WHAT IS AN INGUINAL HERNIA?
In the groin, there are natural openings connecting the abdomen to the root of the thigh, through which pass blood vessels, nerves, and connections to the testicle in men.
Loosening of these orifices may allow some of the abdominal contents to push through. This is called a hernia, and depending on its location can be inguinal or femoral. A hernia usually manifests itself in localised swelling of the groin, worse when standing and on exertion.
Hernias can appear at any age. Inguinal hernias are more common in men, femoral hernias are more common in women. Hernias in children are more often the result of a specific birth defect.
WHAT ARE THE CONSEQUENCES?
Once a hernia forms, it usually gradually increases in size, but there is a variable rate of evolution. A hernia will not resolve whitout surgery.
Hernias usually become more uncomfortable over time. The major risk is blockage of the intestine in the hernia. The hernia becomes irreducible and very painful. This requires an immediate visit to the emergency room and an immediate surgery.
The risk of strangulation varies depending on the anatomical type of hernia: low for direct inguinal hernias, high risk for femoral hernias. This risk should be discussed with the surgeon during the consultation.
Hernias may be painful without strangulation or blockage of the intestine. Such pain may be related to other pathologies, and as such may persist after hernia repair.
WHAT IS THE TREATMENT OF A GROIN HERNIA?
The only suitable curative treatment of a groin hernia is surgery. Old techniques such as a hernia support bandage are no longer acceptable option.
A surgical consultation is an absolute necessity without delay.
HOW DO YOU FIX A HERNIA?
Two types of procedures have been developed:
Reconstruction of the abdominal wall by suturing the muscles.
Wall reinforcement using a mesh of synthetic fiber.
The two techniques differ on the location of the mesh:
Anterior direct pathway (single incision in the groin).
Posterior laparoscopic pathway (mini-incisions close to the navel).
Several types of anesthesia are possible. The final choice of the chosen technique is validated at the end of the anesthesia consultation.
The laparoscopic pathway requires general anesthesia. The anterior route is possible under local or loco-regional anesthesia.
In all cases, the post-operative period of final consolidation is three to four weeks during which it is advisable to avoid significant physical exertion (carrying loads of more than 5 kgs).
Congenital hernia in children does not require prosthetic reinforcement.
WHAT ARE THE RISKS OF GROIN HERNIA SURGERY?
Rare complications are associated with any abdominal surgery:
Thromboembolic complications (phlebitis, pulmonary embolism)
Hemorrhagic complications (vascular injuries, hematomas)
Infectious complications of incisions, catheters, drains and probes.
Digestive injuries, secondary intestinal obstructions and obstructions
Bladder injuries, post-operative urine retentions
There are also exceptional complications related to laparoscopy:
When the abdomen is swollen or when the first trocar is introduced at the beginning of the operation, conversion to open surgery may be necessary (laparotomy).
Serious complications can exceptionally result in the death of the patient.
Early specific complications:
Seromas (clear liquid collection) and bruises (hematoma) that can spread in the tissues of the penis and scrotum (between 5 and 10% of cases). The volume and sensitivity of the testicle and scrotum due to surgical dissection around the spermatic cord may lead to ischemic atrophy of the testicle (less than 1% of cases).
Rarely infections of the prosthesis, improperly called “rejections”, may require re-intervention for the removal of the mesh (less than 0.35% of cases).
Late specific complications:
Prolonged pain, most often regressing within two years of the procedure, more frequently observed after the anterior approach. Residual inflamation is often seen, but the mechanism involved is not always identified.
Recurrence of the hernia (around 2% after wall reinforcement using the installation of a prosthetic mesh).