1394 sokak No: 11 Sağlık Merkezi Apartmanı. Kat: 4 Daire: 10 Alsancak - İzmir
Inguinal hernia is a swelling under the skin where the intestines or organs in the abdomen protrude from weak areas in the abdominal wall. Hernias are divided into two as direct and indirect hernias, depending on the way they occur. Hernias protruding from layers such as the muscle and muscle sheath are called direct hernias, and hernias protruding from the inguinal canal are called indirect hernias. The treatment method for both types is the same.
What are types of inguinal hernia?
Inguinal hernias can be classified as direct, indirect and femoral hernias. Indirect hernias protrude out of the inguinal canal. The incidence of indirect hernias in the community is quite high, and the age of incidence is lower when compared to direct hernias. Direct hernias are hernias that arise directly from the weak area of the abdominal wall and increase with age. Femoral hernias are less common. It is more common in women and the risk of strangulation of the hernia is higher than other types.
What are the causes of inguinal hernia?
Inguinal hernia can be seen in all age groups and in both genders. However, the incidence is much higher in men. This is because the inguinal canal of men is congenitally weaker than women. In addition, inguinal hernia occurs more easily with occupations where heavy loads are lifted. Other major causes are listed below:
What are the symptoms of inguinal hernia?
Inguinal hernias are usually noticed by the patient with swelling in the inguinal region. There may be pain and a burning sensation accompanying the swelling. Movements may be restricted, especially in cases where internal pressure increases, and the pain can be seen as cramps. Inguinal hernias are mostly invisible when the internal pressure of the abdomen decreases (lying down). Because the inguinal hernia is not always visible, itwould be a mistake to think it will go away on its own with time and rest. Inguinal hernias should be evaluated and treated by a physician.
How is it diagnosed?
Generally, a physical examination will determine whether an inguinal hernia has occurred. The patient's complaints also play a major role in identifying the problem. In some cases, radiological imaging methods such as ultrasonography or MRI may be needed.
How is inguinal hernia treated?
Formed hernias do not heal on their own. It is not possible to treat hernias with medication. The only treatment of inguinal hernia is surgery. The purpose of inguinal hernia surgery is to remove the part of the stuck intestine from the hernia sac and place it in its place. In inguinal hernia surgery, surgical interventions are applied to remove the existing hernia and prevent it from recurring. Hernia operations can be performed under general anesthesia, local anesthesia or epiduralanesthesia depending on the condition of the patient and the hernia. Local anesthesia in hernia surgery is a viable method for small hernias. The surgeries are usually performed with general anesthesia.
Inguinal hernia surgery can be performed with open or closed (laparoscopic) surgical methods. Laparoscopic surgery is used quite extensively today due to its advantages. Laparoscopic inguinal hernia surgery can be performed in two ways.
1. TEP (Totally extra-peritoneal) – This type of inguinal hernia surgery is almost always done through 3 small holes and involves creating a space between the layers of the abdominal wall muscles and therefore does not require entry into the abdominal cavity. After the hernia is retracted, the procedure is terminated by placing a synthetic patch in front of it.
2. TAPP (Fully intra-abdominal extraperitoneal) – This type of inguinal hernia surgery is also performed under general anesthesia through 3 small holes. While unilateral hernia surgery is planned, if a hernia is suspected in the groin, it is better to use this method, as it allows evaluation during the surgery.
How long does it take to heal after inguinal hernia surgery?
You usually stay in the hospital overnight after inguinal hernia surgery and are discharged the next morning. In some special cases, the hospital stay may be extended for one more day, although it is rare. You will be informed about this before the operation. Postoperative pain level is low. By the time you are discharged, you will have already returned to your daily life. You can easily go about your day. Patients are encouraged to refrain from lifting heavy objects for at least one month after surgery, as well as possibly avoiding heavy tasks for another month. It is usually possible to return to full regular activities 2-3 weeks after the surgery. There will be no dietary restrictions after the surgery.
What are the risks of inguinal hernia surgery?
In the evaluation before inguinal hernia surgery, you will be informed about possible complications. After all surgical procedures, whether open or laparoscopic, there is a risk of bleeding at the surgical site. These usually do not require any additional intervention. Color changes in the form of small bruises due to subcutaneous leaks can be seen in the skin area or testicle area. This situation disappears on average in 2 weeks.
In elderly patients and those with large hernias, fluid deposits, which we call seroma, can be seen in this region after surgery. It usually occurs in the early postoperative period. This liquid is harmless and is absorbed by the body in an average of 6-8 weeks.
Another complication is wound infection. It is quite rare and easy to treat with appropriate follow-up and medication.
