An Inguinal Hernia is a hole in an area of weakness in the muscles located at the groin area, most often on the right side. The Femoral Hernia is often mistaken for the Inguinal hernia, however, the Femoral Hernia is located lower and develops in the upper part of the thigh near the groin just below the inguinal ligament, where abdominal contents pass through a naturally occurring weakness called the femoral canal.
The Inguinal Hernia develops when fatty or intestinal tissues push through a weakness in the abdominal wall near the right or left inguinal canal. Each inguinal canal resides at the base of the abdomen. Both men and women have inguinal canals. In men, the testes usually descend through their canal by around a few weeks before birth. In women, each canal is the location of passage for the round ligament of the uterus. If you have a hernia in or near this passageway, it results in a protruding bulge, which is easy to see and feel, although not all are visible by the patient, especially when obese. It may be painful during movements like coughing, bending, or lifting.
Types of Inguinal Hernias
- Indirect inguinal hernia - An indirect inguinal hernia is the most common type. It often occurs in premature births, before the inguinal canal becomes closed off. However, this type of hernia can occur at any time during your life. This condition is most common in males and anatomically sits to the side of the Inferior Epigastric Vessels, the arteries and veins that run through the iliac crest in the pelvis and carry blood to the lower abdominal wall.
- Direct inguinal hernia - A direct inguinal hernia most often occurs in adults as they age. The popular belief is that weakening muscles during adulthood lead to a direct inguinal hernia. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), this type of hernia is much more prevalent in men, and anatomically to the inside of the Inferior Epigastric Vessels, the arteries and veins that run through the iliac crest in the pelvis and carry blood to the lower abdominal wall.
- Incarcerated inguinal hernia - An incarcerated inguinal hernia happens when the tissue becomes stuck in the groin and isn’t reducible. This means it can’t be pushed back into place.
- Strangulated inguinal hernia - Strangulated inguinal hernias are a more serious medical condition. This is when the intestine in an incarcerated hernia has its blood flow cut off. Strangulated hernias are life-threatening and require emergency medical care.
Causes of an Inguinal Hernia
There isn’t one cause for Inguinal Hernias. However, weak spots within the abdominal and groin muscles are thought to be a major contributor, with causes for this weakness around the inguinal canal, dependent on pre-existing conditions or previous surgeries in that area, lifestyle activity, weight, and heredity. Extra pressure on this area of the body can eventually cause a hernia.
Some risk factors that can increase your chances of this condition include:
- Older adults with sedentary lifestyles and weakened musculature
- Heredity
- Having a prior inguinal hernia
- Being Male
- Premature Birth
- Being overweight, or obese
- Preganancy
- Connective Tissue Disorders
- Trauma from a sudden twist, pull or strain
- Cystic fibrosis
- Chronic cough
- Chronic constipation
Symptoms of an Inguinal Hernia
In men, Inguinal Hernias are often easily visible as a bulge in the scrotum or groin, however, sometimes in women, it is easy to miss signs of an inguinal hernia. It is also important to determine that a perceived Inguinal Hernia is not enlarged lymph nodes, cysts, or testicular problems.
The following symptoms should be monitored and evaluated for a possible presence of an inguinal hernia.
- Pain In The Pelvic AreaBecause they rarely cause a bulge, some hernias in women are misdiagnosed as fibroids, ovarian cysts, or endometriosis based on the region of pain. Although they may cause pain in the leg or back, an MRI is usually required to identify these small but very painful hernias.
- Weakness or NumbnessA feeling of muscle fatigue and weakness in the upper leg and groin can be a sign of a hernia or numbness if nerves have impinged.
- ConstipationBe aware that constipation may mean there is a blockage in the large intestine interfering with digestion. Additionally, it will be difficult to pass gas.
- Pain Under Certain ConditionsIf you have pain while lifting heavy objects, or pressure in your abdomen when you bend down, this could be a silent sign of a hernia. Other common signs can be a pain when you cough, or tightness in the groin or abdomen.
