How to treat Inguinal Hernia
Written by:When and how does an inguinal hernia develop? Which therapies can solve this pathology? Dr. Salvatore Martelli, an expert in General Surgery in Turin, talks about this disease.
What is Inguinal Hernia?
The hernia is the exit of a viscera from the cavity in which it is normally contained through a weak point or an anatomical structure, which is also natural. We say this to distinguish normal hernias from those hernias that can take over when the point of abdominal weakness, for example in the athlete, consists of a wound or surgical scar. The latter are called laparocele.
The normal inguinal hernia is instead a primitive hernia due to leakage of intestinal loops through the inguinal canal. The inguinal canal is a structure that is born with the organism and is due to the descent of the testis in the male from the point where it is embryologically formed, ie in the abdomen, outside the scrotum. Normally, the testicle begins to form in the abdomen and during gestation the emigration of the testis takes place from the abdomen to the scrotum. Normally the testis migration begins at the 25th week and ends only at the 40th week. The testis from the abdomen rests inside the wall and the muscles expand to allow the testis to pass through the scrotum. This dilation occurs through the inguinal canal, which should be closed at the time of gestation. However, we know that some children are already born with hernias or that hernia manifests itself early in the first months or years of life. Generally this is due to the closure of this natural communication between abdomen and scrotum.
In women the mechanism is always the same: there is a weakness, which is due to the fact that the uterus is attached and held suspended by a ligament (round ligament) that crosses the abdominal wall to latch out to the soft parts in front of the pubic bone.
When and how does a hernia manifest itself?
Hernia can be formed at any age, mainly between 20 and 60 years. Hernia in children and adolescents is not uncommon, however. When the hernia manifests itself for the first time in the elderly person, the main symptoms are the following: the leakage of an intestinal loop through this channel generates tension and sometimes pain, but above all that which impresses and which denounces the presence of the hernia is inguinal swelling. In general, it is however easily reducible. In other cases, the hernia can also manifest itself acutely as a result of "incarceration" or "choking". This happens when suddenly, due to an abnormal dilation of the inguinal canal, a fair amount of loop comes out and remains forced, strangled in the contraction of the musculature in the abdomen. In this case, strangulation of the loop introduces an ischemia, that is a difficulty in blood circulation of the loop, which can lead to the necessity of resection of the loop itself.
What are the techniques for treating groin herniation?
When the inguinal hernia manifests itself with great pain, reduction maneuvers are tried which in most cases offer good results, at other times, when the reduction maneuvers are unsuccessful, urgent intervention is used. The operation consists of putting the herniated sac back into the abdominal cavity through the inguinal canal: the surgeon must proceed to detach the hernial sac from the elements of the spermatic cord and release the sac and the anxieties it contains in the abdomen. Therefore, in reality, when a hernial plastic surgery is performed, a hernia is not removed, but the herniated viscera is repositioned in the abdomen and closed, reinforcing the abdominal wall by means of a prosthetic network.
A new solution for groin hernia: the prosthetic network
The prosthetic network consists of a small sheet of plastic material, which is generally polypropylene. This is a prosthesis for the man that fits between the muscular layers. The prosthesis should not be placed below the skin or below the subcutaneous fat, but it is inserted between the three muscular layers that make up the abdominal wall in the groin area.
What are the advantages of the prosthetic network?
The use of the prostheses has led to important advances in the treatment of the hernia, because, thanks to the prosthesis, the stabilization of the wall takes place immediately and therefore already a few hours after surgery the patient, depending on the type of anesthesia benefited, he can stand up and move freely, accusing only a slight annoyance. The implant of the prosthesis is therefore a safe technique, relatively simple and more refined than any other previous technique. Once performed, the patient can return to his work and social activities in a short time.