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  health > men > story page AIDSAlternative MedicineCancerDiet & FitnessHeartMenSeniorsWomen

Groin hernia surgery: Quicker and easier than ever

September 23, 1999
Web posted at: 9:46 AM EDT (1346 GMT)

By Daniel Hayes, MD

(WebMD) -- Abdominal hernias are a sensitive topic that few will discuss voluntarily, even though more than five million Americans, mostly men, have this painful condition, according to the National Center for Health Statistics. Unfortunately, lack of awareness can put people suffering from a hernia at risk: An abdominal hernia can potentially have fatal complications if not treated properly.

With modern surgical techniques, hernias can be fixed more easily than they could in the past. A shorter operation using a less traumatic technique, along with advances in anesthesiology, have made this a different surgery than the one your grandfather or father may have endured.

Inguinal hernia: The most common type of hernia is an inguinal hernia, which affects about 700,000 Americans, 80 percent of whom are men, according to the Mayo Clinic. An inguinal hernia involves the inguinal canal, which, in men, carries the spermatic cord between the abdomen and the scrotum.

Most inguinal hernias occur when a portion of the intestine bulges out at a weak point in the abdominal wall -- the area where the spermatic cord passes into the scrotum. This condition may result from physical exertion, such as heavy lifting. In other cases, the cause is unknown.

Because a hernia involves a portion of the intestine, complications can occur. Intestinal tissue can get caught or "incarcerated" in the herniated space. If blood flow in the trapped intestine gets squeezed off, the "strangulated" portion of the bowel may begin to die and emergency surgery may be required.

Hernia symptoms range from simple lump to acute pain and fever

What signals an inguinal hernia? A lump in the region of the groin, sometimes associated with pain or tenderness, can be a sign of an inguinal hernia. Often the problem bulge is noticed when coughing or bending increases the pressure inside the abdomen. If strangulation has occurred, pain, nausea, vomiting and fever may signal a life-threatening condition and need for surgery.

Treatments for an inguinal hernia: Typically, a patient with an inguinal hernia is referred by their primary care doctor to a general surgeon for an evaluation. The surgeon may not always recommend surgery, but it is usually the best choice. Sometimes a support called a truss is placed against the groin. This can offer temporary relief, but it does not correct the problem or prevent complications.

If surgery is recommended, it is likely to be one of the following two techniques: 1.) Herniorrhaphy. This "open" procedure involves creating an incision at the site of the hernia, pushing the protruding intestinal sac back into the abdomen, and tightening the weakened muscle and supportive tissue with stitches. 2) Hernioplasty. In this procedure, a mesh of synthetic fiber is sewn over the weakened muscle.

New 'keyhole' surgery promising, but controversial

A controversial but promising new surgery: Doctors are now able to repair groin hernias using a technique called laparoscopy, or "keyhole" surgery. Of the several types of hernioplasty methods, it is the one receiving the most publicity, not only because it's new, but because it's still controversial. Until more research is done, doctors don't know whether its benefits outweigh reports of increased risks. Preliminary data, however, look promising.

What happens in laparoscopy? In laparoscopy, the surgeon inserts a fiber optic light, surgical tools and a small video camera into tiny incisions. The surgeon watches his or her progress on a video screen while repairing the hernia. The procedure shortens recovery time and leaves less scar tissue than open surgery. It also allows patients to return to their usual activities sooner -- on average, four days earlier than those who undergo open surgery, according to a recent study published in the journal The Lancet.

A patient who undergoes laparoscopic inguinal hernia surgery is usually seen on an outpatient basis and undergoes the procedure with local anesthesia, though spinal or general anesthesia is used in some cases.

Over the years, advances have shortened operating, anesthesia, recovery and return-to-work time dramatically. The Atlanta Medical Center published a report in this month's American Surgery of its six-year experience with the laparoscopic procedure. The average surgery time was only 68 minutes, and minor complications occurred less than 6 percent of the time. There were no deaths. Only 0.2 percent of patients, who were followed for an average of 30 months, had a recurrence of their hernia.

What to expect after surgery: Inguinal surgery patients are often sent home on the day of surgery and encouraged to walk and perform light activities. Heavy lifting and straining is discouraged until full recovery, which takes about three weeks.

A hernia that has been repaired can recur after primary conventional (open) inguinal herniorrhaphy about 10 percent of the time, and less often with the "keyhole" technique. The outcome depends on the type of repair and the expertise of the surgeon.

Overall, inguinal hernia repair in the U.S. this year will be an effective, low-risk experience for the 700,000 people who undergo it.

Copyright 1999 WebMD, Inc. All rights reserved.


The Causes and Surgical Treatment of Abdominal Hernia
Mayo Clinic: Laparoscopic hernia repair
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