Inguinal hernia – types, symptoms, treatment, complications [EXPLAINED]

Proven content

An inguinal hernia is an abnormal ‘bulge’ in the groin area. It is worth knowing what its types are, how to recognize it and how to treat it.

Inguinal hernia – definition

An inguinal hernia is a condition that develops relatively slowly and spreads over time. Its first symptoms are often confusing, but as the condition develops, they become more and more visible. An inguinal hernia is a condition that can occur as a result of an injury or high physical exertion (for example, during childbirth). Regardless of the position and movements taken, the internal organs of the body, most of which are located in the abdominal cavity, remain in the designated places. the abdominal wall, especially the muscles.

Kiedy jednak na styku mięśni pojawi się słaby punkt, mamy do czynienia z efektem szczeliny w tamie: wskutek napierającego ciśnienia to, co jest po drugiej stronie, zaczyna wydostawać się przez szczelinę, najpierw w małych ilościach, z czasem w coraz większych — powstaje przepuklina pachwinowa.

Water leaks through the dam, and in the case of leaky abdominal integuments, the peritoneum (i.e. the membrane lining the abdominal cavity), as well as the organs themselves, most often the intestines, begins to escape through the gap. When we exert pressure on the walls of the abdomen from the inside during exercise, such as lifting heavy objects, we start the process of getting out of what should remain inside.

The systematics of hernias is quite rich, it is distinguished, among others, by abdominal hernias, including inguinal, femoral, umbilical, white and postoperative hernias; congenital, acquired, external and internal … Inguinal hernias are the most common and their surgery is considered to be the most common surgical procedure in the world.

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Inguinal hernia – types

There are two key types of inguinal hernia: indirect and

1. indirect inguinal hernia – occurs when the internal opening of the inguinal canal, which usually closes during labor, remains open. This allows parts of the intestine to slip through the inguinal canal. These hernias are often diagnosed in the first year of life, but may not appear until adulthood. This condition affects 1% to 5% of normal newborns and up to 10% of premature babies.
2. bezpośrednia przepuklina pachwinowa – is formed when part of the intestine protrudes by the weakening of the abdominal muscles along the wall of the inguinal canal. They are common in adults but rare in children.

In adults, direct and indirect inguinal hernias look similar. They can occur on one or both sides of the groin. Your doctor may not know what type of hernia you are struggling with until surgery is performed. However, both types of hernias are treated similarly.

A type of hernia called a femoral hernia can look similar to an inguinal hernia. Przepukliny udowe występują znacznie częściej u kobiet niż u mężczyzn. Mogą powodować guzek, który pojawia się tuż pod pachwiną i rozciąga się na górną część uda. W przepuklinie udowej część jelita wystaje przez kanał, w którym przebiegają duże naczynia, kiedy przechodzą między brzuchem a nogą. Przepukliny udowe występują najczęściej u starszych kobiet z nadwagą.

Read: Not getting enough sleep can make you overweight

Przepuklina pachwinowa — przyczyny

They are most exposed to the occurrence of inguinal hernia obese people. Znaczenie ma również charakter pracy i tutaj najbardziej narażeni są manual workers, especially those who are forced to lift and carry various kinds of loads. Men suffer from inguinal hernia much more often. It is related to the anatomical structure: in the sensitive areas of men there is a soft structure prone to delamination: the spermatic cord. This “weak link” is missing in women.

The anatomical structure plays a big role. In men it is different than in women, which makes it more common in them. More specifically, it is about the construction of the inguinal canal, i.e. the segment in the front of the abdomen for the spermatic cord and the round ligament of the uterus. This section is located above the middle of the inguinal ligament.

The masters’ spermatic cord consists of the vas deferens, along with the nerves, muscles, blood vessels and the testicular levator. Enlargement of the canal causes organs from the abdominal cavity to enter it and the formation of an inguinal hernia. Rather, in women, the formation of a hernia is associated with multiple births, which may cause the femoral canal to widen. Then the abdominal organs slide into the femoral canal without any problems and femoral hernias are formed.

