Inguinal hernia surgery

and Martina Feichter, medical editor and biologist

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts All content is checked by medical journalists.

Inguinal hernia surgery is the standard treatment for an inguinal hernia. There are different surgical methods. A distinction is made between open and minimally invasive procedures. The doctor decides on a case-by-case basis which method is most suitable. In most cases, the inguinal hernia operation proceeds without complications. Read more about inguinal hernia surgery here!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. K40

Why should an inguinal hernia be operated on?

An inguinal hernia does not usually resolve on its own. It remains permanent without treatment. The great danger that exists is the so-called incarceration. This means that supplying blood vessels are pinched off at the hernia port, which means that the hernia contents (mostly intestinal sections) are no longer adequately supplied with blood. The affected tissue can then die and cause dangerous inflammation of the peritoneum (peritonitis).

The inguinal hernia treatment therefore very often consists of an operation. In concrete terms this means:

• An inguinal hernia in children is usually congenital and is always operated on. It does not resolve on its own and can cause complications.
• For women, too, surgery is the treatment of choice for an inguinal hernia - regardless of whether the hernia causes discomfort or not. For one thing, women develop complications more often than men. On the other hand, an inguinal hernia in women often hides a femoral fracture (femoral hernia) and this has a high risk of complications. Only in the case of pregnant women with an inguinal hernia is it often first waited and observed (follow-up observation). The hernia may be operated on after the birth.
• In men, an inguinal hernia is operated upon as soon as it causes symptoms. As long as there are no complaints and the hernia does not enlarge, the strategy of "watchful waiting" is used - one first waits and observes the hernia.

No matter whether adult or child, male or female - a pinched inguinal hernia (incarcerated inguinal hernia) is an emergency! Doctors then perform an inguinal hernia operation as soon as possible.

The choice of the surgical method

Nowadays there are a variety of different inguinal hernia surgery methods. They can be roughly divided into open and minimally invasive techniques. Each of these has its advantages and disadvantages. The doctor decides on a case-by-case basis which surgical procedure is best suited for the respective patient.

Important criteria are, for example

• Location and size of the hernia
• First illness or relapse
• Age and gender of the patient
• The general state of health of the person concerned
• Possible concomitant illnesses

Patients who have had pelvic surgery in the past, for example, are usually given open inguinal hernia surgery. In women with an inguinal hernia, open surgery is avoided whenever possible (because of the increased risk of relapse after open hernia surgery) and a minimally invasive surgical method is chosen instead. However, whether it is a direct or indirect inguinal hernia does not matter.

An inguinal hernia operation is usually performed under general anesthesia. Sometimes it is enough to only numb the part of the body that is being operated on (regional anesthesia).

Sometimes a short hospital stay is necessary for the procedure. For example, small children are usually kept in the clinic overnight as a precaution. Often the inguinal hernia operation can also be performed on an outpatient basis: after a few hours of monitoring, the patient can go home on the same day.

With or without a network?

As soon as the hernial sac has been brought back to its original location (abdominal cavity) and the gap in the abdominal wall has been closed (sewn), the doctor can also insert a plastic mesh. This is made of polypropylene, for example. Due to the additional stabilization with the mesh, the risk of relapse is lower than with an inguinal hernia operation without a mesh insert.

The currently valid international guidelines give preference to network-based procedures (depending on the experience of the respective surgeon).

Nevertheless, a network is not always necessary. This can be the case, for example, with adolescent men with an indirect hernia: They have only a low risk of relapse anyway.

Open inguinal hernia surgery

In an open inguinal hernia operation, the surgeon makes a larger incision in the groin, relocates the contents of the hernia back into the abdomen and then closes the inguinal canal. There are two options:

In the open inguinal hernia operation without a mesh, the surgeon simply sutures the hernial port with adjacent connective tissue. The Shouldice surgical procedure is recommended. It is currently the best suturing method.

In open inguinal hernia surgery with a mesh, the doctor also stabilizes the hernial port with a plastic mesh. The most common procedure is the so-called Lichtenstein method.

One advantage of open surgery for inguinal hernias is that it can be operated under local or partial anesthesia. In addition, the risk of vascular injuries is probably slightly lower than with a minimally invasive procedure. On the other hand, patients after an open hernia operation suffer more often from persistent pain in the groin.

Minimally invasive inguinal hernia surgery

In Germany, many inguinal hernia operations are performed endoscopically (laparoscopically). That means: the surgeon makes several small incisions in the skin, through which he inserts the various surgical instruments into the abdominal wall or the abdominal cavity.Since the incisions are much smaller than in an open inguinal hernia operation, it is also referred to as a minimally invasive procedure.

