An inguinal hernia happens when contents of the abdomen,usually fat or part of the small intestine, bulge through a weak area in the lower abdominal wall (Pic. 1). In general, a hernia occurs when an organ pushes through an opening in the muscle or tissue that holds it in place. It protrudes through body parts though defects in the anatomical structures that normally contains it and are most common in the abdomen (account for about 15-18% of all the surgical procedures).
Inguinal hernias can be either indirect or direct. An indirect inguinal hernia is the most common type. It often occurs in premature births, before the inguinal canal can fully develop. A direct inguinal hernia most often occurs in adults. The popular belief is that weakening muscles during adulthood lead to a direct inguinal hernia. This type of hernia is more prevalent in men. People with a history of hernias are at increased risk of having another hernia. The second hernia usually occurs on the opposite side (recurrent hernia).
Inguinal hernias usually present with a lump in the groin (Pic. 2), that normally goes away with minimal pressure or when the patient is lying down. There is a mild to moderate discomfort in the patients and pain is normally uncommon. Most of the patients who are scheduled for surgery actually do not have any pain.
The diagnosis of inguinal hernia is usually done during a physical exam by easily pushing the hernia back into abdomen when a patient is lying down. Tests such as ultrasound and CT scans (Pic. 3) are not usually needed to diagnose an inguinal hernia.
The prevalence for abdominal wall hernias among all the age groups is estimated to be 1.7% and 4% for those aged over 45 years. Inguinal hernias are among the most common of the abdominal wall hernias accounting for almost 75% with a life time risk of 27% in men and 3% in women.
Males have been reported to be more affected with inguinal hernias than females. Possible aetiological factors include conditions which can raise intra-abdominal pressure , such as chronic bronchitis (type of obstructive lung disease) or hyperplasia (increased volume of the organ or tissue) of the prostate.
Inguinal hernia surgery refers to a surgical operation for the correction of an inguinal hernia. Surgery is not generally advised in most cases if the hernia produces no symptoms; watchful waiting being the recommended option. In particular, elective surgery is no longer recommended for the treatment of minimally symptomatic hernias due to the significant risk (>10%) of chronic pain (Post herniorraphy pain syndrome).
Symptoms
Associated diseases
Male fetility
Hernia repair surgery is the only treatment and cure for inguinal hernia and is one of the most common surgeries done in the world every year. Men with inguinal hernia should consider the risk of complication which results from hernia repair. The inguinal obstruction which may follow groin hernia surgery leads to fertility problems in the future. If the surgery is done on both sides, left and right obstruction of spermatic cord could cause azoospermia (condition, when there is no sperm in ejaculate). Smaller probability of azoospermia is associated with only one sided surgery. The most common consequences are Spermatic granuloma formation (lump of extravasated sperm being present as a result of the pressure-induced changes) and testicular atrophy, unilateral or bilateral (pathological condition in which there is abnormal shrinkage of the testicles, either in one or in both).
Men should consider sperm cryopresevation (technique designed to preserve sperm for future use by freezing them) before they undergo the groin surgery. Cryopreservation allows to do in vitro fertilization (IVF) and intracytoplasmatic sperm injection (ICSI), if any fertility problems will appear after the surgery.
Female fertility
Inguinal hernias occur in less than 5% of women. Even though infrequent, when present, hernias must be evaluated and treated urgently due to possible incarceration (trapped organs) or strangulation (disruption of blood flow) of organs, including, on rare occasion, the ovary and fallopian tube. As with any type of laparoscopic surgery, risks are associated with hernia repair. Bleeding from vessels in the inguinal area, permanent damage to nerves, infection, adhesions, and continued pain are all potential risks.
Surgical repair of inguinal hernias is the most common general surgical procedure in the world. Chronic groin pain lasting more than 3 months after surgery, which is one of the most important complications occurring after inguinal hernia repair. Men with bilateral hernia repair could have a slightly increased risk for infertility compared to them with used on only one side. The cumulative incidence (measures the number of new cases per person in the population over a defined period of time) is still less than 1%.
An accumulation of clear fluid in the tunica vaginalis, the most internal of membranes containing a testicle.
An inflammation of the testes, involving swelling and heavy pains.
In the case of cryptorchidism one or both testes are absent from the scrotum. It is is the most common etiologic factor of azoospermy in the adult.