- FeverA fever with a hernia is a bad combination. This can indicate a “strangulated” hernia which is not getting enough blood flow.
- Nausea and VomitingAlthough not usually thought of as a symptom of a hernia, an upset stomach can indicate a serious condition known as an incarcerated hernia. In this case, the hernia doesn’t return in place by a gentle push and can require immediate medical attention.
- Feeling Full, or BloatedAn inguinal hernia can cause someone to feel like they had an enormous meal when in fact they did not. This quite common type of hernia can also make you feel bloated accompanied by pain in the groin and lower abdomen.
Robotically-Assisted Inguinal Herniorrhaphy or Hernioplasty
with The Da Vinci® Robotic Surgical System
Surgical Robotics for Minimally Invasive Surgery
As a Board-Certified General Surgeon, Dr. David W. Ford operates with a minimally invasive robotic system to repair ventral and inguinal hernias. This minimally invasive approach requires one or a few small incisions that doctors use to insert surgical equipment and a camera for viewing.
Robotically assisted Inguinal Hernia surgery utilizes an advanced robotic platform that is not autonomous, but is controlled by the surgeon who is seated in the operating room and operates via the Surgeon Console that controls the Patient Cart’s robotic devices, including various surgical instruments and a camera. The da Vinci Surgical System allows surgeons to perform minimally invasive hernia repairs with clinically supported precision and accuracy. Robotically assisted surgery uses a laparoscope (a thin lighted tube with a camera on the tip) that is inserted through one of several small incisions, made away from where the hernia has occurred. The images gathered from the laparoscope’s camera are high-definition 3D, which are sent to a monitor that Dr. David W. Ford uses to guide the surgical system during the operation. If needed, the abdomen can be inflated with a harmless gas (carbon dioxide), which creates space to allow the doctor to view the inside of the body.
For the Inguinal Repair, the abdominal wall at the groin is cut to allow Dr. David W. Ford to see the weakness in the abdominal wall. The surgery can also cut into the peritoneum (the sac created in the inguinal canal holding intestines) or it can repair and push fatty tissue, muscle and intestines back in without cutting the peritoneal sac. For women, sometimes an ovary can be caught in the inguinal hernia. Surgical mesh material is usually inserted to strengthen the weakened area and reconstruct the abdominal wall, although sometimes a suture-only repair is needed. After the procedure is completed, the small incisions in the abdomen are closed with a stitch or two or with surgical tape. Dr. David W. Ford’s use of the state-of-the-art da Vinci Surgical System in his robotically assisted hernia repair surgeries has allowed him to set a very high standard of expertise that can combine this method with traditional Open Surgery if required.
Many robotically-assisted surgical systems are FDA approved and in use today. However, many are specially designed for specific organs, procedures, or conditions, such as lung or pulmonary surgeries or knee and other extremity replacement surgeries. The da Vinci Robotic Surgical System is the premier system specialized in hernia repair surgery. Dr. David W. Ford is not only an expert board-certified surgeon but also certified in the use of this leading-edge technology.
This robotic platform offers Dr. David W. Ford fully wristed instruments and a 3D high-definition camera with 10x magnification. As a result, the repair can be done with more precision, and complex hernias can be fixed with small incisions. Furthermore, the robot doesn’t get tired and Dr. Ford sits during surgery, so there is less surgeon fatigue. For the patient, this translates into quicker recovery, less pain, and fewer complications. This is the preferred approach for medium to large hernias and many inguinal hernias as it combines the best of open and laparoscopic surgeries. Also, Dr. Ford is more likely to be able to sandwich the mesh between layers of the abdominal wall to keep the mesh from coming into contact with the intestines.
Other benefits of robotic hernia surgery include:
- Access to clear three-dimensional images (unlike laparoscopic surgery’s two-dimensional images) of the inside of the abdomen for more precise surgery.
