional anesthesia, and most often as an outpatient (return home the same day). It lasts 30 to 60 minutes.
Post-operative follow-up
Recovery is rapid:
- Resumption of light activities within a few days.
- Resumption of professional activity within 1 to 3 weeks depending on the profession.
- Resumption of intense physical activities and sport after 4 to 6 weeks.
Pain is managed by analgesics. A post-operative consultation is scheduled approximately 1 month after the procedure.
Risks and complications
Surgery for inguinal hernia is a safe procedure, but as with any surgical act, complications can occur:
- Local hematoma.
- Surgical site infection (rare).
- Chronic post-operative pain (occasional).
- Recurrence of the hernia (rare with current techniques).
Inguinal hernia in children
In children, inguinal hernia is most often congenital, related to the persistence of the peritoneo-vaginal duct. The treatment is surgical, with simple closure of the duct without prosthetic mesh.
Dr Adam Vardi performs inguinal hernia surgery in Paris and Neuilly-sur-Seine, in adults as children.