Inguinal hernia

Inguinal hernia – causes

Both femoral and inguinal hernias are usually due to congenital weak spots in the tissue, which gradually enlarge over time until finally a hole in the tissue gapes open. A gap between the muscles and connective tissue leads to the protrusion of abdominal contents (usually intestines or omentum) covered by peritoneum and skin. If the abdominal hernia occurs above the inguinal ligament, it is called an inguinal hernia (hernia inguinalis). If the hernia occurs below the inguinal ligament, it is called a femoral hernia (hernia femoralis).

Inguinal hernia – symptoms and complications

Initially, an inguinal hernia causes symptoms such as:

• Groin discomfort and pain
• A sense of pressure
• Bulges at the hernia site
• Radiating pain

Over time, inguinal hernias enlarge, and the symptoms can lead to complications such as:

• Incarceration
• Bowel obstruction (ileus)
• Bowel perforation
• Peritonitis

If you show inguinal hernia symptoms, seek medical advice immediately. Early detection of inguinal hernias can prevent complications. In case of incarceration, it is an emergency situation requiring immediate inguinal hernia surgery.

Inguinal hernia surgery or herniorrhaphy

Inguinal hernia surgery is the therapy of choice. Dr. med. Andreas Franczak offers different surgical methods – so, depending on the patient, risk situation, previous surgeries, and life planning, the appropriate inguinal hernia treatments can be chosen. For example, in children, a simple closure of the hernia opening with sutures is often sufficient. Inguinal hernia surgery can also be minimally invasive or performed under local anesthesia if patients are not suitable for general anesthesia.

Mesh hernioplasty

An established inguinal hernia treatment is the use of artificial meshes. The meshes serve to:

• Reinforce the abdominal wall.
• Allow a tension-free closure of the hernia gap.
• Contribute to a better long-term result.

The meshes are made of either polyester or polypropylene. In open procedures, the Rutkov and Lichtenstein operations have been established. In inguinal hernia surgeries using keyhole techniques (minimally invasive), the TEP (TEPP) and TAPP methods are available. The advantage of minimally invasive techniques is the small wounds, resulting in less pain.

Inguinal Hernia Surgery with TAP

TAPP stands for Transabdominal Preperitoneal Plasty. In this inguinal hernia treatment, the hernia is closed from the inside with a plastic mesh using three small openings in the abdominal wall. The advantage of this method over the TEPP procedure:

• With the TAPP method, the organs inside the abdomen can be examined.
• It can also be applied to patients who have previously had lower abdominal surgery (e.g., appendectomy)

Inguinal Hernia Surgery with TEPP

TEPP, or TEP, means Total Extra Peritoneal Plasty. In this procedure, three small openings are also made in the abdominal wall. However, the peritoneum (abdominal lining) is not injured. A space is created between the peritoneum and the abdominal muscles, where the inguinal hernia surgery is performed. The hernia sac is released from adhesions and pushed back. In case of a large hernia gap, it is closed with sutures. Then, a plastic is placed over the hernia gap, achieving coverage and security. The advantages over the TAPP procedure:

• Bauchfell muss nicht geöffnet werden. Somit werden Verletzungen der Bauchorgane oder spätere Verwachsungs­beschwerden minimiert.
• The mesh is not fixed with staples or clamps, minimizing the risk of nerve injury and subsequent pulling pain (neuralgia).
• No risk of a future abdominal wall hernia (trocar hernia).
• Patients are usually discharged home one day after the operation. After 3 days, they are able to work while sitting and exercise 1 week after the surgery.
• According to the Herniamed study from 2019, the TEPP method results in the lowest complication rate. In this case, the study results from 2012 were refuted.

The European Hernia Society (EHS) recommends TEPP as the method of choice when surgeons have sufficient experience. Dr. med. Andreas Franczak has been using the TEPP procedure foringuinal hernia treatments since 1997. Our practice in Vienna has received the quality seal of the EHS (European Hernia Society).

Author: Dr. Andreas Franczak, specialist in surgery, vascular surgery and visceral surgery