Inguinal (Groin) Hernia

Groin Hernia (Inguinal hernia)

Groin hernias occur at the junction of the lowest part of the belly, just above where your legs begin (in the groin crease).  The junction of the lower abdominal wall muscles and the pelvis is thinner than the rest of the belly. This is especially true for men because the testicles start out inside the belly and later descend into the scrotum just before being born. The muscles have to open up to allow the testicles to pass and then close behind once they have completed their descent. Unfortunately, this process is not always perfect and the closure is incomplete. The problem is further worsened because the muscles cannot ever completely close due to the fact the the spermatic cord is in the way. Groin hernias can occur in both women and men but are far more frequent in men due to the issue with testicular descent.

Groin hernias can occur at anytime and in fact many young children undergo hernia repair. Groin hernias may be the source of groin, hip, lower abdominal, testicular, or leg pain. Many times groin hernias are present but go unnoticed if there is no bulge or pain.

Groin hernias do not always have to be fixed immediately when they are found and in fact many people know they have small hernias, that only cause minimal discomfort,  and they choose to live with their hernias. Hernias should be considered for repair if they are moderately large, becoming larger and / or starting to cause substantial pain. Hernias should generally be repaired while they are small as it generally is an easier, less complicated surgery to recover from.  20-25% of people will decide to have surgical repair of their groin hernia with 18 -24 months of finding out they have a hernia due to increasing size and / or pain. This number rises to about 50% by 5 years.

Groin Hernia Surgery:

There are 3 common types of surgery performed: Open,  Laparoscopic or Robotic. The majority of hernia repairs are performed using mesh as it has been shown to reduce the risk of recurrence (hernia coming back) by 50-75%.

Open Surgery:

An incision is made in the groin over the hernia itself. The muscle layers are split until the inguinal canal and hernia are reached. The hernia is then repaired by sewing the muscles together with suture (string) and /or placing a piece of mesh.

Open groin hernia surgery is still the most widely performed style of surgery in the world, the two  most common procedures are the Lichtenstein repair and the Shouldice repair.

The Lichtenstein repair is known as a “tension free” repair and always uses a piece of mesh to close the hole (hernia) so that the muscles do not have to be pulled tightly together. This was the first repair to be extensively studied and demonstrate superior results when compared to traditional operations that did not use mesh. Expected risk of hernia recurrence after a properly performed repair is generally expected to be less than 1%. The repair occurs in the same area as 3 important nerves and small portion of patients undergoing this hernia repair report chronic pain

The Shouldice repair also requires an open cut in the groin but does not use mesh for reinforcement of the repair, rather the lower abdominal wall muscles are pulled tightly together in order to eliminate the hole (hernia).  The Shouldice repair, when studied by surgeons other than those at the Shouldice Clinic itself,  generally have noted increased pain, longer post op recovery times and higher recurrence rates than similar repairs performed with mesh.

Laparoscopic Surgery:

Laparoscopic surgery is performed by placing 3 small holes in the abdomen within a few inches of the belly button. Instruments are then used to repair the hole (hernia) from the inside of the muscles of the abdominal wall. Mesh is almost always used and the muscles themselves do not need to be pulled together in this type of repair.

This repair is associated with a low risk of recurrence and is generally associated with less post operative pain and a quicker return to normal activities. The risk of chronic nerve pain is low but may be increased if permanent tacks are used to secure the mesh into position.

Robotic Surgery:

Robotic surgery is an advanced form of laparoscopic surgery. The improved technology allows for more precise dissection of the hernia and surrounding important structures( nerves and blood vessels). This allows for larger and more complex hernias to be repaired and also allows for the placement of large sheets of mesh without the use of permanent tacks which should result in less risk of chronic pain.

Robotic surgery is performed from behind the muscles and if an unknown hernia is found it may be repaired at the same time so that a second future operation is not required. The repair requires about an hour to perform and is almost always an outpatient (same-day surgery).

Patients generally are the most sore within the first 48 hours but have excellent pain control with only over the counter medicines such as tylenol and motrin. Patients are free to perform non-strenuous daily activities ( including going up and down stairs) immediately after surgery. Strenuous exercise is recommended to be postponed for a minimum of 2-4 weeks to allow the mesh to become integrated and secure. Light exercise such as walking and stationary bicycling can generally be safely performed within days after the surgery. Most patients with desk jobs return to work within 1-2 weeks. Manual laborers may require 2-4 weeks before return, depending upon the specific requirements of their jobs.

Contact Us Today at 248-551-9090 to schedule your consultation with an expert in Robotic Inguinal Hernia Repair