In men, the inguinal canal functions to transport sperm to the testicles, and from the testicles to the penis. For women, ligaments supporting the uterus pass through the inguinal canal.

There are two types of inguinal hernias: indirect and direct. Indirect inguinal hernias are a result of abdominal abnormalities existent since birth, whereas direct inguinal hernias occur only in males with weak abdominal wall muscles. Direct inguinal hernias are more common in the young or middle aged. Many times, they occur as a result of a chronic cough brought on by bronchitis alveoli, a lung aneurysm or a pulmonary disease.

Symptoms of an inguinal hernia include:

•  Pain or discomfort in the groin region (increased when bending or exerting yourself)
•  A noticeable bulge on either side of the pubic bone
•  Weakness or persistent pressure in the groin
•  A pulling, straining feeling in the groin
•  An aching or burning sensation in the groin where the bulge protrudes

Diagnosis is based on an examination of the patient’s medical history, a physical exam and, where needed, imaging tests such as an x-ray or ultrasound

During the physical exam, the doctor will usually ask the patient to stand and cough to feel whether or not there is a noticeable moving bulge. In some cases, this bulge can simply be massaged back into its rightful place.

It is important that diagnosis is made as soon as possible, as lack of treatment can lead to serious complications such as incarceration or strangulation.

Incarceration occurs when fat or intestinal tissue becomes dislodged from the abdomen and resides in the groin or scrotum. Strangulation occurs when an inguinal hernia is left untreated. When the blood supply to the intestine is cut off, the parts of the intestine that do not receive blood can die. Both of these conditions require the immediate attention of a medical professional.

There is only one option for treatment of an inguinal hernia and that’s surgery. Surgery is necessary in preventing incarceration and strangulation. Two types of surgery are used: Open Hernia Repair or Laparoscopic Hernia Repair.

Open hernia repair entails providing the patient with anaesthesia and making an incision in the groin so that the hernia may be placed back into the abdomen, with stitching in the abdominal wall to strengthen the barrier. A laparoscopic hernia repair is a minimally invasive surgery (MIS) in which the patient is given anaesthesia and the doctor makes three small incisions. A laparoscope is inserted and a camera provides a magnified image of the hernia. The size of the incision for camera insertion via the abdomen is a mere centimetre. The doctor uses this improved image and a monitor system to view the surrounding tissues and repair the hernia with a synthetic mesh. The incision for the tools with which to perform this treatment is just 0.5 cm.

With MIS technology, incisions are smaller, cause less postoperative pain, less blood loss and a faster recovery for the patient. In many cases, a patient can undergo surgery one day and return to work the following day. The chances of infection are extremely low, reducing the need for further treatment and enhancing patient safety.

Though inguinal hernia repair surgery is quite safe, and complications are uncommon, a patient must return to the doctor if any of the following symptoms appear:

•  Elevated body temperature
•  Bleeding from the incision site
•  Inflamed incision site
•  Drainage from the incision site
• l Persistent pain, despite the help of medication

If your hernia is not causing you any discomfort or adversely impacting your life, immediate action is not required. In fact, there are those can live with a hernia for some time without experiencing any noticeable symptoms. However, it is important to be very aware of your body and to look out for symptoms of pain or discomfort. It should be noted that if you are someone who lives a very active life, more immediate action should be taken, as the added strain to the body can worsen the hernia.

While weakness in the abdominal wall cannot be prevented, certain measures can be taken to lead a healthier lifestyle, lessening the chances of developing a direct inguinal hernia.

•  Avoid lifting heavy objects
•  If you must lift, lift with your legs; do not put strain on your back.
•  Stay within your healthy BMI
•  Do not smoke

DR PAKPONG WATHANAORAN is a surgeon specialising in hernia surgery at Samitivej Sukhumvit Hospital. Call (02) 022 2555-6.