Here, too, a distinction is made between various techniques. In all of them, however, not only is the break content shifted back, but a net is also inserted.

One advantage of the minimally invasive inguinal hernia surgery is that those affected can be physically active and work again faster than after an open procedure (on average about four days earlier than after an open inguinal hernia surgery). In addition, the risk of infections, abnormal sensations and lasting pain in the groin and probably also of bruising is lower.

In summary, the doctor usually chooses a minimally invasive inguinal hernia surgery in the following cases:

• women
• Inguinal hernias on both sides
• Renewed inguinal hernia after an open hernia operation
• Significant pain even before the operation
• Fast recovery wanted

Inguinal hernia surgery in children

Doctors also choose either an open or a minimally invasive inguinal hernia surgery procedure for children. There are no clear studies as to which is the better method. However, a net insert does not make sense for children: they are still growing. The pediatrician or pediatric surgeon decides individually which inguinal hernia procedure is the best.

Behavior after surgery

The patient can eat light food shortly after the operation. It is also important to drink a lot. On the other hand, the patient should refrain from smoking - it interferes with wound healing.

It is advisable to cool the operated area. This counteracts swelling and inflammation. You can usually shower normally again around two days after the operation.

Physical activity is possible again very quickly after the operation. Just a few hours after the procedure, many patients can and are allowed to walk around again and do light movement exercises. To be on the safe side, you should wait a few more weeks before lifting heavy loads.

The attending physician will give more precise instructions and recommendations on physical exertion in each individual case. For example, after an inguinal hernia operation without a mesh, you usually have to take it easy for a longer period of time than after an operation with a plastic mesh.

Pain after an inguinal hernia operation is possible. They can get worse if the pressure in the abdomen increases, for example by pressing while defecating or by coughing. Then pain medication can help. However, discuss the use of such medication with your doctor.

In the event of severe pain, reddening, swelling in the groin area and fever, you should inform the attending physician immediately!

Inguinal hernia surgery: complications

Problems after inguinal hernia surgery are relatively rare. As with any surgery, there are general risks. These include, for example:

• Bleeding and bruising (bruising)
• Accumulation of tissue fluid (seroma)
• pains
• Nerve damage (on the skin, in the inguinal hernia surgery region, when the mesh is inserted)
• Wound healing disorders
• Wound infection

To prevent infection, the doctor may prescribe antibiotics. However, the experts in the international guideline only recommend prophylactic antibiotics for patients who are susceptible to infections, such as advanced diabetes. In a minimally invasive inguinal hernia operation, wound infections, bruises and persistent groin pain occur somewhat less frequently than in open surgery.

Injury to structures in the groin region

Surgery for an inguinal hernia can injure surrounding structures. In male patients, it can affect the vessels and nerve cords of the spermatic cord. But the spermatic cord itself or the urinary bladder can also be affected. The testicle may recede or a so-called secondary undescended testicle may develop. The secondary undescended testicle occurs especially in operated infants when the newly sewn tissue exerts tension on the testicles.

Groin pain after an inguinal hernia operation is also an unpleasant complication. They arise when nerves that run through the inguinal canal are injured by the procedure or come under tension. The groin pain after an inguinal hernia operation can also become chronic. The following factors increase the risk of chronic pain syndrome after an inguinal hernia operation:

• Younger patients
• women
• Severe pain even before the inguinal hernia operation
• Severe pain early after the operation
• Inguinal hernia recurrences
• Open inguinal hernia surgery, without a mesh
• Small pore networks

The doctor ensures that the pain is treated quickly and adequately after an inguinal hernia operation. If this is neglected, the risk of chronic groin pain increases significantly.

Complications from the network used

The mesh used in an inguinal hernia operation is a permanent foreign body for the body. The organism can be overly sensitive to it, for example with inflammation. A mesh infection is also possible - even a few weeks or months after the hernia operation. In some patients, the mesh slips, rolls up or shrinks.

In the event of such network-specific complications, it may be necessary to remove the network again.

Relapse

In a few cases, operated patients have a new inguinal hernia that also requires surgery. The relapse rate is higher at

• Direct inguinal hernias
• Sliding hernias
• women
• Recurrent hernia already present
• Smokers

If a net is used during the operation, the risk of relapse is significantly reduced. In the event of a relapse, doctors typically choose a different approach than for the first inguinal hernia operation.

Tags:  stress digital health therapies