Inguinal hernia is a condition in which part of the abdominal organs (often the intestine) passes through a weakened part of the abdominal wall in the groin area. This condition can be congenital or acquired during life due to increased pressure in the abdomen.
An inguinal hernia is very common, particularly in men. Approximately 27% of men and 3% of women develop an inguinal hernia during their lifetime, with men being about nine times more likely to experience it due to anatomical differences in the groin area. It most frequently occurs in children and older adults, with cases in newborns and infants often resulting from a congenital defect. Diagnosis is typically based on a physical examination, where a doctor may ask the patient to stand and cough to make the hernia more visible. In some cases, imaging methods such as ultrasound, CT, or MRI may be required for confirmation.
- A visible bulge in the groin or scrotal area that may enlarge when coughing, lifting heavy objects, or straining
- Pain or discomfort in the groin area, which may be dull or sharp and worsen with physical activity and improve with rest
- A feeling of heaviness or pulling in the groin area, often associated with hernia enlargement
- Swelling in the scrotal area (in men) accompanied by pain can occur if part of the intestine protrudes into the scrotum
- Sudden, intense pain accompanied by nausea and vomiting
- A red, purple, or dark bulge, which indicates that blood flow to the intestine has been cut off, a medical emergency
- Symptoms of bowel obstruction, such as bloating, inability to pass stool, or gas
Treatment for a hernia may be conservative (observation) or surgical. Surgical intervention is often recommended, especially if the hernia is symptomatic or at risk of complications. There are two main types of surgical procedures: open hernioplasty and laparoscopic hernioplasty.
For a better understanding and management of this condition, it is important to consult with a physician who can provide individual recommendations based on specific patient needs and health status.
Laparoscopic hernioplasty is a modern and less invasive approach to treating inguinal hernias, offering faster recovery and less postoperative pain compared to traditional open surgery. Two of the most commonly used laparoscopic approaches for repairing inguinal hernias are TAPP (Transabdominal preperitoneal) and eTEP (Enhanced-view Totally Extraperitoneal).
TAPP (Transabdominal Preperitoneal)
- Performed laparoscopically through the abdomen
- The surgeon makes small incisions in the abdominal wall through which a laparoscope and other tools are inserted
- The abdominal cavity is inflated with gas (usually carbon dioxide) for better visualization
- After visualizing the inguinal area, the surgeon identifies the hernia and gently separates the peritoneum (lining of the abdominal cavity) from the abdominal wall
- The hernia sac is pushed back into the abdominal cavity, and the defect in the abdominal wall is covered with a synthetic mesh that is secured in place
- Finally, the peritoneum is returned to its original position, and the incisions are closed
- Good overview of the abdominal cavity and hernia area
- Ability to address other potential pathologies in the abdominal cavity during surgery
- Faster recovery and less postoperative pain compared to open surgery
eTEP (Enhanced-view Totally Extraperitoneal Repair)
- The eTEP approach is more advanced and less invasive, avoiding entry into the abdominal cavity
- The surgeon creates access through a small incision under the skin and muscles, avoiding entry into the peritoneal cavity
- Inflating the spaces under the abdominal wall with gas allows the surgeon to see and work in this area without opening the abdominal cavity
- The hernia sac is returned to its place, and the defect is covered with a synthetic mesh that is securely fastened
- Incisions are small and heal quickly
- Less invasiveness and reduced risk of injury to abdominal organs and tissues
- Lower risk of peritoneal complications, such as adhesions
- Faster recovery and less postoperative pain
Postoperative recovery and return to normal life - TAPP vs. eTEP comparison
Laparoscopic TAPP and eTEP approaches offer significant advantages over traditional open inguinal hernia surgeries in terms of recovery and return to normal life. Both approaches typically allow for faster recovery, less pain, and shorter hospital stays.
- Most patients can leave the hospital on the day of surgery or the following day
- After surgery, mild to moderate pain may be present, which is manageable with common analgesics. Pain at the incision sites and abdominal bloating from gas is common.
- Recovery generally takes 1-2 weeks until the patient feels well enough to return to normal activities. Return to strenuous physical activity and sports is recommended after 4-6 weeks.
- Complications - complications such as bleeding, infection, or organ damage may rarely occur. Adhesions and ileus are rare but possible.
- Similar to TAPP, most patients can leave the hospital on the day of surgery or the following day
- Pain and discomfort are typically milder than with TAPP because this approach avoids entry into the peritoneal cavity. Pain at the incision sites is less pronounced.
- Recovery - recovery is often faster, sometimes within 1 week. Return to normal activities is possible sooner, and patients can return to strenuous physical activity after 2-4 weeks.
- The risk of complications is lower, especially regarding injury to abdominal organs and adhesions. Infections and bleeding are also less common.
- Common activities - most patients can return to normal activities within 1-2 weeks
- Work - return to work is possible after 1-2 weeks, depending on the nature of the work. Physically demanding work may require 4-6 weeks.
- Sports and physical activity - lifting heavy objects and intense physical activities are not recommended before 4-6 weeks after surgery
- Common activities - usually within 1 week
- Work - most patients can return to work within 1 week, although physically demanding work may require 2-4 weeks
- Sports and physical activity - patients can resume sports and physical activity after 2-4 weeks, which is a shorter time than with TAPP
Both TAPP and eTEP approaches have their advantages and are effective in treating inguinal hernias. TAPP provides an excellent overview of the abdominal cavity and is suitable for addressing other pathologies, while eTEP offers a less invasive approach with faster recovery and less discomfort. The choice of method should be based on the patient's individual needs.