Inguinal hernia is a condition that can be influenced by several factors. Dr. Luca Covotta, expert in General Surgery in Avellino , explains how we need to intervene and what are the possible risks of surgery
What is meant by an inguinal hernia?
This pathological condition of the abdominal wall consists in the leakage of abdominal contents and is due to a failure of the muscle-tendon structures of this area. This region of the abdominal wall represents an ideal area for this subsidence, because there is anatomically a natural passage called “inguinal canal” which in man contains both the vessels for the testicle and the conduit for the sperm (deferent), while in the woman it contains the round ligament of the uterus.
In relation to the point where this leak occurs, we can distinguish two types of hernias: the inguinal one and the crural or femoral one.
The inguinal hernia represents about 90% of all hernias of the abdominal wall where the herniated contents cross the inguinal canal. In relation to the point where they are located within the canal and are distinguished in:
- Direct inguinal hernia: characterized by a weakness in the transversalis fascia;
- Indirect inguinal hernia: located in the lower epigastric vessels and characterized by a protrusion of the hernial sac.
In the crural or femoral hernia , however, the hernia passes under the inguinal ligament and crosses the femoral canal between the femoral vein laterally and the pubis medially.
What factors can favor the escape of a hernia?
Some conditions have been identified that can favor the escape of a hernia , among these:
- Congenital malformations of the abdominal wall;
- Pregnancy;
- Senility (which causes thinning and weakening of the abdominal muscles);
- Physical efforts or weight lifting;
- Constipation;
- Obesity;
- Trauma of the abdominal wall;
- Chronic respiratory failure.
How does an inguinal hernia manifest?
The most frequent symptom is the appearance of a more or less painful swelling in the groin region, which could progressively increase in size until it descends into the scrotal sac in men and into the large lip in women. This condition in the vast majority of cases does not cause particular problems but in some cases it can lead to complications, such as:
- Clogging: the herniated content remains blocked on the outside;
- Strangulation: due to clogging the hernial contents undergo ischemic damage with consequent tissue necrosis,
How to intervene?
The only therapy is surgical repair (in technical terms ” alloplasty ” or “inguinal hernioraphy”) which, in addition to reducing the herniated tissue in the abdomen, must ensure an effective system of “closing” the defect with a mesh (prosthesis) of synthetic material. This surgery can be performed under general, spinal or local anesthesia in relation to:
- Hernia size;
- Accused symptoms;
- Physical constitution of the patient;
- Any comorbidities and consequent therapies of the patient.
The intervention generally involves for a few days mild pain and / or tension in the area of the intervention. Rest for at least a week is recommended, before gradually resuming normal activities. To resume sports activities or lift weights, we recommend waiting for at least a month.
What are the risks of the intervention?
Possible post-surgical complications include:
- Hematoma in the intervention area;
- Surgical wound infection;
- Injury (transient or permanent) to structures of the inguinal canal, for example testicular, vascular, nervous lesions;
- Chronic pain caused by the entrapment of nerve structures in the suture of the prosthesis;
- Possible testicular damage caused by the ligation of the genital blood vessels or the vas deferens;
