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The abdominal wall is a strong muscle and connective tissue structure that wraps the abdominal organs like an envelope and gives our body its shape. This envelope has some potential weak points. Intra-abdominal organs (especially adipose tissue and intestines) pass through the abdominal wall through these weak points and cause swelling under the skin. It is also called hernia. Abdominal wall hernias are treated surgically by General Surgery specialists.
There are some potential weak spots in the abdominal wall, both congenital and later. One of them is the inguinal region. Both inguinal regions are the places where the testicles in the abdomen pass through the abdominal wall while coming to their normal places in the scrotum in men. The groins are also weak in women. These areas contain the inguinal canal and contain the veins leading to the testicles and the semen canal in men, and some suspensory ligaments of the uterus in women.
An opening between the tissues in the inguinal canal normally closes until birth. In cases where this opening is not closed, inguinal hernia may occur in the newborn or early childhood period and is treated during this period. From time to time, the emergence of this hernia can also be seen in adult life. Although this opening is closed, the weakness of the inguinal region prepares the ground for hernia formation at any time. Severe and sudden or chronic strains that may occur in the abdomen may cause inguinal hernia development, especially from the age of 40, when tissue resistance begins to decrease. Situations that increase intra-abdominal pressure create these strains. Conditions such as carrying heavy loads for a long time, constipation requiring constant straining, and prolonged coughing increase intra-abdominal pressure.
There are many difficulties that an inguinal hernia brings to one's personal life. Its symptoms vary. While small hernias are manifested by pain, as the hernia grows, it causes a swelling under the skin, causing a physical appearance disorder and restriction in daily movements. This situation prevents the person from moving freely in society and damages his self-confidence. Since hernia is a growing and progressive disease unless treated, it should be treated as soon as possible after detection.
TAvoiding more serious medical problems also necessitates the treatment of inguinal hernia. As described, inguinal hernia occurs when intra-abdominal organs pass through the opening in the inguinal region and form a swelling under the skin. Often, organs constantly enter and exit through these openings. From time to time, due to the high intra-abdominal pressure, a large volume of organs passes through the abdominal wall and settles under the skin, but due to the large volume, it cannot return to the abdomen. This condition is called compression of the hernia (incarceration) and can lead to intestinal obstruction. If this process is prolonged, the blood vessels feeding the organs will be under pressure and can cause decay, a condition called strangulation of the hernia. Both conditions should be treated surgically under emergency conditions. Since surgery in emergency conditions may involve unpredictable risks for both the patient and the physician, surgical treatment should be performed as soon as possible by providing ideal conditions when a hernia is detected. This is much more comfortable for both the patient and the physician.
The principle of treatment in abdominal wall hernias is basically the same as repairing a hole in a wall. It is clear, therefore, that a mechanical problem must have a mechanical solution. In today's conditions, there are no drugs or methods (exercise, etc.) to close the openings in the abdominal wall by creating new and solid tissues. Until a better one is developed, surgery will be the only option in the treatment of abdominal wall hernias. Inguinal ligament etc. Methods like this do not solve the problem, they can only provide temporary relief.
In the treatment of inguinal hernia, the opening in the groin is repaired without tension with a patch. This patch can be created from the body's own tissues, or some synthetic materials can be used. With the development of new technology materials, the use of synthetic materials has become very common today. Synthetic patches are advantageous for tension-free repair. When the patch is placed on the body, it is perceived by the body as a foreign body and a hard tissue forms around it. This hard tissue provides a solid and durable closure of the hole in the hernia area.
Hernia operations can be performed with open or closed (laparoscopic) methods.
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In open surgery, the inguinal canal is entered with an incision of approximately 6-7 cm in the inguinal region, the anterior wall of the inguinal canal is opened, and the weak spot on the abdominal wall is closed without tension with a synthetic patch spread over it (Lichtenstein method).
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In the laparoscopic method, the inguinal canal is entered from the back. The weak point is detected and closed with a patch. This procedure can be done intraperitoneally (TAPP) or anterior to the peritoneum (TEP).
There is no difference between the two methods in terms of success, but since the incisions made in laparoscopic surgeries are smaller, postoperative pain is significantly less. While both repair with the patient's own tissue and synthetic patch can be used in open surgeries, it is obligatory to use synthetic patch in laparoscopic surgeries. Considering that the currently accepted ideal treatment of hernia is repair with synthetic patches, this should not be seen as an advantage of open surgery. Especially in surgical hernias, it may be necessary to make large incisions in direct proportion to the size of the hernia. In such cases, laparoscopic methods that allow the problem to be solved through very small incisions provide significant comfort for both the patient and the physician. In large hernias, the laparoscopic method shortens the hospital stay. Laparoscopic method is offered to the patient as the first choice in all hernia types due to the comfort it provides to the patient in the postoperative period.
In the vast majority of hernia surgeries (assuming no problem occurs), the hospital stay is short. In inguinal hernias, in umbilical hernias that are not very large, the hospital stay is one night. In surgical site hernias, this period may take up to a week, albeit rarely, depending on the size of the hernia. Application of the laparoscopic method will shorten the hospital stay. After the patient returns home, he is invited to the hospital for a control examination on the seventh day of his surgery, and the patient does not have to come to the hospital for a check-up, mostly, the doctor is consulted if there is any complaint.
Since the repair is done in the groin area, the surgical area will be weak at the beginning, so heavy exercise and strain should be avoided until the wound healing process here reaches a certain stage. Patients can return to their daily lives 48 hours after the surgery. The patient should rest between 3 and 7 days, depending on the weight of the job and the pain condition. The vast majority can return to work (not requiring heavy physical activity) within 4-5 days. Lifting more than 5 kg or heavy sports for six months is not recommended for those who do not do active sports. Active athletes can start routine training after 6 weeks.
The most important problem that may occur during or in the early postoperative period is bleeding in the operation area. Rarely, second surgeries may be required to control bleeding. Since men work very close to the semen, testicular vessels and nerves during the operation, these tissues may be injured. This condition can cause infertility, so it should be studied very carefully.
After a well-performed inguinal hernia surgery, the recurrence rate is very low if the risk factors for the patient are not too high. After hernia surgery, the most important issue to solve is pain. Prolonged pain often disappears over time, but in some cases, treatment options such as injection of medication into the painful area and re-surgery may be considered. _cc781905-5cde-3194-bb3b- 136bad5cf58d_