Older men may have difficulty urinating for the first time, especially after laparoscopic inguinal hernia surgery. Usually this is due to the enlargement of the prostate gland in this age group. In this case, it may be necessary to place a temporary catheter in the bladder. However, this is a temporary situation and in most patients the urinary catheter is removed within 24 hours.
During laparoscopic inguinal hernia surgery, the risk of bowel, bladder or vessel injury, although rare, may occur. Laparoscopic surgery can be converted to open surgery for a variety of rare reasons. This may be necessary for the surgery to be performed safely. Otherwise it is not a failure.
One of the most important problems is the recurrence of hernia. Although the world average is around 7-10%, recurrence rates have decreased with the development of the techniques used and the modernization of the patches. This rate is below 1% in centers specialized in the field of hernia.
Another problem is chronic inguinal pain, which is more common in open surgery repairs. Its treatment requires a complex process.
Inguinal hernia in the elderly
According to statistics, the risk of obstruction or compression and strangulation of inguinal hernias seen in elderly people is higher.
Elderly individuals, who seem to be more vulnerable to the negative effects of anesthesia drugs, also have many comorbidities.
It is possible to successfully perform hernia surgeries in elderly patients with a good plan and effective preparation.
Spinal or local anesthesia can be safely applied to patients at risk for general anesthesia.
I have an inguinal hernia, should I have surgery?
Inguinal hernias mostly affect men. It is often thought that hernias are caused by aging, but hernias can occur at any age.
As we age, the muscles that surround our bodies like a corset weaken. As a result, the organs in the abdomen are pushed outward through a weak point in the groin and herniate.
If an inguinal hernia is not treated, it can cause significant problems. These include:
- Obstruction in the intestines: After a section of the intestine becomes trapped in the inguinal canal, symptoms such as pain in the groin or abdominal area, nausea, and vomiting may occur.
- Strangulation in the intestines: When a section of the intestine becomes trapped and blood flow is cut off, it is a condition that requires emergency surgery within hours.
What to expect after inguinal hernia surgery?
It is normal to have some pain and discomfort in your groin after surgery. You will be given painkillers in the hospital to relieve this discomfort.
You may still have mild pain after going home. Continue to take painkillers as recommended by your doctor.
If you apply gentle pressure to your wound with your hand or a pillow while coughing or sneezing, your pain will decrease.
Straining while using the toilet will not harm your hernia surgery. However, it may cause pain in the surgical area. If you have constipation, your doctor may recommend some laxatives.
It is recommended that you avoid driving for a while immediately after surgery. This is due to a possible delay in braking time. You can usually drive after 1 week as your pain will decrease.
Factors affecting success in inguinal hernia surgery
Patient characteristics (age, presence of diabetes and similar chronic diseases, obesity)
Hernia status (size, recurrence of hernia, need for emergency intervention)
Surgical technique and experience
Appropriate mesh selection
Compliance with postoperative care rules
Can I lift weights after inguinal hernia surgery, can I go to the gym, when can I start training?
* The first 2 weeks after surgery:
1. Avoid lifting things heavier than 10 kg during this period. It is considered safe to lift light objects such as 1 bag of groceries from the market, a laptop or a 5-liter water bottle.
2. You can take slow walks. However, avoid pushing yourself.
3. If possible, do not drive for 1 week after surgery. Delay in braking due to pain can endanger your life.
* Week 3:
1. You can start cardio exercises such as cycling at a slow pace on a flat road or swimming.
2. Continue to avoid lifting anything heavier than 10 kg during this period.
3. Avoid exercises that strain the abdominal muscles such as sit-ups and planks. Exercises that put pressure on the abdominal area can cause the hernia to recur.
* 4-6 weeks:
1. Avoid exercises such as running and jumping. These movements can damage healing muscles.
2. Start exercising with your own body weight before starting to lift weights. Work with light weights for a while before starting serious strength-requiring exercises such as squats or bench presses.
3. You can start light stretching and stretching exercises.
* 6-8 weeks:
1. You can start training with light weights. However, be careful not to push yourself.
2. You can switch to exercises that work the core muscles such as push-ups and planks in a controlled manner. However, pay attention to your body's reactions during this process and be sure to stop if you feel pain.
* After 8 weeks:
1. Gradually return to your previous training intensity. However, trying to return to your old level quickly can negatively affect your recovery.
2. You should still be careful with high-level exercises.
* 3 months and later:
1. You can return to high-impact sports activities such as running, jumping, football or basketball.
2. You may return to heavy strength exercises such as squats, deadlifts, and bench presses. At this stage, most patients can return to all sports activities and exercises without restriction.
3. However, always pay attention to your body's reactions and stop if you feel pain or discomfort.
