Dr Pinkesh Thakkar

Laparoscopy in the surgical management of inguinal hernia

Dr Pinkesh Thakkar

Inguinal Hernia is a condition where there is a protrusion of abdominal contents through the inguinal canal.

It may present with a dull ache in the groin region.

It may occur due to increased intra-abdominal pressure caused by tumors, trauma, straining during bowel movement or coughing, etc.

A clinical examination by an expert surgeon is usually sufficient to make a diagnosis of an inguinal hernia.

Surgery is often required.

Open surgery is a well-established technique to cure hernia but can lead to some complications like chronic pain and scar over the surgical site, however, Laparoscopic Surgery can be helpful in treating inguinal hernia without the problems encountered in open surgery.

What is an Inguinal Hernia?

Inguinal Hernia is a condition where there is a protrusion of abdominal contents through the inguinal canal.

 

The inguinal canal is located in the groin, which is the area between the thigh and abdomen. The inguinal canal is a passageway through which the spermatic cord and the gonadal vessels pass.

 

This type of hernia is more common in men than women.

 

This condition can be present at birth or acquired later in life. It may be the result of a defect in the posterior muscle wall of the abdomen, but it can also occur because of other conditions such as obesity, chronic cough, or heavy lifting that put pressure on your abdomen. According to statistics published by the World Health Organization (WHO), 15% of people worldwide suffer from this problem at some point in their lives

Types of Inguinal Hernia:

There are two types of hernias - 

Indirect Inguinal Hernia & Direct Inguinal Hernia

 

An indirect hernia tends to go down the spermatic cord while a direct hernia occurs directly through the weak muscle fibers of the inguinal canal.

The inguinal canal is a passage between the abdomen and the scrotum, which is a weakness in abdominal wall muscles (external oblique muscle and transversus abdominis muscles).

What Causes Inguinal Hernia?

  • Trauma to the abdominal wall can cause a hernia in the inguinal area.
  • Genetics plays a role in the development of inguinal hernias.
  • Obesity is another factor that contributes to an increased risk of developing an inguinal hernia.
  • Straining can also lead to an increase in pressure within the abdomen and thus result in an inguinal hernia occurring.
  • Smoking can lead to weakness of muscles, cough, and development of an inguinal hernia.

 

If the hernia becomes strangulated, it is a medical emergency.

A strangulated hernia occurs when blood flow to the tissue is restricted and results in severe pain and vomiting.

Other types of inguinal hernias include congenital hernias which are present at birth due to an abnormal development of the fetal abdominal wall, incarcerated (stuck) tumors which cannot be reduced back into place easily without surgery or manual manipulation by a physician.

What are the Symptoms of Inguinal Hernia?

When you have an inguinal hernia, you may experience the following symptoms:

  • Pain in the groin region
  • Swelling in the groin region
  • Pain when walking or standing for a long period of time
  • Pain when lifting heavy objects (more than 10 pounds)
  • Pain when coughing or straining to pass stool
  • Pain when standing up from a seated position (e.g., when getting out of a car)

 

It may present with a dull ache in the groin region.

A hernia may present with a dull ache in the groin region. The pain may be present in the groin, abdomen, or scrotum. The pain is usually worse when coughing or straining and improves with rest. If you have these symptoms, it is important to see your doctor as soon as possible.

 

In some cases of inguinal hernia, there may not be any symptoms at all until the hernia becomes strangulated (i.e., cut off from blood supply). In these cases, severe abdominal pain will develop rapidly along with nausea and vomiting resulting from pressure on adjacent organs such as the intestines or stomach by the trapped bowel inside an incarcerated inguinal hernia.

How is an Inguinal Hernia Diagnosed?

The diagnosis of an Inguinal Hernia is usually made on the basis of a clinical examination by an expert surgeon. If there is any doubt about the diagnosis, further investigations such as Ultrasonography of the inguinal canal or CT scan may be required to confirm it.

An imaging scan can show if there are any hernia defects that are not apparent when looking directly at the groin area. It can also determine if other organs such as the bladder, bowel, and prostate gland have been displaced into or through a hernia defect.

 

A clinical examination by an expert surgeon is usually sufficient to make a diagnosis of an inguinal hernia.

 

The patient should lie with his knees flexed, thighs apart and the scrotum down. With one hand, the surgeon will feel for the abdominal contents as they pass through different parts of the inguinal canal on their way down into the scrotum and then back into the abdomen. The testes are palpated to detect any firmness or irregularity which could indicate testicular torsion

How is an Inguinal Hernia Treated?

Surgery is the only definitive treatment for an inguinal hernia.

 

Open surgery, which involves making a large incision in the abdominal wall and sewing the pre-existing hole closed, is still commonly performed worldwide. However, it can lead to adversities like chronic pain and the scar at the site of surgery, and recurrence of the hernia.

 

Laparoscopic Surgery is a safer and more effective treatment for inguinal hernia.

Laparoscopic surgical techniques have been shown to be safe and effective in treating inguinal hernias compared with open surgery, with much lower recurrence rates. It also has a shorter recovery time and less post-operative pain than open surgical procedures.

Laparoscopic Surgery for Inguinal Hernia

The laparoscopic treatment of inguinal hernia is a minimally invasive procedure and is always safer than open surgery.

It can be classified into total extra peritoneal technique (TEP) and trans abdominal pre peritoneal technique (TAPP).

In TEP procedure, the surgery is done outside the peritoneal cavity.

TAPP involves making an incision just below your belly button that allows access to your abdominal cavity through which the hernia repair is done.

In both the procedures, a mesh is placed to cover the hernia defects and prevent any recurrence.

Conclusion:

The importance of laparoscopy in the surgical management of inguinal hernia cannot be overstated. It is an effective and safe treatment with minimal complications.

 

The surgical management of inguinal hernia is dependent on the patient’s age, associated comorbidities, and symptoms. Laparoscopic surgery has been proven to be an effective and safe treatment option for inguinal hernias.

 

Laparoscopic surgery provides a less invasive procedure with minimal complications, thus reducing the postoperative pain and shortening recovery time than open surgery.

In addition, it allows for better visualization of the abdominal cavity which results in fewer complications during the postoperative period. The advantages are not only limited to patients but also extend to doctors who can perform these procedures safely and ergonomically.

 

Laparoscopic surgery has become the standard for the treatment of inguinal hernia. It is a safe, effective, and minimally invasive procedure. The benefits extend to patients and surgeons alike, making it the preferred treatment option over open surgery.

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