Surgical repair of an inguinal hernia

In the embryo, the testicle is an abdominal organ that only migrates through the inguinal canal into the scrotum by the time of birth. The spermatic cord then runs through this canal to the testicle. The blood supply and the vas deferens run in the spermatic cord. As a rule, the inguinal canal closes, but it nevertheless remains a natural weak point at the lowest point of the abdominal cavity throughout life. This can lead to the bowel bulging out; this is referred to as an inguinal hernia. Women also have an inguinal canal, but it is much narrower, which is why an inguinal hernia is much rarer.

An inguinal hernia can manifest itself in various ways. Unfortunately, the narrow inguinal hernias that are difficult for laypeople to palpate are also the dangerous ones. These can be very painful. The bowel slips through the small gap and becomes trapped. This can cut off the blood supply and lead to an intestinal obstruction and must be operated on as an emergency. Larger inguinal hernias, which often become noticeable through bulges in the groin or scrotum, are less acute. They can often be pushed back into the abdominal cavity with the fingers.

Initially, yes. However, it eventually becomes noticeable through pain or, at the latest, when it reaches a certain size.

There is no prospect of spontaneous healing, as the inguinal hernia is a mechanical weak point. In fact, the opposite is the case: it must be assumed that the inevitable, recurring pressure from the abdomen will cause the finding to become larger and larger over time.

As the lower abdomen, inguinal canal and testicles are part of the urological specialty, surgery by an experienced urologist is recommended. They are very familiar with the anatomical structures, which minimises the risk of complications such as shrinkage of the testicle due to narrowing of the blood vessels. However, because the bowel is also involved in an inguinal hernia, the operation is also performed by surgeons.

Open surgery is performed via an incision in the groin area. The abdominal cavity is not opened. The hernia gap is closed with several sutures; the insertion of a mesh is normally not necessary. Access to the groin can also be gained via laparoscopy. This is possible with robotic assistance using the da Vinci method, which enables very precise and gentle work. Access is via the abdominal cavity, and the hernia is closed from the inside, so to speak. This requires the insertion of a mesh.

This question cannot be answered in general terms and depends on many factors, which are discussed in a detailed consultation before the procedure. The Goldstadt Private Clinic offers all surgical procedures for the treatment of inguinal hernias.

The advantage of the open technique is that the abdominal cavity does not have to be opened. This avoids complications that can occur after any abdominal operation, such as intestinal adhesions. In addition, no meshes need to be used to close the hernia. Like any foreign body, these carry a risk of infection, which may make another operation necessary. Should a urological procedure in the lower abdomen become necessary later in life, e.g. for prostate cancer, the previous operation not infrequently makes it considerably more difficult.

Of course, keyhole surgery offers the advantage of small incisions in the abdomen, which are usually barely visible later on. In addition, the hernia recurs less frequently. Chronic pain is also less common.

Depending on the procedure, an inpatient stay of 1–2 days is recommended after the operation. You should take it easy for some time after the operation. A follow-up examination is definitely necessary later on.

Yes, an inguinal hernia can sometimes recur, but this is the exception.