Prognosis

The prognosis is good, the recurrence rate is between 2-10% depending on the surgical method.

Inguinal hernia in pregnancy

During pregnancy there is an increased risk of inguinal hernia. The reason is the increased pressure within the abdominal cavity and a weakness of the abdominal wall muscles. Due to the constantly present pressure in the abdomen, which is constantly increasing, the abdominal wall, through which the intestine protrudes, becomes weaker.

Furthermore, the typical weak points are additionally weakened by a decrease in the strength of the muscles. Therefore, pregnant women more often suffer from an inguinal hernia, which usually becomes noticeable during a prenatal examination or due to a given symptomatology. Inguinal hernias during pregnancy are usually not treated surgically or only after birth.

Since such an inguinal hernia is almost always caused by pregnancy, this trigger disappears after birth, which is why one often waits. If the symptoms do not improve after birth, surgery is indicated. If complications or severe pain occur during pregnancy, the hernia will be operated prematurely.

Different forms of hernia in women

In indirect or “lateral” (external) inguinal hernia, the hernia sac enters the canal through the inner ring of the inguinal canal. There, the hernia sac accompanies, among other things, the uterine ligament (Ligamentum teres uteri), which runs from the uterus to the labia. The hernial sac then exits through the outer ring of the inguinal canal, above the inguinal ligament, where it is usually palpable.

Indirect inguinal hernias can be congenital or acquired in the course of life. In contrast to men, the hernia here accompanies the uterine ligament and not the sperm duct. Since there are larger structures within the inguinal canal in men, the inner ring, i.e. the entrance port, is enlarged.

Therefore, inguinal hernia is much more common in men. In a direct or “medial” (“central”) inguinal hernia, the hernia sac is leaking through a weak point in the abdominal muscles. The hernia therefore does not enter the inguinal canal through the inner ring, but accompanies it only as it progresses.

Since the hernial sac does not break through the inguinal canal but directly through the abdominal wall, this hernia is also called a “direct inguinal hernia”. Direct inguinal hernias are always acquired, usually by increased pressure. Their classic point of passage is the so-called “Hesselbach’s triangle”.

This is the name given to the weak point in the musculature which typically exists in humans and which projects itself relatively centrally on the abdomen. Congenital inguinal hernias occur mainly in newborns and infants. During embryonic development, there is a lowering of structures that draw into and pass through the inguinal canal.

This causes the peritoneum to be pulled along, creating a natural connection between the abdominal cavity and the groin. The connection usually grows together very early. However, if it remains, an inguinal hernia develops early on, which is usually conspicuous by a reddened swelling.

Congenital inguinal hernias are therefore always indirect hernias, since they make their way through the inner ring of the inguinal canal.Women account for only about 10-20% of the total number of inguinal hernias. About two thirds are indirect inguinal hernias and one third direct inguinal hernia. In the case of indirect and/or congenital inguinal hernias, the right side is significantly more frequently affected. This is probably due to embryonic developmental causes and is probably related to the width of the inguinal canal. In direct inguinal hernias, no distinction is made between right and left in the probability of occurrence.