Overview
A hernia occurs when one of your organs pushes through the muscle or tissue that contains it. The organ moves in and out of the hole when straining, lifting, laughing, or coughing. From the naked eye, a hernia may look like an abnormal bulge in your body and may or may not come with symptoms. They are not usually serious, but over time, they can be. As such, they should be treated surgically. Other methods, such as medication, can reduce the pain, but only through surgery can the hernia go away.
In severe cases of hernia, the organ gets stuck in the weak muscle or tissue hole and cannot return to its’ correct place. The organ could then be strangulated, leading to a pain that feels like a dull ache or pressure on the affected area. At its extreme, the strangulation cuts off the organ from the blood supply, causing necrosis. That is why it is best to treat hernias to prevent the worst from occurring. Smaller hernias may be left untreated but monitored so that the patient does not decline in health.
This article will focus on a specific type of hernia called an inguinal hernia. The word ‘inguinal’ means ‘in the groin’. This type of hernia accounts for 75% of all hernias, and mostly men or people assigned male at birth are affected. An inguinal hernia occurs when part of the bowel protrudes into the inguinal canal, a passageway that the testes go through during the development of a baby so it can have genitals. During adulthood, it is also the passageway that contains vessels which supply nutrients to the testes and also the passage that carries sperm to the penis. Physically, one might see a bulge around the groin area.
Causes of inguinal hernia may be age-related tissue degeneration, chronic coughing, chronic sneezing, straining to urinate or defecate, or jobs that require standing many hours at a time.
To treat it, patients can opt for laparoscopic surgery, which has a shorter recovery time but higher risks of nerve damage, or open surgical repair, which has lower risks of nerve damage but a longer recovery time. The processes might be different, but their results and concepts are the same: to push the organ back into its right place and support the weak muscle or tissue.
Now, let’s move on to how the surgeries actually work.
Laparoscopic Surgery for Inguinal Hernia
First, the patient undergoes general anesthesia. They will be unconscious for the entire procedure. A hole is then made so that the trocar can be inserted, helping separate the peritoneum from the inner abdominal wall. A balloon attached to the trocar’s end is then inflated with CO2 gas so that the surgeon will have more room to operate. Two more small keyhole incisions are then made in the abdomen, with trocars also going into both of them. The laparoscope, a thin rod with a camera attached, and other surgical instruments, such as handles and forceps, are then inserted through the trocar so that they can enter the abdomen for the surgeon to use during the repair. The instruments are used to gently separate the hernia sac from the weak abdominal wall and pull the abdominal contents back into the abdomen. To prevent another inguinal hernia from occurring again, the surgeon will also place a mesh on the entrance of the inguinal canal and stabilize it with surgical staplers. The tools are then taken out, with the incisions sewn up. The patient will then return to daily life in 2-3 weeks.
Here is a quick video of the procedure: Total Extraperitoneal (TEP) Laparoscopic Inguinal Hernia Repair | Nucleus Health
Open Surgical Repair for Inguinal Hernia:
In contrast to laparoscopic surgery, open surgery uses local or regional anesthesia, given through an IV or orally using a pill. This allows the patient to be awake during the procedure but without pain involved, as the area of the procedure will be numb from the anesthetics. The surgeon will then make one big incision, about 7-10 cm in size, right over the hernia. They then cut through the fat and tissue and inguinal canal to reveal the hernia sac. The hernia sac is the peritoneum, the piece of tissue that protects your organ. The surgeon then cuts through the peritoneum and uses their fingers or tools to push the organ back into the abdomen gently. The peritoneum is then closed, with the excess peritoneum being removed. The inguinal canal is then stitched up, and weakness in the muscle is stitched up and fixed to prevent another hernia from occurring. At times, a mesh patch is also placed on top of the muscle using surgical staplers to reinforce the muscle. The patient is then stitched up with a nice comfy gauze pad placed on top and will get back to daily life within a few weeks.
Video on the Open Surgery
Conclusion
With the case study of inguinal hernia, we can see how a single problem could be solved through different methods. Surgery is diverse and creative that way. It is also pretty fun with the solutions of inflating a balloon to make space inside the body and a surgeon’s finger being used to poke an organ back into place. Surgical techniques have greatly improved to be as minimally invasive as possible, but techniques could still be better developed to ensure less damage and stress to the patient’s body. A possible solution that engineers and researchers have come up with is robotic surgery. Perhaps in the future, even remote patients can have access to world-class surgeons with that invention.
Works Cited
Cleveland Clinic. “Hernia | Cleveland Clinic.” Cleveland Clinic, 2018, my.clevelandclinic.org/health/diseases/15757-hernia .
Cleveland Clinic. “Inguinal Hernia: Types, Symptoms, Diagnosis & Treatments.” Cleveland Clinic, 2022, my.clevelandclinic.org/health/diseases/16266-inguinal-hernia.
Healthwise, Staff. “Laparoscopic Inguinal Hernia Repair | HealthLink BC.” Www.healthlinkbc.ca, 2022, www.healthlinkbc.ca/health-topics/laparoscopic-inguinal-hernia-repair. Accessed 1 Apr. 2024.
Hewitt, Brock, and Karen Chojnacki. “Validate User.” Jamanetwork.com, 2017, jamanetwork.com/journals/jama/fullarticle/2656170.
UK, NHS. “Inguinal Hernia Repair.” Nhs.uk, 23 Oct. 2017, www.nhs.uk/conditions/inguinal-hernia-repair/what-happens/#:~:text=Laparoscopic%20(keyhole)%20surgery.
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