Ventral Hernia Article

Inguinal Hernias-Symptoms and Diagnosis

People who have inguinal hernias ususally complain of vague groin pain. These hernias may not present any symptoms at all, be discovered during a physical examination or be felt by the patient. Since most of these hernias rquire surgical repair, the patient must be seen by a qualified surgeon. A diagnosis is most often made upon physical examination. Sophisticated tests including ultrasound and x-rays are typically not required.

Somtimes a patient with groin pain has no history of a groin bulge and upon examination there is no physical evidence of a hernia. The outcome may be due to a groin muscle strain and not a hernia. However, if the patient describes the symptoms of a groin bulge but no hernia is found upon physical examination, a hernia is still likely to be present. Femoral hernias are often felt as pain that develops below the groin crease and are, at times, very hard to diagnose particularly in the elderly or the obese female who develps sudden groin pain.

Most groin hernias are reducible, have very little tenderness and can be performed as an elective surgery. However, if the hernia is not reducible and is tender, then there is the risk of having a strangulated bowel. This requires immediate surgery.

Treatment

People with groin hernias are usually in no need of emergency surgery, and this can be done at the patient's convenience. The incidence of non-reducible hernias remains relatively low. However, more than 2,000 deaths per year are noted in North America due to strangulated hernias. These deaths could be avoided if a prompt diagnosis had been made.

The inguinal hernias that require repair are those that are symptomatic or become enlarged over time. Hernia belts should NOT be encouraged and should only be limited to people who do not qualify for the elective surgery. The use of the hernia belt can lead to a much harder repair and a much higher risk of recurrence and/or complications. Femoral hernias should always be surgically repaired due to the high incidence of bowel strangulation. The timing of hernia repair is determined by the symptoms.

The main objective of any femoral or inguinal hernia surgery is that the defect in the abdominal wall has to be repaired. There are three basic approaches: first, the open or traditional repair using the patient's own tissue; second, tension-free repair using mesh to cover the defect; and third, laparoscopic repair which is also a tension-free repair that also uses mesh. Laparoscopic surgery is minimally invasive which cuts down on the hospital stay, recovery time, scarring and post-operative pain.

Surgical Qualifications

Surgeons who are board certified by the American Board of Surgery or the equivalent should be allowed to perform both elective and emergency inguinal surgery repair. For the most part, these doctors have successfully completed at least five additional years of surgical training after their graduation from medical school and are qualified to perform inguinal surgical repair utilizing tension-free techniques or not. Additional training is required for the doctor who is going to repair hernias laparoscopically. The surgeon's qualifications should be determined on the training he or she has, experience and outcomes.