Inguinal Hernia - Inguinal Hernia

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Inguinal Hernia - Inguinal Hernia
Inguinal Hernia - Inguinal Hernia

Video: Inguinal Hernia - Inguinal Hernia

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Video: Introduction to Direct and Indirect Inguinal Hernia 2023, January
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Inguinal hernia

An inguinal hernia (inguinal hernia) is a protrusion of the peritoneum through a gap in the abdominal wall. Parts of the intestines (e.g. fatty tissue or intestinal parts) emerge from the abdominal cavity through the hernia into the existing inguinal canal (lateral hernia) or through acquired gaps in the abdominal wall to the surface (medial hernia). The gap in the abdominal wall caused by an inguinal hernia is also known as the hernial portal. The peritoneum, with the intestinal parts contained therein, bulges out like a sack through the hernial opening in the abdominal wall, forms the so-called hernial sac.

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  • How does an inguinal hernia develop?
  • What are the symptoms?
  • How does the doctor make a diagnosis?
  • How is an inguinal hernia treated?
  • Whom can I ask?
  • How are the costs going to be covered?

How does an inguinal hernia develop?

An inguinal hernia is usually caused by weak points in the muscles of the abdominal wall in the area of ​​the groin. It can be congenital or acquired. In the case of a congenital inguinal hernia, a hernial port is already present at birth. The acquired inguinal hernia usually arises as a result of a weakness in the abdominal wall that has developed over the course of life.

In the case of an inguinal hernia, one differentiates between, depending on the hernial port

  • direct (medial) inguinal hernia: is always acquired and is mainly found in adults (mostly men). With this type of hernia, the abdominal wall is torn due to heavy strain or overload (e.g. heavy lifting, chronic coughing, straining during bowel movements as a result of constipation) or due to a weak connective tissue. The weakening abdominal muscles can contribute to the fact that the contents of the hernia at the rear wall of the inguinal canal emerge from the abdomen. The outer break point is closer to the center of the body, which is why it is also called a medial inguinal hernia.
  • indirect (lateral) inguinal hernia: can be congenital or acquired. The hernial sac penetrates into the inguinal canal through the opening. The hernial orifice is to the side of the middle of the body (lateral). The hernial sac can move forward through the inguinal canal towards the middle of the body. In men, it can penetrate into the scrotum, in women into the labia majora.

What are the symptoms?

If there is a rupture in the abdominal wall, the first symptoms can be stabbing and pulling pains (especially with heavy exertion) and a bulging in the groin region (which is especially noticeable when coughing, pressing or sneezing). Sudden severe pain in the groin area - usually associated with a strong swelling that is not easily suppressed - can indicate a trapped hernia. However, an inguinal hernia can also be completely symptom-free. Nevertheless, due to the incalculable risk of entrapment and the always expected increase in size and the associated development of complaints, surgical treatment is advisable.

Note A trapped hernia is always a surgical emergency. Since incarceration can lead to direct pressure-related damage to the intestinal wall, or supplying blood vessels are pinched off at the hernial port, the contents of the hernia (usually intestine) can no longer be adequately supplied with blood die. This creates a life threatening condition.

How does the doctor make a diagnosis?

An inguinal hernia is usually diagnosed during an anamnesis discussion and a physical examination (palpation). During the physical examination, the doctor palpates the groin region - usually while standing or lying down under abdominal pressure or coughing. In addition, to diagnose an inguinal hernia, further examinations, such as an ultrasound examination (sonography) - more rarely magnetic resonance imaging (MRI) - can be carried out.

How is an inguinal hernia treated?

Since an inguinal hernia does not usually resolve on its own, it is recommended that an inguinal hernia be operated on. Alternatively, so-called trusses are still offered. However, these cannot repair the break and cannot prevent entrapment, but can even damage the tissue through pressure on the skin. Furthermore, an operation on the inguinal hernia can prevent entrapment (incarceration). Entrapment of the abdominal viscera is very painful and represents a threatening complication that must be operated on immediately.

In the case of asymptomatic hernias, surgery is not essential. In principle, waiting in the sense of “watchful waiting” is also possible here. That means a wait-and-see attitude, with regular medical checks.

Note In studies, however, it has been shown that about ¾ of those patients who were initially not operated on were operated on in the long term. This is due to the almost always observable increase in size with the development of symptoms of the break. In addition, entrapment can also occur with previously symptom-free fractures, so that from a surgical point of view an operation is indicated.

Surgical procedure

In principle, many of the surgical techniques described are available for treating an inguinal hernia. The most common techniques in Austria include:

  • Plastic reinforcement techniques: In this surgical method, the weak abdominal wall is supported with a non-absorbable plastic mesh. Inguinal hernias can be treated tension-free through the use of nets. One distinguishes

    • Open technique (Lichtenstein method): The operation takes place via an incision in the groin region. After the contents of the hernial sac have been pushed back into the abdomen, the fracture site is covered with a plastic net to strengthen the groin region. The bar can also be reinforced from behind with self-expandable nets (TIP)
    • Endoscopic and laparoscopic technique: With this method, only a few small abdominal incisions (between five and twelve millimeters) are necessary. The inguinal hernia is closed with a video camera and miniature instruments from the abdomen (TAPP) or in front of the peritoneum (TEP) with a plastic net. For details, see Examination Methods.
  • Suturing techniques: To close the break in the inguinal canal, the hernial sac is pushed back and the peritoneum and the muscle layers are sutured. A major disadvantage of this surgical technique is high tension in the row of sutures. This is created by sewing together tissue that is normally next to each other without tension. Suturing techniques therefore favor the recurrence of an inguinal hernia (recurrent hernia).

Note General anesthesia is not absolutely necessary for open operations. With the help of modern procedures, inguinal hernia operations can also be performed under regional or local anesthesia.

What should you watch out for after the inguinal hernia operation?

After an inguinal hernia operation, only a short inpatient hospital stay is usually required. Complications rarely occur. The most likely to be bruises, which usually resolve on their own. How long the patient should not exert themselves physically after the operation must be discussed with the treating doctor.

Whom can I ask?

To clarify symptoms such as stabbing and pulling pains or visible and palpable protrusion in the groin area, please contact as the first point of contact:

  • General Practitioner,
  • Specialist in surgery (visceral surgery).

How are the costs going to be covered?

All necessary and appropriate therapies are covered by the health insurance carriers. Your doctor or the outpatient clinic will generally settle accounts directly with your health insurance provider. However, you may have to pay a deductible with certain health insurance providers (BVAEB, SVS, SVS, BVAEB).

However, you can also use a doctor of your choice (ie doctor without a health insurance contract) or a private outpatient clinic. For more information, see Costs and Deductibles.

When hospitalization is necessary

In the case of an inpatient stay in the hospital, the hospital costs are billed. The patient has to pay a daily contribution to the costs.

For more information, see What does a hospital stay cost?

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