- Dr. Ford can easily use stitches to sew tissue and meshes into the inside of the abdomen.
- The patient is left with smaller scars rather than one large incisional scar.
- The possibility of much less pain, faster recovery, and quicker return to normal diet and activities after surgery are observed, compared to all other types of hernia repair surgery.
Should robotically-assisted surgical laparoscopic surgery be recommended as part of treatment for your hernia repair, Dr. David W. Ford and his team will have the best state-of-the-art technology at their disposal to usher in your recovery.
How The Da Vinci® Robotic Surgical System works
Da Vinci surgical systems are comprised of three components: surgeon console, patient-side cart, and vision cart.
Surgeon Console
Patient Cart
The patient-side cart is positioned near the patient on the operating table. It is where the instruments used during the operation move in real time in response to your surgeon’s hand movements at the surgeon console.
A camera provides a high-definition, 3D magnified view inside your body. Every hand movement your surgeon makes is translated by the da Vinci system in real time to bend and rotate the instruments with precision.
Vision Cart
The vision cart makes communication possible between the components of the system possible, and supports the 3D High Definition vision system.
This traditional surgical method is employed when the hernia is very complex, and is most often used with inguinal or umbilical hernias. A complex hernia repair may require mesh removal, resection of the abdomen, or removal of extraneous skin or fat, and therefore is easier with open surgery.
The open surgery requires that an open incision be made in the abdomen, in the groin area over the hernia, and then the peritoneal sac is removed after the intestine or abdominal tissue is pushed back into place. Synthetic mesh material is usually placed to reinforce this repair and reduce hernia recurrences, however, sometimes, a suture-only repair is needed. The skin is usually closed with dissolvable stitches and glue.
Open repairs are classified via whether prosthetic mesh is utilized or whether the patient's own tissue is used to repair the weakness. Prosthetic repairs enable surgeons to repair a hernia without causing undue tension in the surrounding tissues while reinforcing the abdominal wall.
Repairs that utilize mesh are usually the first recommendation for the vast majority of patients including those that undergo laparoscopic repair. Procedures that employ mesh are the most commonly performed as they have been able to demonstrate greater results as compared to non-mesh repairs. Approaches utilizing mesh have been able to demonstrate faster return to usual activity, lower rates of persistent pain, shorter hospital stays, and a lower likelihood that the hernia will recur.
Non-Surgical Options:
- Conservative, watch & wait management is helpful for patients with minimal or no symptoms.
- The hernia itself should not limit your ability to engage in your usual daily activities.
Surgical Options:
Hernia repair involves an operation, with overall one of two main approaches:
- Mesh repair – the use of mesh to enhance the repair & provide further reinforcement
- Non-mesh repair – closing the abdominal defect with stitches, creating some tension
Safety of Surgical Mesh:
- There is a large volume of data on the outcome of various hernia operations and different types of mesh, and the use of mesh to repair the majority of hernias has been the preferred method in the US, UK, and worldwide for over 30 years.
- When surgeons themselves have hernias that require surgery, they opt for mesh repairs.
- Patient safety is a critical component, and therefore, different meshes used in surgery are tightly regulated in both the US and UK.
What is the “Gold Standard”?
- Using mesh has become the gold standard in hernia repairs – and has a lower recurrence rate.
- Many patients with hernias have tissue weakness and often do not hold stitches well, which may explain why non-mesh repairs have a higher failure/recurrence rate than with mesh.
- For the vast majority of patients, mesh poses little if any additional risk.
Risks of Mesh:
- Mesh is a foreign material, like synthetic implants, such as dentures, crowns, heart valves, etc.
- It is possible for mesh to become infected, but this is rare.
- Some patients develop chronic pain after surgery. There is no strong relationship with the use of mesh and chronic pain. Furthermore, non-mesh repairs can result in similar pain outcomes.