See: What is a scrotal hernia?

The formation of an inguinal hernia

The opening through which the inguinal hernia extends to the outside of the abdominal wall is called the hernia gate. A hernia, specifically the hernial sac, which reaches the layers of the skin through the hernia canal, may be empty – these are usually small hernias, but it may contain fragments of the intestines, and even entire organs, e.g. the urinary bladder.

There are two types of inguinal hernia, and the division was made taking into account the path of the hernia canal. Gdy przechodzi on przez kanał pachwinowy aż do moszny, przepuklina nazywana jest skośną. This variety may be congenital or acquired. Inguinal hernia straight jest zawsze nabyta, zwykle mniejsza niż skośna, nie kończy się w mosznie, nie przebiega przez powrózek nasienny i zdarza się znacznie rzadziej.

W początkowym stadium przepuklina jest małą gulką, którą najczęściej da się wtłoczyć z powrotem do jamy brzusznej (to tzw. przepuklina odprowadzalna). Jednak z czasem worek przepuklinowy powiększa się i nieleczony może osiągnąć gigantyczne rozmiary.

In pathological cases, patients have a lump the size of a large pumpkin in the groin area, and intestines in it, although in their situation it is difficult to talk about the existence of a groin at all. It is hard to believe that you can bring yourself to such a state, especially since if a hernia does appear, you cannot expect it to disappear by itself; most of the time surgery is simply a matter of making a decision.

Inguinal hernia – symptoms

Initially, an inguinal hernia may not cause any symptoms or may only cause a feeling of heaviness or pressure in the groin. Symptoms will most likely develop after standing for a long time or when performing activities that increase abdominal pressure, such as lifting weights, a persistent cough, or straining to urinate.

As the hernia grows, it eventually causes an abnormal bulge under the skin near the groin. This bulge may become increasingly uncomfortable or soft to the touch. As the hernia grows larger, part of the intestinal hernia may become trapped and unable to slide back down into the abdomen. If this happens, there is a danger that the trapped intestine could twist and die from blood supply being cut off. This causes severe pain and requires immediate treatment.

In some cases, there may even be a trapped hernia that causes obstruction of the gastrointestinal tract or ischemia of the trapped intestinal wall. Then the only solution is an operation, during which it is sometimes necessary to excise a fragment of the ischemic intestine.

Przepuklina pachwinowa — jak rozpoznać?

Before the palpable nodule is highlighted, discomfort appears in the groin area: pain, tension, burning, and sometimes an unidentified “something”, especially when tensing the abdominal muscles: coughing, laughing, singing, visiting the toilet. Pain can also affect the testicle. Even if you can’t see it yet, an inguinal hernia can already be felt under the skin.

A hernia is diagnosed during a physical examination, although the doctor may additionally order an ultrasound to show the hernial sac and its contents. Ultrasound examination is also performed to differentiate an inguinal hernia from other ailments, e.g. lymphadenopathy, pseudoaneurysm.

Read also: What is the ultrasound of the testicles and scrotum?

Inguinal hernia – treatment

Radical opponents of the operation delude themselves that the so-called hernia can be dealt with. hernia belt, however, experience shows that the chances of this happening are negligible. Cures with its help, if they happen, are in small children. However, even if you insist on the belt or because of contraindications to surgery while being doomed to it, you should carefully follow the procedures for putting it on (only with drainable hernias, lying down, when the hernia is first manually inserted into the abdominal cavity), otherwise it may cause additional troubles.

Z powyższego wynika, że jedynym sposobem poradzenia sobie z przepukliną jest operacja.

Currently, the standard procedure is the voltage-free technique, with the use of special meshes – explains Dr. Paweł Mrozowski. – This method is, above all, more comfortable for the patient, because it minimizes pain and, according to statistics, reduces the risk of hernia recurrence. In the past, with traditional surgeries, the percentage of consecutive cases in the same person reached 20%, and nets allowed to minimize this number to only 2-3%.

