WHAT IS INGUINAL HERNIA?
The bulging that occur as a result of the intra-abdominal organs (especially the intestines) trying to get out of the weak points in the groin area is called inguinal hernia. Hernia of the intra-abdominal organs is most common in the inguinal region and approximately 70-75% of abdominal wall hernias are inguinal hernias. Every year, 20 million inguinal hernia surgeries are performed worldwide.
Inguinal hernias are seen 8 times more common in men than women and can be unilateral or in both groin at the same time.
WHY DOES INGUINAL HERNIA OCCUR?
The inguinal region is one of the weakest points of the abdominal wall. In the canal (inguinal canal) of this region, the testicles pass through the scrotum before birth and migrate to the place where they should be, and there is a structure (spermatic cord) that carries the veins and sperms in the canal. In women, the ligament that suspends the uterus passes through this channel. If the canal that needs to be closed after birth is not closed or is weakly closed, herniation may occur over time. In addition, there are 2 other weak points in the inguinal region other than the canal. One of them is the femoral canal on the edge of the femoral vein and the other is the posterior wall of the inguinal canal on these structures.
ARE ALL INGUINAL HERNIAS SIMILAR?
There are 3 most common types of inguinal hernia caused by different weak spots in the inguinal region. These are indirect inguinal hernia passing through the inguinal canal, direct inguinal hernia emerging from the inner edge without passing through the canal, and femoral hernia originating from the edge of the femoral vessels, which are the leg veins.
More than 90% of hernias in the inguinal region are direct and indirect. Femoral hernia is about 5-7% and is often seen in women.
While inguinal hernias are usually seen with one side, herniation can be detected on both sides at the same time, albeit at a lower rate. Therefore, in unilateral inguinal hernias, the opposite side should be examined.
HOW IS LAPAROSCOPIC SURGERY PERFORMED?
Generally, the patient, who is under general anesthesia, is first entered into the abdomen with a small incision under or above the umbilicus, and the abdomen is inflated by giving carbon dioxide gas from here.
Again, through the same hole, a medical device (trocar) that allows the passage of the camera (telescope) is placed and the organs are made visible on the screen After the camera is inserted, other trocars suitable for the organ to be operated are entered and the operation is performed with cutting and holding tools such as scissors and forceps.
WHICH SITUATIONS CAUSE INGUINAL HERNIA?
Since the abdomen is a closed environment, it occurs as a result of the organs trying to get out of the inguinal region, which is the weakest point, in all cases that increase intra-abdominal pressure.
Causes of increased intra-abdominal pressure;
HOW DOES THE INGIUNAL HERNIA show SYMPTOMS?
Pain and swelling in the inguinal region are the main complaints in patients. However, from time to time, it may show symptoms as just swelling without pain or pain. The characteristic of the distention in inguinal hernias is the enlargement of the distention in conditions that increase the intra-abdominal pressure such as straining and coughing. The distention of the hernia sac becomes very large and descends into the testicular skin called scrotum in men and disappears only when lying down or pressed with the hand. In some cases, if it does not go back by lying on the back or pressing with hands and causes severe pain, this is called hernia strangulation.
HOW IS INGIUNAL HERNIA DIAGNOSED?
Although patients can often diagnose inguinal hernia by noticing pain and accompanying swelling in the inguinal region, the actual diagnosis is made as a result of a general surgical examination. In some cases, patients who cause pain but cannot detect swelling are diagnosed using imaging methods such as ultrasonography or MRI.
HOW IS INGIUNAL HERNIA TREATED?
In patients with inguinal hernia and related complaints, the main treatment is to surgically close the weakness that causes hernia. Inguinal hernia treatment should not be done with medication or corset. With surgical treatment, weak spots in the inguinal region are strengthened with stitches and meshes, preventing organs from coming out of this orifice (opening).
Operations performed with the open method in the past years are now performed closed,ie laparoscopically.
- Close Observation:
Some inguinal hernias that do not cause complaints and do not interfere with the daily activities of the person can be followed up with an elderly person with a high risk of surgery, provided that they closely observe with a common decision of the surgeon and the patient.
HOW SHOULD ANESTHESIA CHOOSE IN PATIENTS WHO WILL have SURGERY?
Surgery in inguinal hernias can be performed with general anesthesia or spinal, ie regional anesthesia. The type of anesthesia to be determined primarily as a result of the patient’s preference, how the surgery will be (open-laparoscopically) and the evaluation of the anesthesiologist. Spinal anesthesia preference stands out in high risk patients for general anesthesia.
HOW ARE CLOSED SURGERY PERFORMED?
In the past, hernia surgeries were performed only with the open method, that is, with an incision of approximately 8-10 cm on the inguinal canal, but today it is performed closed (laparoscopically) with the help of 3 special devices entered from 0.5-1 cm long incisions and video. The herniation reflected on the screen by the camera is removed with suitable hand tools and the patch is reinforced.
WHICH OPERATION SHOULD I PREFER OPEN REPAIR? LAPAROSCOPIC REPAIR?
In current surgical practice, laparoscopic surgeries are increasingly performed Laparoscopic surgeries have many advantages such as smaller incision, less pain and early return to work. It is an ideal method for athletes and patients with bilateral hernia.
Considering the long-term results, In clinical studies, it has been shown that it is as effective as the open method and is superior to the open method in terms of its advantages.
IS THERE ANY DANGER OF INGUINAL HERNIA SURGERY?
These operations (open-laparoscopically) are evaluated with advances in surgical technique and anesthesia science and they are performed with great confidence. Risk assessment is made by looking at the condition of the hernia, the patient’s current illnesses, the medications she uses and previous surgeries.
IS EMERGENCY SURGERY NECESSARY FOR INGIUNAL HERNIA?
Emergency surgery in inguinal hernias is required when the hernia is strangulated. Hernia strangulation; It is called that the intra-abdominal organ that comes out from the weak point is not come back by pressing with the hand or by lying down. In case this situation is accompanied by abdominal pain, inability to perform bowel movements, nausea and vomiting, it is understood that there is an intestinal obstruction, and it should be corrected by emergency surgery.
WHEN CAN BE RETURNed TO NORMAL LIFE AFTER SURGERY?
Although the operation varies depending on the method you are undergone, you will be discharged from the hospital the first day after the operation.
Although it varies according to individual differences and the type of work performed (desk-top work that requires force), it can be returned to the pre-operative working order 5-7 days after the surgery.