Inguinal hernia (hernia inguinalis; inguinal hernia) is the most common type of hernia of the intestines. It is much more common in men than in women (6-8:1). In men, the prevalence is about two percent. The preferred age is in the sixth decade of life and in infants. In premature infants, the prevalence is 5-25%. A distinction can be made between direct and indirect inguinal hernia, with more than 70% belonging to indirect hernia:
- Direct hernias, unlike indirect hernias, do not pass through the inguinal canal.
- Indirect inguinal hernias may be congenital or acquired; direct hernias are always acquired.
Furthermore, inguinal hernia can be distinguished according to their size:
- Hernia incipiens – protrusion of the hernia sac into the inguinal canal.
- Hernia completa – hernia with hernia sac on the outer inguinal ring.
- Hernia scrotalis – hernia with hernia sac in the scrotum (scrotum).
- Hernia labialis – hernia that extends into the labia (labia).
The surgical procedures
Herniotomy (synonym: hernia surgery) is an operation to remove or correct a hernia. In inguinal hernia surgery (inguinal hernia; inguinal hernia), a distinction is made between open surgery and keyhole surgery (laparoscopy; minimally invasive procedure). In open surgery (according to Shouldice), an incision is made in the groin to expose the affected structures. Then, a plastic mesh is usually inserted and the individual layers are well sutured. Complications of open surgery may include wound healing problems, infection, bleeding, nerve and vascular damage, or injury to internal organs (see below under possible complications). Furthermore, sterility and undescended testicles may occur. Recurrence, that is, recurrence of an inguinal hernia, may also occur. In laparoscopic hernia surgery, small incisions are made to insert the instruments, which are then used to operate via video camera. A plastic mesh is usually inserted in this form of surgery as well. In addition to the above-mentioned complications, this type of surgery can lead to dysesthesia, orchitis (inflammation of the testicles), scrotal emphysema (accumulation of air in the scrotum) and hydrocele (see below under possible complications). The type of surgery chosen depends on the patient’s condition, exact findings, and secondary conditions. The operation is mainly performed under general anesthesia. However, in infants, it is often performed with spinal anesthesia (“spinal anesthesia“).
Possible complications
- If the hernial orifice is narrowed by sutures or by scarring, male inguinal hernia may result in damage to the blood-supplying vessels or the vas deferens. This can lead to temporary swelling of the testicles. In very rare cases, it can lead to testicular atrophy (testicular shrinkage) or even testicular loss.
- Often there is a blue discoloration of the skin to the scrotum (scrotum) due to the formation of a hematoma (bruise), which usually forms itself back within days to weeks.
- When very large fractures are displaced back, a massive increase in intra-abdominal pressure (in the abdominal cavity) can lead to a so-called abdominal compartment syndrome. This can lead to damage to the tissues and organs located in the compartment (heart, lungs, liver, kidneys, intestines) due to the pressure-induced reduction in blood flow and it can thus possibly come to a multi-organ failure.
- During surgery for a femoral hernia (femoral hernia; femoral hernia; thigh hernia), it can come in very rare cases to a to a thrombosis (formation of a blood clot in a blood vessel), with the consequence of a circulatory disorder of the leg.
- In laparoscopic hernia surgery, the following additional complications are possible:
- Pneumothorax – presence of air in the pleural space (actually airless space between the pleura and the lung).
- Skin emphysema – excessive presence of air in the skin due to injury during laparoscopy.
- Wound healing disorders
- Injuries to internal organs (bowel, bladder, ureter, vas deferens) or major blood vessels (aorta (large body artery) or iliac artery (common iliac artery) and major veins) are rare
- Rupture of the abdominal suture (abdomen burst) (very rare).
- Adhesions (adhesions) in the abdominal cavity. This can lead to ileus (intestinal obstruction) after a long time.
- As after any surgical procedure, thrombosis (formation of a blood clot) may occur, with the possible consequence of embolism (occlusion of a blood vessel) and thus pulmonary embolism (danger to life). Thrombosis prophylaxis leads to a reduction in risk.
- The use of electrical devices (e.g. electrocoagulation) can cause leakage currents, which can lead to skin and tissue damage.
- Positioning on the operating table can cause positional damage (e.g., pressure damage to soft tissues or even nerves, resulting in sensory disturbances; in rare cases, this can also lead to paralysis of the affected limb).
- In case of hypersensitivity or allergies (e.g. anesthetics/anesthetics, drugs, etc.), the following symptoms may temporarily occur: Swelling, rash, itching, sneezing, watery eyes, dizziness or vomiting.
- Infections, after which severe life-threatening complications concerning heart, circulation, breathing, etc. occur, are very rare. Similarly, permanent damage (eg, paralysis) and life-threatening complications (eg, sepsis / blood poisoning) after infections are very rare.
- Mortality (death rate) in herniotomies without simultaneous bowel surgery: 0.13% (Germany; period. 2009-2013).