A hernia (or “rupture”) is a weakness or defect in the wall of the abdomen. This weakness be present at birth. Or, it can be caused by the wear and. PDF | Inguinal hernia repair is performed in more than cases every year in the United States. However, the true prevalence be. Background: Inguinal hernia is a common surgical problem, but it can present a surgical dilemma for the skilled surgeon when it exhibits.
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Inguinal hernias are one of the most common reasons a primary care patient need referral for surgical intervention. PDF; Print page. This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the. Beneficios–La única forma de reparar una hernia es una operación. Usted puede regresar a sus actividades normales y, en la oría de los casos.
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Inguinal hernias: should we repair? Surg Clin North Am. National Guideline Clearinghouse. February 23, Introduction Inguinal hernia repair is an extremely common operation performed by surgeons. More than , repairs performed annually. An inguinal hernia is an opening in the myofascial plain of the oblique and transversalis muscles that can allow for herniation of intraabdominal or extraperitoneal organs.
These groin hernias can be divided into indirect, direct, and femoral based on location. Most patients present with a bulge or pain in the groin. An open or laparoscopic approach can be used with the goal of defect closure and a tension-free repair. A mesh is usually used for a tension-free repair.
When the mesh is contraindicated, primary suture repair can be performed. Most adult hernias are considered acquired. However, there is evidence to suggest genetics also play a role. Patients with a known family history of a hernia are at least 4 times more likely to have an inguinal hernia than patients with no known family history. Studies have also shown that certain diseases like chronic obstructive pulmonary disease COPD , Ehlers-Danlos syndrome and Marfan syndrome contribute to increased incidence of an inguinal hernia.
Also, it is believed that increased intra-abdominal pressure, as seen in obesity, chronic cough, heavy lifting, and straining due to constipation, also plays a role in the development of an inguinal hernia.
It is estimated that about , inguinal hernias are performed annually. The incidence of inguinal hernias has a bimodal distribution, with peaks around age 5 and after age Two-thirds of these hernias are indirect, making an indirect hernia the most common groin hernia in both males and females. An indirect hernia occurs more often on the right.
This is believed to be attributed to the slower closure of a patent processus vaginalis on the right side compared to the left. Pathophysiology Studies have shown that inguinal hernia patients have demonstrated higher proportions of type III collagen as compared to type I. Type I collagen is associated with better tensile strength than type III.
Studies have also shown that a patent processus vaginalis predisposes to the development of an inguinal hernia in adulthood. The majority of pediatric inguinal hernias are thought to be congenital due to a patent processus vaginalis.
During normal development, the testes descend from the abdomen into the scrotum leaving behind a diverticulum that protrudes through the inguinal canal and becomes the processus vaginalis. In normal development, the processus vaginalis closes around 40 weeks of gestation eliminating the peritoneal opening at the internal ring. Failure of this closure can lead to an indirect hernia in the pediatric population.
A patent processus vaginalis does not always lead to an inguinal hernia. History and Physical Inguinal hernias can present with an array of different symptoms. Most patients present with a bulge in the groin area, or pain in the groin.
Some will describe the pain or bulge that gets worse with physical activity or coughing.
Symptoms may include a burning or pinching sensation in the groin. These sensations can radiate into the scrotum or down the leg.
It is important to perform a thorough physical and history to rule out other causes of groin pain. At times an inguinal hernia can present with severe pain or obstructive symptoms caused by incarceration or strangulation of the hernia sac contents.
Physical examination is the best way to diagnose a hernia. The exam is best performed with the patient standing. Visual inspection of the inguinal area is conducted first to rule out obvious bulges or asymmetry in groin or scrotum. Next, the examiner palpates over the groin and scrotum to detect the presence of a hernia.
The palpation of the inguinal canal is completed last. The examiner palpates through the scrotum and towards the external inguinal ring. The patient is then instructed to cough or perform a Valsalva maneuver. If a hernia is present, the examiner will be able to palpate a bulge that moves in and out as the patient increases intraabdominal pressure through coughing or Valsalva. It is not essential to differentiate an indirect from a direct hernia on the exam as surgical repair is the same for both.
A femoral hernia should be palpable below the inguinal ligament and just lateral to the pubic tubercle. Femoral hernias can easily be missed in an obese patient.
In cases when there is high suspicion but no hernia can be detected on physical exam, a radiologic investigation may be warranted to elicit the diagnosis.
Evaluation Most inguinal hernias are diagnosed with a thorough history and physical examination. When history strongly suggests a hernia, but none can be elicited on an exam or in situations where body habitus makes physical examination limited, then radiologic investigation may be warranted. By omental resection, we sufficiently gained space to mobilize the protruded colon back into the abdominal cavity.
Complete resection of the hernial sac required the removal of the vascularization of the right testicle. Therefore, ipsilateral orchiectomy was performed. Since the former content of the herniation was too voluminous to allow direct tension-free suturing of the lower part of the laparotomy wound, we subsequently performed modified components separation completed by mesh insertion. Bilateral access to the rectus sheath allowed the preparation of a retromuscular plane. Suction drainages were placed subcutaneous plane.
During the early postoperative period no complications occurred. Intensive care treatment was not necessary. No impairment of respiration or oxygenation was registered. We discharged the patient on postoperative day 8 in an excellent condition. Six months after the operation, a hematocele in localization of the former right testicle was diagnosed.
The operative removal of the hematoma and adjacent tissue was performed. After having removed the hematoma, the patient was fully satisfied with the overall postoperative result. Plastic surgery, in order to reduce the size of the scrotal skin surface, was not performed at any time. Clinically and sonographically no hernia recurrence was registered.
An acceptable cosmetic result prevailed Fig. Furthermore, the patient reported to be sexually active again. His quality of life had improved notably after the restoration of the giant inguinoscrotal hernia. Different approaches are possible. Open abdominal and inguinal approaches are commonly used, if necessary in combination.
According to the outer circumstances, ranging from high-end surgery in developed countries to surgery with limited resources in less developed countries, the surgical therapy has to be adapted to achieve the optimal result for the individual patient.
It is necessary to treat inguinoscrotal hernias, since organ perforation can occur, potentially causing peritonitis and sepsis [ 9 , 10 ].