Surgery for an inguinal hernia

Inguinal hernia therapy

The definitive therapy for an inguinal hernia is surgery.
Conservative, i.e. non-surgical, therapeutic approaches are used for large fracture gaps that have a rather minimal risk of entrapment. Conservative therapy can be considered for patients with such fractures and additional risks. Trusses are used to prevent the break from leaking far.
The trapping of a hernia in the groin, which cannot be brought back into the abdominal cavity even by a surgeon, is an urgent indication for surgery. In addition to fatty tissue from the abdominal cavity, intestines in particular can be trapped. In these situations, an intestinal obstruction occurs, which can only be treated surgically.

Operative therapy

The whole History of surgery of Inguinal hernia is characterized by efforts to develop a surgical method in which the risk of a recurrence of the fracture is eliminated or at least minimized as far as possible.
Such surgery does not exist yet. A few dozen hernia methods were used in the past century. In most of them, the body's own material was used to close the hernial gap. In the 80s and 90s techniques were also developed for which Plastic nets that support connective tissue be implanted.
With the development of the Minimally Invasive Surgery (MIS) one began to close the fracture gap also laparoscopically.
Nowadays in Germany (but also in English-speaking countries) there are mainly three methods of hernia closure, whereby there are numerous clinics that also use surgical procedures other than those listed here. These are not to be regarded as "better" or "worse". Rather, the surgeon's experience with the respective method plays an essential role in the success of the operation.

Surgical methods

Most commonly used surgical methods of the inguinal hernia:

• Operation according to Shouldice
• Operation according to Lichtenstein
  
• Laparoscopic operations = minimally invasive surgery of the inguinal hernia

Operation according to Shouldice

The body's own tissue is used to close the hernia, whereby the connective tissue sheets are sewn twice. It is hoped that this will increase the stability of the affected area. This method is often used at young people preferred with smaller fracture gaps.

Operation according to Lichtenstein

This is a Plastic mesh implanted in the groin. In the process, tight scar tissue forms around the meshes of the net, which together with the plastic net provide support for the connective tissue. Many years of experience with plastic nets shows that the initial fear of rejection reactions could not be confirmed. This hernia closure is used in older people or in larger hernia gaps, as well as in Relapse interventions (recurrence of an already treated hernia) recommended. However, there are surgical clinics that almost exclusively use this method.

Laparoscopic operations

(by means of a tummy tuck or abdominal walloscopy) = minimally invasive surgery of the inguinal hernia
There are two techniques of "minimally invasive" hernia closure. For one, it is "laparoscopic", via a Laparoscopy, operated on and attached a plastic mesh to the hernia from the inside. No plastic mesh is implanted in this operation in childhood. In these cases, the hernia is closed with a suture. The significance of this surgical technique is controversial today (see surgical risks). In the second method, the hernia is closed by means of a laparoscopy, also using a plastic mesh.

Operational risks

• Bleeding
• Rebleeding and
• Impaired wound healing, especially if there is inflammation,

are complication risks inherent in every operation. The open operations of the hernia also have other risks. It can be here too Injuries from neighboring structures. Next Vessels, are here in particular annoy who cause pain after the operation and may require further surgery.
An attempt is made to isolate and cut the affected nerve. However, such operations have a rather modest success rate, so that it should only be decided in a detailed discussion with the surgeon whether the risks of a new operation are in a reasonable proportion to the symptoms.
The most common in open inguinal hernia operations is injury of Spermatic cord fears that this could lead to infertility. The spermatic cord runs very close to the hernia in the groin. For this reason, the spermatic cord, together with the supplying vessels, is prepared and exposed during the operation. This means that it can be spared throughout the operation. Injury to the spermatic cord is extremely rare during an initial operation. However, the risk increases significantly with the number of recurrent interventions, since each operation causes adhesions that make a renewed dissection in the area difficult.
This complication can be treated during surgery. Urologists are often called in intraoperatively for this, who can restore the injured spermatic cord with sutures.

The surgical techniques on a Laparoscopy were seen as very modern in the 1990s and were widely used. In the course of time, this approach was abandoned by many surgeons because the abdominal surgery resulted in unacceptable complications. Large studies have now appeared showing that this risk is indeed greater than that of open surgery. This is why many surgeons nowadays refuse access via a laparoscopy.
The laparoscopic method is likely to regain a place in surgery in the future Inguinal hernia take, as it offers an access, especially in the case of repeated recurrence of inguinal hernias, which avoids a surgical procedure, due to the severely scarred tissue in the groin in these cases. This could potentially reduce the risk of further complications that are specific to surgery for recurrent inguinal hernias.
An abdominal examination (laprascopy), in which the abdominal cavity is not opened, is one way of avoiding the risk of an abdominal surgery.

After the operation

After the open operations, the patients often complain of pain, which is more pronounced with the Shouldice method. This type of operation also takes the longest time for the body to regenerate.
As a rule of thumb: no lifting of loads that are heavier than 5 kg in the first 6 weeks after the operation. This time is significantly shorter in the Lichtenstein operation (using a plastic mesh) and is 1-2 weeks.