Diseases

Inguinal hernia - causes and therapy

Inguinal hernia - causes and therapy


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Causes, symptoms and treatment of a hernia

The hernia or inguinal hernia (inguinal hernia) is a relatively widespread symptom that is characterized by pain and a visible swelling in the groin area. However, not everyone affected suffers from clearly perceptible symptoms. In the case of an inguinal hernia, a so-called hernia forms, through which the intestines can emerge from the abdominal cavity, which in the worst case are pinched. This can lead to life-threatening complications and rapid medical intervention is urgently required here.

Definition

The inguinal hernia (hernia inguinalis) is a so-called intestinal rupture of the abdominal wall in the area of ​​the inguinal canal. A fracture gate forms here, which cannot withstand the internal pressure, and a so-called fracture sac emerges. Depending on the location of the hernia, direct and indirect inguinal hernias can be distinguished. While the hernial sac in the direct inguinal hernias passes through the rear wall of the inguinal canal, indirect inguinal hernias are characterized by a hernia in the inner inguinal ring and are therefore slightly offset to the side. A special form of inguinal hernia in boys or men is the so-called testicular hernia, when the hernial sac extends into the scrotum. In women, the vaginal hernia describes an inguinal hernia in which the hernial sac extends into the labia. Furthermore, a distinction can be made between congenital and acquired inguinal hernias. If organ parts are trapped in the hernia, this is called an incarcerated inguinal hernia.

Symptoms

Typical features of an inguinal hernia include a feeling of pressure in the groin area, groin pain (especially when lifting, coughing and other stress) and a visible bulge in the area of ​​the groin on the affected side of the body. However, the complaints of some of those affected are limited or cannot be determined at all.

An existing swelling can usually be pressed in with the finger and emerges again when the finger is lifted off. The swelling can also increase with physical exertion and, in the event of a testicular fracture or a vaginal hernia, extend into the scrotum or the large labia. If the swelling cannot be pushed in or only with severe pain with the finger, this is a possible indication of trapped organ parts and a doctor should be consulted as soon as possible.

If parts of the intestine are pinched in the fracture portal (incarcerated inguinal hernia), this can trigger serious further symptoms. Because, for example, intestinal obstruction and the pinched organ parts are at risk of death. Severe abdominal pain, nausea and vomiting are possible warning signals here. In the worst case scenario, life-threatening peritonitis can result if left untreated.

Causes and spread

With regard to the causes of the inguinal hernia, a basic distinction must be made between acquired and congenital forms. The congenital inguinal hernias are the result of an error in fetal development in which, for example, the connecting channel between the scrotum and the inguinal canal does not close as intended. After the testicles have descended into the scrotum, an opening remains through which intestines can enter the canal. In girls, an abnormal development along the so-called mother ligament is a possible trigger for the congenital inguinal hernia. However, compared to boys, girls are rarely affected by a congenital hernia.

The acquired forms of inguinal hernia are not infrequently due to a weakening resilience of the tissue structures in the area of ​​the inguinal canal with increasing age, but can also be triggered by excessive loads, such as, for example, strong pressing during bowel movements, heavy lifting or a violent cough. Pregnancy also increases the pressure on the inguinal canal and sometimes triggers an inguinal hernia. Men are also the main sufferers of the acquired forms of hernia.

The gender-specific distribution of the symptoms is given as 80 to 90 percent men and 10 to 20 percent women. In children, the spread of congenital inguinal hernias is estimated in up to three cases in one hundred newborns. With regard to the total number of surgical interventions in Germany, according to the Federal Statistical Office (Destatis), in 2014 the occlusion of an inguinal hernia was the second most common in 155,999 cases. A total of 176,300 surgical operations on inguinal hernia were performed in 2014. The figures show on the one hand the significantly higher prevalence among men and on the other hand the widespread distribution of the symptoms.

Diagnosis

Based on the symptoms and a scan of the groin region, a relatively reliable initial diagnosis can already be made in many cases, but further examinations may be necessary to determine the extent of the groin hernia and / or to rule out other diseases. Above all, imaging methods such as ultrasound or MRI examinations are increasingly used diagnostic tools. If the examination shows that organ parts are trapped in the fracture, an operation is immediately necessary to avoid further complications.

Treatment

If an inguinal hernia is secured and causes complaints, there is always the risk that parts of the abdominal viscera (intestines) can get caught when leaving the hernia. This can quickly lead to incarceration and an acute clinical picture with immediate indication for surgery.

In principle, the inguinal hernia is a reason for surgery in most cases, but surgery is not possible for other reasons for some of those affected. Here treatment is conservative with a so-called truss band, which is worn in everyday life and exerts pressure on the fracture from the outside. This prevents the hernial sac from escaping and the intestines are not pinched in the hernial portal. A rupture band can also be prescribed up to a later date for an operation.

Since the congenital forms of the inguinal hernia sometimes subside by the time they reach the age of one, younger children are only operated on if there is an incarcerated groin hernia. For children older than one year, surgery should always be performed according to the guidelines of the German Society for Pediatric Surgery.

Various surgical techniques are available for the operation of the inguinal hernia, the use of which can also be seen depending on the extent of the symptoms. A basic distinction must be made between open operations and so-called laparoscopic interventions. The goal is to close the fracture portal and, in adult patients, any weak spots in the tissue that may be present can be reinforced by a kind of mesh. In the open operation, this is done by making a correspondingly large cut to expose the inguinal canal. In laparoscopy, minimally invasive surgery is performed using endoscopes that are pushed into the abdominal cavity through small incisions.

Both surgical techniques are considered routine interventions in this country and can often be performed on an outpatient basis. However, complications during the procedures cannot be ruled out in principle. For example, the treatment guidelines of the German Society for Pediatric Surgery name wound infections (1.2% of patients affected), secondary undescended testicles (up to 13% affected depending on age), hydroceles (0.06%), testicular atrophy (0.3%) or chronic groin pain (3.2%) as possible negative consequences of surgery in children.

According to the German Society for Pediatric Surgery, the recurrence rate after laparoscopic surgery tended to be somewhat higher than after open surgery (4% versus 2%). However, a basic recommendation on open operations cannot be derived from this.

In recent years, however, the minimally invasive surgical technique with the introduction of a network has become established and significantly improved. Complications have improved significantly thanks to improved surgical techniques and the development of anti-allergic mesh material. In addition to faster healing tendencies, fewer wound healing disorders, shorter hospital stays and faster recovery are advantages of this procedure.

Ultimately, the appropriate surgical technique should be selected depending on the individual symptoms and the constitution of those affected. (fp)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters, Dr. med. Andreas Schilling

Swell:

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  • Professional Association of Pediatricians e. V .: Inguinal hernia (inguinal hernia, Latin: inguinal hernia) (access: 13.08.2019), kinderaerzte-im-netz.de
  • German Society for Pediatric Surgery (DGKCH): S1 guideline, inguinal hernia, hydrocele, status: September 2014, detailed view of guidelines
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  • Mayo Clinic: Inguinal hernia (accessed: August 13, 2019), mayoclinic.org
  • Harvard Health Publishing: Inguinal Hernia (accessed: August 13, 2019), health.harvard.edu

ICD codes for this disease: K40ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.


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