Inguinal hernia - causes and therapy

Causes, symptoms and treatment of a hernia

The hernia or inguinal hernia (Inguinalhernie) is a relatively widespread symptoms, which is characterized by pain and a visible swelling in the groin area. However, not all sufferers suffer from appropriately noticeable symptoms. In the inguinal hernia, a so-called hernia portal forms, through which intestines can escape from the abdomen, which in the worst case become trapped. This can lead to life-threatening complications and rapid medical intervention is urgently needed.

contents

• Causes, symptoms and treatment of a hernia
• definition
• symptoms
• Causes and distribution
• diagnosis
• treatment

definition

Inguinal hernia (Hernia inguinalis) is a so-called intestinal rupture of the abdominal wall in the area of ​​the inguinal canal. Here forms a herniation, which can not withstand the internal pressure, and it emerges from a so-called break bag. Depending on the location of the hernia, direct and indirect inguinal hernias can be distinguished. While in the direct inguinal hernias the hernia sac passes through the posterior wall of the inguinal canal, indirect inguinal hernias are characterized by a hernial gate in the inner inguinal ring and therefore slightly laterally offset. A special form of inguinal hernia in boys or men is the so-called testicle breakage, when the hernia sack extends into the scrotum. In women, the vaginal hernia describes a hernia, in which the hernia spreads to the labia. Furthermore, a distinction can be made between innate and acquired inguinal hernias. If organ parts are trapped in the hernia, this is called incarcerated inguinal hernia.

A hernia is usually associated with a feeling of pressure, pain and swelling in the groin area. (Image: Robert Kneschke / fotolia.com)

symptoms

Typical features of Inguinalhernie are a feeling of pressure in the groin, groin pain (especially when lifting, coughing and other stresses) and a visible bulge in the area of ​​the groin on the affected body side. However, the complaints are limited or not detectable in some patients.

An existing swelling can usually be impressed with the finger and emerges when the finger is raised again. Also, the swelling may increase during exercise and in a testicular fracture or a vaginal hernia to reach the scrotum or the labia majora. If the swelling can not be pressed in or only with strong pain with the finger, this is a possible indication of jammed organ parts and a doctor should be consulted as soon as possible.

If parts of the intestine are trapped in the hernial portal (incarcerated inguinal hernia), this can trigger serious further symptoms. For it threatens, for example, an intestinal obstruction and death of the clamped organ parts. Severe abdominal pain, nausea and vomiting are possible warning signs. If left untreated, a life-threatening peritonitis is the result.

In an incarcerated hernia organ parts are trapped in the hernia. This is a medical emergency and requires immediate surgery. (Image: blueringmedia / fotolia.com)

Causes and distribution

The causes of inguinal hernia are fundamentally differentiated between acquired and innate forms. The innate inguinal hernias are the result of a defect in fetal development in which, for example, the connecting canal between the scrotum and inguinal canal does not close as intended. After descending the testicles in the scrotum an opening remains through the entrails can enter the channel. In girls, a malformation along the so-called mother ligament is a possible trigger of innate inguinal hernia. However, girls are rarely affected by congenital inguinal hernia compared to boys.

The acquired forms of inguinal hernia are not infrequently due to a decreasing load capacity of the tissue structures in the area of ​​the inguinal canal with increasing age, but can also be triggered by excessive burdens, such as strong pressing during bowel movements, heavy lifting or severe coughing. Even a pregnancy increases the pressure on the inguinal canal and is sometimes the trigger of a hernia. In the acquired forms of inguinal hernia men are also the main victims.

The gender-specific distribution of the complaints is given as a whole with 80 to 90 percent men and 10 to 20 percent women. In children, the prevalence of innate inguinal hernias is estimated at up to three cases in one hundred newborns. According to the Federal Statistical Office (Destatis) for men in 2014, the closure of a hernia with 155,999 cases was in second place with regard to the total number of surgical interventions in Germany. In total, 176,300 Hernia inguinalis operations were performed in 2014. On the one hand, the figures clearly show the significantly higher prevalence among men and, on the other hand, the widespread prevalence of the symptoms.

diagnosis

On the basis of the symptoms and a sampling of the inguinal region can be in many cases already provide a relatively reliable first diagnosis, but it may be necessary further investigations to determine the extent of inguinal hernia and / or exclude other diseases. Above all, imaging techniques such as ultrasound or MRI examinations are increasingly used diagnostic tools. As part of the investigation shows that organ parts are trapped in the fracture, immediate surgery is required to avoid further complications.

An ultrasound examination can provide information about the extent of inguinal hernia. (Image: Barabas Attila / fotolia.com)

treatment

Basically, the inguinal hernia is in most cases a surgical reason, but in some cases an operation for other reasons is not possible. Here conservative treatment is carried out with a so-called break band, which is worn in everyday life and exerts pressure on the break point from the outside. This will prevent the breakage bag from escaping and the entrails will not be trapped in the break port. A breakline may also be prescribed until a later scheduled surgery date.

Since the innate forms of inguinal hernia sometimes disappear on their own until the age of one, younger children are only operated on if there is an incarcerated inguinal hernia. In children over the age of one year, according to the guidelines of the German Society of Pediatric Surgery should always be an operation.

An ultrasound examination can provide information about the extent of inguinal hernia. (Image: Barabas Attila / fotolia.com)

For the operation of inguinal hernia, various surgical techniques are available, the use of which is also to be seen depending on the extent of the symptoms. Basically, a distinction must be made between open surgery and so-called laparoscopic interventions ... The goal is to close the hernia and, in the case of adult patients, any additional weak spots in the tissue can be reinforced by a kind of mesh. This is done in the open operation by a correspondingly large section to expose the inguinal canal. In laparoscopy, a minimal invasive operation is performed with the help of endoscopes, which are pushed through small incisions in the abdomen.

Both surgical techniques are considered routine procedures in this country and can often be performed on an outpatient basis. However, complications during surgery can not be ruled out. For example, the treatment guidelines of the German Society of Pediatric Surgery name wound infections (1.2% of patients affected), secondary undescended testicles (up to 13% affected, depending on age), hydrocele (0.06%), testicular atrophy (0.3%) or chronic groin pain (3.2%) as possible negative consequences of surgery in children. The recurrence rate after laparoscopic surgery tended to be slightly higher than after open surgery (4% vs. 2%). However, a general recommendation on open operations can not be derived from this. Rather, depending on the individual symptoms of the affected person to select the appropriate surgical technique. (Fp)