Inguinal hernias are located in the groin region. Inguinal hernia is the classical hernia that people tend to associate the term “hernia” with. Inguinal hernias are far more common in men than women.
There are of two types of inguinal hernia, direct and indirect. For patients this distinction is irrelevant as the same operation fixes both types.
An inguinal hernia is essentially a weakness in the muscle wall of the abdomen. This weakness allows the lining of the abdominal contents (the peritoneum) to bulge through as a sac. This peritoneal sac can contain bowel, so usually when you stand up the hernia appears as a lump/bulge in the groin and when you lie down it goes.
Typically the major problem that patients get with a hernia is a continual discomfort that often slowly worsens as the day goes on and usually eases at night when lying down.
Very rarely the bowel can get jammed in the peritoneal sac. This results in an incarcerated or even obstructed hernia. This will usually require admission to hospital as an emergency for acute repair.
Repairing an Inguinal Hernia
Inguinal hernias can be repaired in one of three ways, each has its merits and demerits
Open Hernia Repair by Mesh
I repair hernia by open mesh technique in patients who prefer their hernia repair under local anaesthetic or patients who are not fit for a general anaesthetic. An incision is made in the groin, a split is made in the external oblique muscle and the hernia sac is identified. The sac is then tied off and a synthetic mesh is overlaid to strengthen the abdominal wall and prevent recurrence of the hernia. This method is quick, very reliable, safe and has withstood the test of time. The surgery can be carried out under local or general anaesthetic.
LaparoscopicHernia Repair (TAPP)
With a Transabdominal Pre-Peritoneal Repair (TAPP) a telescope is placed into the abdomen via a small umbilical incision and the hernia sac is identified from the inside. The sac is pulled back and inverted. The peritoneum is then incised and a mesh placed behind the peritoneum to close the hernia hole.
This method gained initial popularity a few years ago but there is potential to damage the bowel and is probably not so widely used at present. Most surgeons undertaking minimal access hernia repair seem to favour the endoscopic repair (TEP).
Endoscopic Hernia Repair (TEP)
The Totally Extaperitoneal Repair (TEP), is a minimal access technique. A small incision is made below the umbilicus and a camera is passed into a space behind the abdominal muscles but in front of the peritoneum. The hernia sac is identified and pulled back. A large mesh (bigger than that used for open or laparocopic techniques) is placed over the hernia hole.
This is a more difficult procedure than the TAPP repair but in experienced hands this is an efficient technique. It is certainly more comfortable post-operatively than an open repair. Recurrence rates appear to be slightly higher with a TEP than an open repair.
This technique is not suitable for very large hernias. The National Institute for Clinical Excellence (NICE) recommend TAPP or TEP to be the favored technique for bilateral inguinal hernias and for recurrent inguinal hernia repair with experienced surgeons. In selected cases and in experienced hands it may also be indicated for fist time unilateral inguinal hernia repair.