Groin Hernias

What is a groin hernia?

Generally, a groin hernia can be either inguinal (lower abdominal area) or femoral (pelvis area) in origin. An inguinal hernia (of which there are two types) is a protrusion of abdominal cavity contents through the inguinal canal. These hernias are very common in men, occurring at about 7% in men, and occurring less in women at about 3%. A femoral hernia occurs via the femoral canal, which normally allows passage of the common femoral artery and vein from the pelvis to the leg. Sometimes, people will have a combination of hernias. Clinical classification of hernias is important in helping both patients and surgeons make determinations between elective and more urgent operations.

What are the symptoms of a hernia?

Groin hernias present as bulges in the groin area that can become more prominent when patients cough, strain, or stand up. They are rarely painful in their early stages, and the bulges easily disappear when patients lie down. The inability to place the bulge back into the abdomen, with pain usually suggests the hernia is incarcerated and requires emergency care. Severe, persistent pain is suggestive of a strangulated hernia. As the strangulated hernia progresses, it may compress the contents of the abdominal cavity (such as the intestines).  This will not only lead to intestinal obstruction but also proceed to ischemia (lack of blood flow) and gangrene. This process can have fatal consequences. The diagnosis of a groin hernia may not be straightforward and should be evaluated by a general surgeon.

Management of hernias:

Conservative therapy

For those who are not suited for repair procedures, a hernia truss, which is a special belt with a pad that a patient wears in order to prevent the hernia from bulging, can be used under the direction of a surgeon. Although this treatment can improve symptoms, it may lead to some adverse effects, which make subsequent repairs more difficult.

Surgery

Surgical correction of groin hernias is called hernia repair. Surgery is the ultimate way to treat this abnormality. Depending on the general condition of a patient and the type of groin hernia, there are various surgical strategies that may be considered in the planning of groin hernia repair. At Shanghai United Family Hospital (SHU), surgeons have comprehensive knowledge of and experience in hernia repair. Our expertise extends to considerations of mesh use (e.g., synthetic or biologic), type of repair (tissue, tension-free, or laparoscopy repairs), type of anesthesia, and appropriateness of bilateral repair. Laparoscopic repair is the most commonly used technique at SHU and allows patients to experience less pain and quicker recovery. SHU also developed Complete Care Pricing in 2015 to help patients with groin hernia receive optimal care at one simple price.

References:

1. Bay-Nielsen M, Kehlet H, Strand L, et al. Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet 2001; 358:1124.
2. Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, et al. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA 2006; 295:285.
3. EU Hernia Trialists Collaboration. Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg 2002; 235:322.
4. Chowbey PK, Garg N, Sharma A, et al. Prospective randomized clinical trial comparing lightweight mesh and heavyweight polypropylene mesh in endoscopic totally extraperitoneal groin hernia repair. Surg Endosc 2010; 24:3073.
5. Bittner R, Arregui ME, Bisgaard T, et al. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc 2011; 25:2773.