About Inguinal Hernia
An inguinal hernia (pl herniae) is the commonest type of hernia affecting the abdominal wall. It is more common in males and is either a direct or indirect hernia. A direct inguinal hernia is due to a defect in the transversalis muscle in the groin allowing the protrusion of some intra-abdominal fat or a section of bowel through the defect. The other type of hernia is an indirect inguinal hernia and is due to a finger like projection (sac) of peritoneum (the lining of the abdominal cavity) that persists alongside the spermatic cord instead of being obliterated at birth. It usually only becomes evident later in life, although can present in infancy. The sac opens up through an area of potential weakness in the muscle, exacerbated by the wear and tear that occurs with advancing age, allowing some fat or a loop of bowel to move in and out through the defect and into the sac. The typical symptoms of an inguinal hernia be it direct or indirect are discomfort and swelling of the groin bought on by exertion and relieved upon reclining.
Sometimes a hernia, if left long enough, can progress all the way into the scrotum. A surgical repair is advisable mainly to relieve the pain but also to negate the small risk of strangulation - this is when the bowel becomes irreducible, i.e. it can't be pushed back in and its blood supply becomes compromised.
The operation involves eliminating the sac (if it is an indirect inguinal hernia), repairing the weakness and reinforcing the area with a piece of inert plastic mesh (polypropylene) that stays in place forever. Irrespective of whether it is an indirect or a direct hernia, the operation can be done using an open technique or using the more contemporary laparoscopic (keyhole) technique. Strictly speaking the approach is extraperitoneal i.e. the abdominal cavity itself is not actually entered. Both procedures are generally very successful with comparable results, although the latter will allow the more active patient to resume their daily routine more rapidly.