Types of Inguinal Hernias and Treatment Options

A hernia is a common ailment in the United States, with about 600,000 hernia repair operations being performed each year.  While hernias can occur at birth or later in life, they are generally due to a weakness that occurs in the abdominal wall. There are two major classifications of inguinal hernias along with two types. One classification occurs at birth. This is an Indirect Inguinal Hernia and is considered a birth defect that may be caused by the peritoneum or abdominal lining not closing properly.

But the more common and second classification occurs in adults. It is the Direct Inguinal Hernia that is caused by a weakness in the abdominal muscles. This class of hernias may occur for many reasons including:

• Heavy or chronic coughing
• While lifting something heavy
• The normal aging process
• Strenuous activity
• Pregnancy or smoking

What happens in the case of direct inguinal hernias is the internal tissue or organs (usually the intestines or fat from the abdomen) start to bulge through a muscle. This bulging may occur in the diaphragm, the abdomen, or near the groin areas.

More about Inguinal Hernias

What is also known, is that inguinal hernias do not get better with time, nor do they go away without treatment.  If you’ve been diagnosed with an Inguinal Hernia, you shouldn’t worry because there are treatments and surgical procedures available to treat this medical condition – a condition that is more prevalent in males. According to The Cleveland Clinic:

• Adult males over age 40 are much more likely to develop direct inguinal hernias
• About 25% of males, and only about 2% of females, will develop an inguinal hernia in their lifetime
• A family history of inguinal hernia…and men who have had previous abdominal surgery are at greater risk for developing an inguinal hernia

While an inguinal hernia is not a dangerous condition, it can be the cause of acute pain. The patient may have pain or difficulty while bending, lifting, or straining during a bowel movement.  While they can occur in women, they will typically occur in males as a bulge along the groin or pubic areas. The affected area may be sensitive to the touch and may increase in size when the patient coughs or stands up.

Risk factors of having an Inguinal Hernia

• Being male, being older, or being Caucasian
• A family history, especially a close relative
• Chronic cough or chronic constipation
• Chronic constipation
• Pregnancy or Premature births
• A history of inguinal hernias

Signs of Inguinal Hernias

• Bulging on one or both sides of the groin area that reduces when you lie down
• Pain or swelling in the groin area, especially when lifting heavy objects, coughing, or physical exertion
• A burning sensation or a feeling of weakness or heaviness in the groin area
• A swollen scrotum or the portion of the male genitalia is the sac-like part underneath the penis

Two Major Types of Direct Inguinal Hernias

Incarcerated inguinal hernia

When the contents of a hernia (either fat or a portion of the intestine) become trapped or incarcerated within the abdominal walls or get stuck in the groin or scrotum, this is considered an incarcerated inguinal hernia. It is distinguished by the inability to push the hernia in. In other words, the tissue is stuck within the groin area and is not easily moved or reduced.

Symptoms of an incarcerated inguinal hernia:

• Obstruction of the bowel
• Severe abdominal or groin pain
• Nausea, vomiting, constipation, or bloating

Strangulated inguinal hernia

A strangulated hernia is considered a complication of incarcerated inguinal hernias and can be life-threatening if it isn’t treated.  These hernias may develop when an incarcerated hernia becomes strangulated, or blood flow is cut off to the tissue that is trapped. This “strangulation” of the intestines can be a life-threatening condition. Immediate medical attention should be sought if the possibility of an incarcerated inguinal hernia transitioning to a strangulated inguinal hernia has occurred.

Signs of a strangulated inguinal hernia:

• Vomiting, nausea, or both
• A high fever (maybe with chills)
• Acute pain that quickly intensifies
• A bulging hernia that turns red or purple
• Difficulty moving your bowels or passing gas

Seeking Treatment for Direct Inguinal Hernias

If your condition is diagnosed as a strangulated inguinal hernia, then it is a severe complication that will require emergency surgery. For this reason, if you have symptoms of a hernia, you should seek a medical diagnosis and treatment as early as possible. If your symptoms are not a severe hernia, then a medical professional may suggest a time of watching and waiting.

But, once you’ve passed the threshold to an incarcerated inguinal hernia, there will be treatment options that you can discuss with your doctors.

Open Surgery for Hernias

Open hernia surgery is when a surgeon cuts into the groin area. This way, they can view and repair the hernia by either removing the hernia sac or gently pushing the sac back into the abdomen or groin area. After the repairs are completed, the area is closed with stitches along with a small piece of mesh that will strengthen the weakened portion of the affected area.

The patient may receive either general anesthesia or to numb such as a spinal block to numb the area from the waist down. Another option is local anesthesia which a sedative to cause drowsiness or twilight sleep.

Laparoscopic Hernia Repair

Laparoscopic hernia repair is a great option for many patients with an incarcerated inguinal hernia. Typical laparoscopy operations use small incisions in the abdomen and the aid of a camera to diagnose and remove the hernia via a few small cuts in the abdomen

But, this surgery can also be performed with robotics technology that has high definition vision and can precisely manipulate surgical instruments in 3 dimensions. The da Vinci System used by Orange County Robotics Surgery is one example of advanced robotic technology for laparoscopic hernia repair that results in a safe and minimally invasive removal of the hernia.

Laparoscopic surgery is a delicate operation, but with the use of this state-of-the-art surgical platform, the most precise and delicate of maneuvers are accomplished – even surpassing the ability of the human hand. The surgeon will gain better access to the abdominal area and the patient will experience less pain and a faster recovery.

Contact Orange County Robotic General Surgery to learn more about the removal of Direct Inguinal Hernias with robotic, laparoscopic technology. We serve patients in Orange County and the greater Los Angeles metropolitan area and we are associated with St. Joseph’s Hospital in Orange County, one of the leading hospitals in Southern California.

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