January 10, 2024 In an inguinal or groin hernia , a portion of the intestine (and/or other organs and tissues) crosses an area of weakness of the abdominal wall muscles inguinal region, commonly known as the groin, forming a noticeable or visible swelling or tumefaction . The volume and extension of the hernia varies it can extend from the groin to the scrotum in men and to the area of the labia majora in women. In less severe cases, the tumefaction may appear and disappear , and this is related to intra-abdominal pressure. When intra-abdominal pressure increases (for example, when coughing, sneezing, or exerting), it appears or gets bigger, then disappears. In some cases, it only disappears if pushed, which is called manual reduction of the hernia. When manual reduction of a groin hernia is not possible, this means that the bowel has become trapped in the muscles it crossed and that the hernia is incarcerated . When in an incarcerated hernia blood supply is also compromised, necrosis (death) of the tissues of the intestine may result. In this case, which is the most serious, it is said that there is a strangulated hernia . A diagnosed inguinal hernia has surgery indication ; the most suitable time to perform the surgery varies. An incarcerated hernia and a strangulated hernia are serious conditions that require immediate medical attention. What is the abdominal wall The abdominal wall is the structure that surrounds the abdominal and pelvic cavity . It extends from the lower edge of the ribs to the spinal column posteriorly and to the pelvic bones and inguinal region inferiorly. It is mainly made up of muscles . The functions of the abdominal wall are to stabilize the trunk and allow it to move, protect the abdominal organs and keep them in their correct position when intra-abdominal pressure increases, for example, when coughing, sneezing, making efforts, among others . Who can have an inguinal hernia? Inguinal hernia can occur at any age and is more frequent in men than in women . The cause of groin hernias is not known for sure, but among the risk factors that increase the likelihood of developing it are: Male; Prematurity; Aging (over 50 years); Chronic cough; Chronic constipation; Obesity; Pregnancy; Smoking; Abdominal trauma; Any other factor that causes an excessive increase in intra-abdominal pressure, especially when it is recurrent. Inguinal hernia symptoms In less severe hernias, the most common initial symptoms that usually lead to seeking medical attention are: Feeling of heaviness or tightness in the groin; Presence of a tumefaction in the groin area that appears and disappears, which is more evident when standing and disappears completely when lying down, which disappears by itself or with manual reduction; Local pain and/or discomfort, often associated with actions that increase pressure or require movement in the groin area. In incarcerated hernias, manual reduction is no longer possible. The occurrence of the following symptoms raises the suspicion that the hernia is strangulated : Severe pain; Nausea and vomiting; Fever; Change in the color of the hernia area, which turns red or blueish; Increased abdominal volume: No elimination of stool and intestinal gases. Treatment of inguinal hernia The definitive treatment for an inguinal hernia is surgery and the procedure is called herniorrhaphy or inguinal hernioplasty. Not all inguinal hernias need immediate treatment when diagnosed; Taking into account the specifics of the case, the particularities of each patient and the potential complications, even an inguinal hernia with mild symptoms may have a surgical indication. Incarcerated hernias and strangulated hernias always have indication for surgery, is this cases emergency surgeries. The surgery can be done in two ways – open or minimally invasive . Minimally invasive surgery for inguinal hernias Minimally invasive surgery is superior to open surgery because it allows: Treating both sides at once; Diagnose hernias in rare locations that can be confused with inguinal hernias; A faster recovery; Less pain and an almost zero infection rate; Better aesthetic result. Therefore, this is today the preferred approach, except in patients with contraindications, such as, for example, those who have had a radical prostatectomy. The minimally invasive approach to the abdominal cavity is called laparoscopy. This technique uses small incisions to introduce a camera that transmits images to a monitor in the operating room and instruments that can be as small as 5 mm to perform the intervention. The intestine is repositioned and the repair of the area of muscle where the hernia formed involves the placement of a mesh for reinforcement and protection. In the end, the patient is left with only a 1 cm intra-umbilical scar and two small abdominal scars measuring around 5 mm each. Some surgeons with more expertise and experience use self-adhesive mesh to repair the muscle, which does not require fixation with staples. In this way, it is possible to further reduce the level of post-operative pain and the risk of chronic pain associated with surgery is practically reduced to zero. Meet the general surgery clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
