Condition: Hernias of the Groin and Abdominal Wall

An inguinal hernia is a lump in the groin that occurs when the bowels or other tissues are pushed through a defect in the muscular wall of the lower part of the abdomen wall. It is the most common type of hernia and can happen on both sides.

Mr Jonathan Wilson, Consultant Colorectal and General Surgeon at OneWelbeck Digestive Health gives an overview of hernias, the most common types and outlines the symptoms patients may commonly experience.

These hernias can occur in anyone but are commonest in men, and are more likely in certain groups of people including those who:

• Have a persistent cough
• Suffer with constipation
• Are overweight
• Lift heavy loads or do a lot of high-intensity training
• Smokers

This is because all these results in the patient spending significant amounts of time with an increase in the pressure inside their abdomen.

Many hernias are asymptomatic. But sometimes they present as a swelling that can temporarily be gently pushed back in the abdomen, but which comes out again when straining. These hernias are referred to as being ‘reducible‘.

Often, hernias can become permanently stuck outside the abdomen, and are ‘irreducible’. This may not cause any symptoms at all, or may result in aching or a dragging sensation. It also increases your risk of something more serious happening, which is that the contents of the hernia can get tightly squeezed. The impact of this can be serious, depending partly on what gets stuck inside the hernia. If it is a loop of your bowel, and the bowel becomes blocked, this can cause severe pain, sickness and vomiting, with patients being unable to pass wind or stool. This ‘bowel obstruction’ requires an emergency operation.

Sometimes the blood supply to the contents of the hernia is also affected and these hernias are called ‘strangulated‘ hernias, and always require an emergency operation to save the bowel and its blood supply.

In most cases it is much better to repair inguinal hernias with routine surgery rather than in an emergency when they have become strangulated.

Your doctor will take a history and they will examine you. He/she may also ask you about your medical history.

As part of the examination, the doctor may press gently with their fingers over the lump and gently attempt to push it back temporarily (this is called “reducing” the hernia).

If there is any uncertainty, your doctor may refer you for an ultrasound scan or MRI scan of the groin. You will then be advised on the treatment options.

The two main reasons to repair a hernia are:

1. The hernia is getting bigger or becoming more uncomfortable or has become irreducible.
2. To prevent the hernia from becoming strangulated (the emergency scenario outlined above)

If you decide not to have surgery, the hernia will remain and may get bigger or more uncomfortable. It may cause you very few problems, but it will be at continued risk of strangulation.

Some patients may be able to reduce the progression or symptoms of the hernia by:

• Losing weight.
• Stopping smoking and thereby reducing coughing.
• Taking steps (such as eating a high fibre diet) in order to reduce constipation.
• Wearing a fitted truss that helps to support the hernia (this will not fix the hernia merely ameliorate its symptoms).

None of these methods will make a hernia go away once it has developed.

Surgery can be performed by a number of different techniques and your doctor will help you decide. Most hernias will be repaired under a general anaesthetic however this operation can be performed under local anaesthetic in some circumstances.

Hernias are commonly repaired through a cut made in the groin. This is a safe operation that is performed in large numbers in the UK. Laparoscopic or ‘keyhole’ surgery is also performed for inguinal hernia repair and this is routinely done as a day-case procedure. This is what we aim to do for the majority of our patients. Laparoscopic inguinal hernia repair can only be done under general anaesthesia, which means you will be asleep during your operation.

Mesh Repair

Nearly all hernias are repaired using a synthetic plastic mesh. A large number of trials have been performed using this technique and many international registries have demonstrated that this is a safe method that significantly reduces the risk of the hernia recurrence after surgery.

Recent reports in the lay press have raised concerns about the use of mesh in the repair of vaginal prolapse where significant complications have been reported. However,  this is very specific to this use of mesh, and there is no evidence that mesh repair in hernia surgery causes chronic pain or complications.

The Royal College of Surgeons of England have issued a statement on this issue.

Mr Jonathan Wilson, Consultant Colorectal and General Surgeon at OneWelbeck Digestive Health explains how you can reduce the risk of a hernia as we age and gives his top tips to help prevention of new or recurrent hernias.