Groin and Abdominal Wall Hernia

Hernia is the displacement of the abdominal organs due to a weakness in the anterior abdominal wall. It can also be encountered as an incision hernia, most commonly in the groin area, around the umbilicus or at the previous surgical site. Rarely, hernias may also develop from defects at the umbilical level or from the abdominal wall.

It is more common in men

75% of all hernias are in the groin region. 2/3 of them are indirect, while the rest are direct inguinal hernias. Incisional hernias account for 15%, of anterior abdominal wall hernias, umbilical hernia for 10%, and femoral hernia for 5%. It is more common in men than in women.
 

It causes swelling and pain

Hernia patients usually present with swelling, pain and cosmetic problems in the hernia area.  Swelling may also occur near the testicles in men. Swelling can develop within a few weeks or longer. Sometimes that swelling arises when lifting heavy objects, coughing, straining or laughing. Sudden onset of pain, hernia sac stiffness, nausea-vomiting, inability to pass gas or to defecate, this may be a sign that a portion of the intestine may be stuck in a hernia and a physician should be consulted urgently.
 

Why do hernias occur?

The causes of hernia include chronic coughing, heavy weight lifting, obesity, constipation, prostate enlargement, pregnancy, congenital connective tissue disorders, old age, previous surgeries and smoking. Hernia may be confused with hydrocele, varicocele, spermatocele, epididymal cyst or testicular tumor.
 

How is it diagnosed?

Diagnosis is usually made by physical examination. Hernias that cannot be identified in physical examination can be identified by ultrasound (USG), computed tomography (CT) or magnetic resonance (MR) imaging techniques. It is not possible to treat the hernia with drugs or non-surgical methods. Methods such as pubic ligament, which is occasionally used among the public, are far from being curative and provide only temporary relief.
 

Only treatment is surgery

The only and exclusive treatment of hernia is surgery. Emergency surgery is inevitable if parts of the intestine are stuck in and strangled by the hernia sac. This will affect the dimensions and timing of the surgery. Therefore, it is more convenient to operate on the hernia defect before it grows further.
 

Treatment methods

There are 3 main methods of surgical treatment: Open, laparoscopic or robotic surgery is possible. In the open method, an incision is made over the hernia, and the formations coming out of it are placed back into the abdominal cavity. After this area is repaired, it is reinforced with a material called mesh-graft patch made of synthetic material. The hernia defect is thus repaired without tension.
 

Laparoscopic method

In the laparoscopic method, the hernia area in the groin is reached using a camera and tools to enter the abdomen through the umbilicus (TAAP), or by advancing through the peritoneum and abdominal muscle (TEP). In the same way, the strangled tissues are placed in their proper places, a patch is placed on this area and the repair is completed. Because the incision is smaller in the laparoscopic method, postoperative pain is less, comfort and early return to work is higher. Another important advantage is that it is more aesthetic because of the smaller incision. Especially in patients with bilateral inguinal hernia and in recurring hernias, the advantages of laparoscopic method are emphasized. 
 

Robotic method

In the robotic method, the approach is essentially similar to the laparoscopic method and it allows more convenient application of the synthetic material that is used, especially in wide anterior abdominal wall defects, and allows more convenient suturing of the opening. Numbness at the operation site, hematoma due to bleeding, seroma and complications related to nerve injury may be observed In the postoperative period.  These complications can be prevented by laparoscopic and robotic approaches applied by experienced surgeons.

The robot has many advantages

After robotic and laparoscopic hernia surgery, patients can walk within a few hours and be discharged on the same day or the following day. Patients can return to work within 2-3 days. Light exercises can be started after 2 weeks. Heavy sports and heavy exercises are generally not recommended in the first 3 weeks. After inguinal hernia repair, the disease may reoccur depending on patient-related factors and technique. Factors facilitating relapse are inexperienced surgeon, technical inadequacy, wound infection, chronic coughing, smoking, diabetes and especially excessive weight. The surgeon's experience, the patch material used in the repair, and the preferred surgical technique also have an effect on recurrence.