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Fix My Hernia
Groin Hernias
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What is a Groin Hernia?  A groin hernia is a hernia which develops in the groin of the individual either through a natural or a developed defect in the abdominal wall.  Groin hernias are divided into inguinal hernias and  femoral hernias.  Inguinal hernia are further divided in to indirect and direct inguinal hernias.  Direct inguinal hernias are typically found in older individuals.  They come from a developed weakness in the groin tissues. when the tissues become stretched out over time a bulge develops.  An analogy to this situation would be if you pushed your fist through a sheet of rubber.  Your fist would represent the hernia and the rubber sheet would represent the abdominal wall.  An indirect hernia comes from a congenital defect in the lower abdominal wall.  In both men and women there is a tunnel called the inguinal canal.  In men the blood vessels to the testicle go through here to get to the scotum.  In women a similar structure called the round ligament goes through here to attach to the female external genitalia.  In this kind of inguinal hernia a pocket of peritoneum gets into the canal and may fill with fluid or tissue, creating a bulge.  An analogy of this situation is your pants pocket where when you stand your pocket may be filled with change and a visible bulge may be seen.  When you sit down the change falls out of your pocket and the bulge goes away.  In a femoral hernia, the hernia bulges into the inside thigh through an abdominal wall defect next to the blood vessels going into the thigh.  The hernia may flip up over the lower abdominal wall and so may look like an inguinal hernia.
 
What are the symptoms?  The hernia may at first show up as a painless bulge.  Over time it may become larger and painful to the touch.  While a direct hernia may become a larger and larger bulge over time, the indirect hernia follows the course of the inginal canal and may be sausage-shaped.  As this type of hernia progresses it may even reach all the way into the scotum in men or the genitalia in women.  Initially it may be reducible which means that the bulge goes away when you lay down or relax.  At this time it only comes out when your cough, sneeze or strain your abdomen.  Over time the hernia may become incarcerated which means that the bulge remains regardless of your attempts to reduce it.  It the problem progresses then the incarcerated hernia becomes strangulated.  Similar to putting a rubber band around your finger, the tissue inside the hernia sac is at risk for dying because of a loss of blood supply.  The mass becomes more painful and the overlying skin may become red, swollen and warm.  Depending on what is in the hernia the person may develop fevers and difficulty moving his bowels or passing his urine.  This a surgical emergency and medical help should be sought immediately.
 
What is in my hernia?  When a hernia is small it may just be some fluid or fatty tissue.  As the hernia enlarges it may contain bowel or other organs.
 
How do you treat a Hernia?  A hernia involves a physical defect in the wall of the abdomen.  It will not get better over time or heal itself.  It must be repaired with surgery.  Today a hernia is typically repaired using a patch made of plastic, similar to patching a hole in a tire.  At one time goin hernias were repaired by simply closing the hole with sutures or using tissues in the immediate area to repair the defect.  Over time a tension-free technique was developed which uses mesh to patch the defect. The tension-free technique has reduced the number of failed hernia repairs and is done almost universally today in repairing hernias in adults.  Hernias may be repaired using either an open technique or a laparoscopic technique.  Using the open procedure the surgeon goes through an incision in the groin to reduce the hernia and repair the defect.  In the laparoscopic procedure the surgeon inflates the space between the abdomen and the peritoneum (the thin layer of tissue that lines the abdominal cavity). He then uses a special telescope and instruments to look behind the abdominal wall and place a piece of mesh over the defect to repair the hernia.
 
Should I have my hernia repaired?  Almost everyone who is healthy enough to undergo surgery should have it repaired.  Persons with significant health problems which would make surgery too dangerous may be better at using an alternative to surgery.  Anyone with an incarcerated hernia should have it repaired before it becomes strangulated.  A strangulated hernia is a surgical emergency and medical help should be sought immediately. If you have any doubts you should seek medical care.
 
What are the alternatives to surgery?  Wearing a supportive garment such as an abdominal binder or truss may keep the hernia reduced and eliminate some of the symptoms.  If the hernia is incarcerated then the above garment will not be helpful.
 
What are the risks of surgery?  Risks common to all surgeries are bleeding, infection and scar.  Despite the best efforts of your surgeon there is a very small chance of recurrence of your hernia.  This is much more likely should the hernia be repaired without mesh.  There is much less of a chance of recurrence should your surgeon use mesh.  Depending on the complexity of the hernia other potential complications may be present.  These may include in injury to bowel or other intra-abdominal structures and healing with adhesions that can lead to further surgery. 

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View of a normal inguinal area of the abdomen from inside of the abdomen

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Indirect inguinal hernia going through internal ring

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Inguinal area with the peritoneum peeled away (preperitoneal); indirect hernia sac has been reduced

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Laparoscopic placement of mesh over the direct and indirect spaces

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hernia defect for a direct inguinal hernia (preperitoneal view)

J. Douglas Reid III, MD, FACS, 3 St. Francis Dr, Suite 490, Greenville, SC 29615

J. Douglas Reid III, MD, FACS, 3 St. Francis Dr, Suite 490, Greenville, SC 29615

J. Douglas Reid III, MD, FACS, 3 St. Francis Dr, Suite 490, Greenville, SC 29615

J. Douglas Reid III, MD, FACS, 3 St. Francis Dr, Suite 490, Greenville, SC 29615