Diagnosis

The examination by the doctor is usually performed lying down. The doctor places a hand in the groin region and tries to feel for a bulge, thickening or a gap in the abdominal wall. To improve the examination conditions, the patient can cough or tense the abdominal wall.

Possible inguinal hernias then become more prominent. Nevertheless, the diagnosis of an inguinal hernia without a protruding hernia sac can be difficult in women. The diagnosis can be confirmed by an ultrasound examination or, in more complicated cases, by magnetic resonance imaging (MRI).

Therapy

An inguinal hernia must be treated surgically due to the risk of incarceration. In 90% of the cases an operation under regional anesthesia is possible, but if the operation is performed laparoscopically (laparoscopy = laparoscopy of the abdominal wall), the operation must be performed under general anesthesia. The operation of the inguinal hernia is performed in three steps.

In the first step, an incision is made in the groin, the muscle wall is cut through and the hernia sac is searched. In the second step the hernia sac is opened, then the hernia contents are moved back into the abdominal cavity and the hernia sac is closed by sutures. In the third step the hernial orifice is closed.

The hernial orifice is closed according to the principle of strengthening the posterior wall of the inguinal canal. The posterior wall of the inguinal canal lies towards the abdomen and can be reinforced by two different methods. Reinforcement can be achieved by a grafting suture and doubling of the muscle fascia.

This method is used, for example, in surgery according to Bassini or in surgery according to Shouldice. In women, the inguinal canal can be closed tightly around the uterine ligament, or the lig. teres uteri can be severed to allow closure of the inguinal canal.

Another surgical technique achieves the reinforcement by a tension-free implantation of a plastic mesh, which can be done either in an open or laparoscopic surgery. This technique is used, for example, in surgery in Liechtenstein. Exactly how long the operation of an inguinal hernia takes depends on the type of procedure.A distinction is made between open and laparoscopic (minimally invasive) procedures.

On average, the pure duration of the operation is about half an hour. It should be noted, however, that before the operation the patient must be introduced to the operation and after the operation an additional stay in the recovery room requires time. Therefore the total duration of the operation is significantly longer.

An operation is not always necessary in inguinal hernia. If, for example, the hernia is a random finding and shows no or very few symptoms, a so-called “watchful waiting” can be performed. In this case, regular checks of the symptoms and the hernia sac are carried out to rule out any deterioration.

Symptomatic inguinal hernias are usually operated on. An exception is the incarceration of a hernia sac, which is always operated on immediately. The choice of the surgical procedure depends mainly on whether a hernia has already occurred in the past. A distinction is made between open and minimally invasive (laparoscopic) surgical techniques:

Open surgical treatment of hernia is usually performed with a mesh insert, which supports the breakthrough point in addition to the suture (Liechtenstein procedure).
Laparoscopic procedures are the so-called Tapp (Transabdominal Preperitoneal Plastic) and the TEP (Total Extraperitoneal Plastic).