Prognosis
The operation of inguinal hernia in the surgical clinics, but also among the resident surgeons, is a routine procedure. The aim of the treatment of inguinal hernias is the permanent closure of the hernia gap. The success rate of inguinal hernia operations is high.
In only about 5% of the cases a recurrence (reoccurrence) of the inguinal hernia occurs. Nowadays, the operation is performed on an outpatient basis. However, the patients should be picked up by an accompanying person, as they are also under the effect of the anesthetics a few hours after the operation.
A hernia (inguinal hernia) occurs significantly less frequently in women than in men. Only about 10% of all inguinal hernias are found in women, 90% occur in men. In women, the so-called mother’s ligament (Ligementum teres uteri) runs through the inguinal canal (Canalis inguinalis), whereas in men the spermatic cord runs along it.
The ligament runs from the uterus to the labia. The causes of inguinal hernia in women are similar to those in men. Hernias can be congenital – i.e. they can make themselves felt as early as childhood – and are then usually caused by poor development or sclerosis of certain connective tissue structures.
More often, however, inguinal hernias are acquired. The acquired forms can, for example, be caused by a weakness of the connective tissue following an operation or simply as part of the body’s natural aging process.Further risk factors are among others: With all these factors, the tissue must be able to withstand higher pressure in the abdominal cavity. If it can no longer withstand this, a hernia can develop.
The symptoms of inguinal hernia are also similar in women and men. For example, a pulling pain can occur in the area of the affected groin which increases when pressure is applied (e.g. coughing) and can radiate into the labia. Often, however, uncomplicated inguinal hernias also remain without symptoms.
Also the therapy for women does not differ from that for men. The operation should be performed as long as no intestinal contents are trapped by the inguinal hernia, but there is no urgent indication and the operation date can be planned in peace.
- Overweight,
- Frequent lifting of heavy loads and
- Pregnancies
The inguinal hernia occurs in men in most cases.
In 10 necessary inguinal hernia operations, about 8 cases (80 percent) are surgical interventions in men. The reason for this is the fact that the inguinal canal is greatly dilated by the structures passing through in men compared to women. Furthermore, the spermatic cord of the man usually runs through the middle of a tendon plate, which actually strengthens the inguinal region.
In this way, this tendon plate in the groin region is strongly stretched and weak points in the abdominal wall are created. The intestine may therefore not be able to be held in the abdominal cavity. The counterpressure triggered by the tendon plate is simply missing.
In addition, the inguinal hernia in men is in most cases favored by strong strain on the muscular structures. Especially the lifting of heavy weights represents a considerable risk factor for the leakage of intestine through the abdominal wall. In addition, strong pressing on the toilet can also lead to the provocation of an inguinal hernia in men.
Furthermore, in the case of an inguinal hernia in men, it must be taken into account that not only visible protrusions of the abdominal wall in the groin area may occur. Also the clamping of the intestine inside the hernia sac does not represent the only risk of an inguinal hernia in men. If men are affected by an inguinal hernia, it can happen in the course of the hernia that the hernial sac together with the intestinal sections lying in it can sag down into the scrotum.
This is a frequently observed phenomenon, especially in the case of a longer lasting inguinal hernia. In these cases, one no longer speaks of an ordinary inguinal hernia, but of a scrotum hernia or scrotal hernia. Due to the limited space inside the scrotum, the testicles may be disconnected over time.
Therefore, a quick initiation of therapy is essential. Inguinal hernias are quite common in newborns. In the fetal period an incomplete closure of the inguinal canal can lead to a congenital inguinal hernia.
This type of inguinal hernia is called indirect or congenital. This congenital malformation is about five times more common in boys than in girls. In addition, the indirect inguinal hernia occurs more frequently on the right than on the left.
Intestines, such as intestinal loops, can pass through it. The cause of an inguinal hernia is an incomplete closure of the inguinal canal. The inguinal canal is an anatomical structure in the inguinal region, which is formed by parts of the anterior abdominal wall.
The organs of the abdominal cavity now exert a certain pressure on the inguinal region due to gravity. If the inguinal canal is not sufficiently closed, organs can break through it. In girls, this so-called hernial sac, which contains the viscera, can protrude up to the labia.
In boys, the hernial sac extends into the scrotum. This inguinal hernia is usually easy to palpate. Physical exertion and increased pressure in the abdominal cavity, for example by pressing during defecation, make the hernia sac protrude even more clearly.
The most obvious symptom of an inguinal hernia is the swelling, which is also easy to palpate. This swelling is soft and does not necessarily cause pain. However, it becomes painful when intestinal loops or other organs are trapped.
This can cause nausea and vomiting. There is also a risk of intestinal obstruction if the intestine is trapped. This situation represents an emergency.
The doctor can usually determine whether it is a hernia by feeling the swelling. In boys the position of the testicles is still palpated and checked. Furthermore, he can make an exact diagnosis by means of sonography (ultrasound examination).As a rule, inguinal hernia in babies is not operated on at first.
In the first three months of life, the inguinal canal can still close by itself. However, if this is not the case, surgery should be performed until the sixth month. A laparoscopy is performed, which leaves only very small scars.
This operation is free of complications and can often be performed on an outpatient basis. One difference to the minimally invasive procedures in adults (see main article ) is that in children, the insertion of foreign material is not necessary. This is done because the foreign material cannot grow with the child and thus does not adapt to the rapid growth of the infant.
Only the hernial orifice is closed with a suture. If intestines become trapped, surgery must be performed immediately, otherwise there is a risk that they will die (necrosis). Especially in boys, this can lead to permanent damage to the testicles. In general, possible complications are intestinal obstruction or peritonitis.
