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INGUINAL HERNIA

INGUINAL HERNIA

An inguinal hernia is the protrusion or exit of the contents or fat of the interior of the abdomen through some of the holes that make up the inguinal canal.

 

The inguinal canal is a region of the abdomen that is located in the lower and lateral part of the abdomen. It corresponds to the groin area, both men and women. The inguinal canal runs between the highest region of the pelvis to the center of the pelvis in its lowest area, the region of the pubis. Within the inguinal canal are two holes through which blood vessels, nerve endings and the spermatic cord in men and the round ligament in the women pass. These two holes are called the superficial inguinal ring and the deep inguinal ring and are the areas where the abdominal contents will protrude and leave, forming the inguinal hernias.

 

Inguinal hernias are seen with the naked eye as the appearance of a lump in the region of the groin of the patients who suffer. Inwardly they may be covered by a hernial sac or contain only fatty tissue. A hernia sac is a tissue lining of the inside of the abdomen that surrounds the abdominal structures that  go out or protrude through the hole of the hernia.

Types of inguinal hernias

 

Inguinal hernias can be classified in several ways according to the medical point of view that we want to highlight. In this way the inguinal hernias can be classified according to the symptoms they produce:

 

Reducible inguinal hernia: A type of hernia that can go out or protrude through the hernia but can usually be reduced, that is, it can be reintroduced into the abdominal cavity again.

 

Incoercible inguinal hernia: That inguinal hernia that comes back every time it is tried to be reduced.

 

Incarcerated inguinal hernia: Inguinal hernia that is not able to be reduced to the interior of the abdomen but that does not produce lesions in the content of the hernia.

 

Strangulated inguinal hernia: A hernia that is not able to be reduced once it has exited through the hernia hole but if it suffers damage inside the tissues due to problems with the blood circulation, it may cause ischemia or infarction of the herniated tissue or even necrosis, which will require emergency surgery.

 

Inguinoscrotal hernia: This type of inguinal hernia is the one whose contents go down into the scrotum in male patients.

 

 

We can classify inguinal hernias according to the primary causes that have provoked their appearance. In this sense we can classify inguinal hernias in:

 

Congenital: The hernias that are already present from birth.

 

Acquired: They are those that occur along the development of human beings without a clear or defined cause.

 

Post-surgical: That it is the recurrent inguinal hernias that appear as a result of a previous surgical intervention taking advantage of the weaknesses of the muscular wall, secondary to the surgery itself.

 

Traumatic: This type of inguinal hernia is due to traumatisms on the inguinal region that provoke the exit of the hernial sac through one of the natural holes or from one created by the own traumatism.

 

From an anatomical point of view, we can divide the inguinal hernias into:

 

Direct inguinal hernia: It is an inguinal hernia that protrudes or is externalized through the defect of the abdominal wall.

 

Indirect inguinal hernia: That inguinal hernia that comes out and appears through the internal inguinal hole entering the inguinal canal.

 

Mixed inguinal hernia: That inguinal hernia that maintains elements of the two previous groups.

 

Treatment

 

An incision of approximately 4 to 6 cm is made, in the transverse inferior skin fold

(At half the distance between the anterior and superior iliac spine and the pubic tubercle).

 

Depending on the size of the hernia sac, it is trimmed at its base or inverted and instead a cap,

that is fixed, is placed. Then reinforcing polypropylene mesh is placed on the inguinal floor which is

fixed with the same material.

The wound closure is by intradermal technique.

 

Any type of inguinal hernia should be repaired with mesh.