The mesh works like the sealing of a hole in a dam: it closes the opening, the hernial gates, and strengthens the abdominal wall so that they are no longer a weak point and do not separate again. An alternative is the tension method, which consists in obstructing the mouth of the inguinal hernia by suturing the muscle tissues of the inguinal canal.. In this case, relapses were very common, and the patient suffered from suture tightness.

Zabiegi wykonuje się klasycznie lub laparoskopowo. Uważane są za bezpieczne i najczęściej pacjent już następnego dnia po operacji wychodzi do domu, z zaleceniem oszczędzania się, a przede wszystkim z zakazem dźwigania ciężarów.

Get to know the clinics that perform inguinal hernia procedures – compare the offers of selected facilities and choose the preferred hernia treatment procedure.

Pomocniczo w leczeniu przepukliny można stosować ciepłe okłady. Wykorzystaj w tym celu Termofor gumowy Sanity 2l, który kupisz na Medonet Market.

Przepuklina pachwinowa — operacje przepuklin

Hernia surgery is so important not only for aesthetic reasons, but above all because there is a risk of a life-threatening hernia entrapment phenomenon. It is a state in which the contents of the hernial sac are mechanically “trapped” in the moment of dilated and then closed gates.

Objawami są bóle brzucha, wymioty, zatrzymanie gazów i stolce, a nawet omdlenie. W następstwie może dojść do the so-called cramps in the intestinewhen intestinal blood supply is impaired, which leads to necrosis and obstruction. Symptoms are similar to the above, but much more violent and the risk of life increases. A patient in this condition should as soon as possible go to the hospital, where a hernia operation will be performed.

As you can see, although probably no one forged an eye with a teaspoon, there was a lot of truth in the mothers’ warning about carrying. However, if a hernia appears despite the observance of this prohibition, it must not be underestimated. The author’s warning to the conscious adult male should be: “Don’t ignore a hernia or it may end up badly or ugly.”

Laparoscopic methods of treatment of inguinal hernia

The advantage of laparoscopy is faster recovery and shorter hospitalization time.

1. TAPP — jest to metoda przezbrzuszna przezotrzwewnowa. Lekarz wykonuje 3 nieduże nacięcia na skórze, a następnie do jamy brzusznej wprowadza kamerę ze specjalnymi narzędziami. Kolejnym krokiem jest otwarcie otrzewnej i odprowadzenie treści przepukliny. Na koniec ścianę kanału pachwinowego wzmacnia się za pomocą wyżej wspomnianej siatki z tworzywa sztucznego i zeszywa się otrzewną.

2. IPOM — is an intraperitoneal method in which the mesh is attached to the peritoneum with absorbable staples inside the abdomen. It uses a two-layer mesh that does not attach to the intestine. The IPOM method is applicable to any type of hernia, not just the inguinal hernia.

3. TEP — to operacja zewnątrzotrzewnowa. Podczas zabiegu lekarz nie ingeruje w otrzewną, a mocuje siatkę bezpośrednio nad nią. Jest to najmniej inwazyjna metoda, ponieważ nie otwiera się otrzewnej.

Complications after inguinal hernia surgery

Inguinal hernia surgery may be associated with the occurrence of complications, which include:

1. nawrót przepukliny (związany z dalszym osłabieniem tkanek w tym samym miejscu; nawroty występują rzadziej po zabiegach z wykorzystaniem siatki);
2. hematoma in the postoperative wound;
3. przewlekły ból spowodowany uszkodzeniem nerwów w trakcie zabiegu lub drażnieniem ich przez założoną siatkę;
4. niekiedy zakażenie siatki (w takich przypadkach jest ona operacyjnie usuwana);
5. rarely testicular ischemia (as a result of vascular damage in the area of ​​the spermatic cord or too tight mesh opening);
6. neuralgia,
7. rzadko migracja siatki.

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