WHAT IS INGUINAL HERNIA?

Inguinal hernias are by far the most common hernias. Inguinal hernias are protrusions of abdominal cavity contents through the inguinal canal. They are very common and their repair is one of the most frequently performed surgical operations. Inguinal hernias are more common in men than in women.

Inguinal hernia are of two types:
•  Direct: These occur when abdominal contents herniate through a weak point in the fascia of the abdominal wall and into the inguinal canal.
•  Indirect: These occur when abdominal contents protrude through the deep inguinal ring; this is ultimately caused by failure of embryonic closure of the internal inguinal ring.

TREATMENT

Surgical correction of inguinal hernias is known as herniorrhaphy or hernioplasty. It is now often performed as an ambulatory, or "day surgery," procedure.

One of the following techniques may be used for the repair of inguinal hernias:

•  Open "tension-free" repair: Almost all repairs done today are open "tension-free" repairs that involve the placement of a synthetic mesh to strengthen the inguinal region. This operation is called a hernioplasty. The operation, which has a very low recurrence rate, is typically performed under local anesthesia, and patients go home within a few hours of surgery, often requiring no medication beyond aspirin or acetaminophen. Some popular techniques include the Lichtenstein repair (flat mesh patch placed on top of the defect), Plug and Patch (mesh plug placed in the defect and covered by a Lichtenstein-type patch), Kugel (mesh device placed behind the defect), and Prolene Hernia System (2-layer mesh device placed over and behind the defect).

•  Laparoscopic repair: Laparoscopic repair is the latest technique of repairing inguinal hernias. "Lap" repairs are also tension-free, although the mesh is placed within the preperitoneal space behind the defect as opposed to in or over it. It has a faster recovery time and a causes less post-operative pain.

•  Open "tension" repair: This technique is no longer the standard of care due to the high rate of recurrence of the hernia, long recovery period, and post-operative pain, yet, a few tension repairs are still in use today. Some popular techniques include Shouldice and the Cooper's ligament/McVay repair.

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