Inguinal hernia strikes: How to identify and remove a hernia?

Author: Jiang Fengru, attending physician at Beijing Chaoyang Hospital, Capital Medical University

Reviewer: Shin Youngmo, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Inguinal hernia, an ancient and common surgical disease, has been with human life since ancient times. From the historical records before the Common Era in the West to the pictographic interpretation of the Chinese character "hernia", the essence of this disease is deeply described - a bulge on the abdominal wall. With the continuous advancement of medical technology, our understanding of inguinal hernia is becoming more and more in-depth, and the treatment methods are becoming more and more perfect.

Inguinal hernia, commonly known as "small intestinal hernia", is the most common type of extra-abdominal hernia, accounting for about 85%-90% of all extra-abdominal hernias. Its main manifestation is the appearance of a reducible mass on the abdominal wall in the groin area (i.e. the root of the thigh). The mass appears when standing, coughing or moving, and disappears when lying down or pressing with hands. The herniated contents are mostly small intestines, followed by tissues with high mobility such as the greater omentum.

The cause of this disease is mainly based on an anatomical weak point, which consists of an oval area with a diameter of about 7.5 cm, called the myopubic foramen. This area lacks sufficient muscle coverage and has only a layer of fascia to withstand the increased abdominal pressure caused by the evolution of humans to walk upright. Therefore, inguinal hernias are prone to form here and are divided into three types: direct hernia, indirect hernia and femoral hernia, which are named according to the location of the hernia ring.

Figure 1 Original copyright image, no permission to reprint

The formation of inguinal hernia is also closely related to human development and aging. The incidence rate is high in newborns, especially premature infants, because the abdominal wall is not fully developed. The incidence rate of elderly people is also significantly increased due to the degeneration and thinning of the abdominal wall tissue, as well as the susceptibility to diseases such as chronic constipation, cough and urinary retention that increase abdominal pressure. According to statistics, the incidence rate of inguinal hernia in men aged 60 is about 1%, while it rises to 44% at the age of 75.

The diagnosis of inguinal hernia is relatively simple. In most cases, an experienced doctor can confirm the diagnosis through physical examination. During the physical examination, the doctor will feel a reducible mass in the groin area and make a preliminary diagnosis based on the patient's description of symptoms. For some complex or unclear cases in the early stages, further confirmation can be performed through imaging examinations such as B-ultrasound or CT.

Once an inguinal hernia is diagnosed, it requires surgical treatment. With the development of medical technology, the surgical method of inguinal hernia has undergone a major transformation from traditional simple suture to the patch repair that is widely used today. The recurrence rate of hernia treated with traditional suture is as high as 30% or even higher, while the recurrence rate can be reduced to less than 1% after repair with a patch. The choice of patch material is closely related to the specific situation of the patient. For example, for children aged one to seven years old, laparoscopic high ligation of the hernia sac is usually used; for adolescents in a period of rapid growth, biological patches tend to be used; while adults and the elderly choose open or laparoscopic surgery according to their health status, and choose the type of patch according to the surgical procedure and the specific situation of the hernia.

Currently available patch materials are diverse, including synthetic materials (such as polypropylene) and biological materials (such as porcine small intestinal mucosal epithelium). Synthetic materials have a stronger repair effect, while biological materials can be completely absorbed and no foreign matter remains in the body in the long term. It is worth mentioning that all patches have undergone rigorous clinical trials and have been approved by the State Food and Drug Administration to ensure their biocompatibility and safety. In addition, in order to avoid postoperative infection, sutures that are prone to bacterial growth, such as silk threads, should be avoided during surgery. Once an infection occurs, it must be treated in a timely manner, and the infected patch must be removed if necessary. The current surgical treatment of inguinal hernia has a significant effect, and the recurrence rate has been greatly reduced, becoming one of the important advances in modern surgery.

Figure 2 Original copyright image, no permission to reprint

The prognosis of inguinal hernia is usually good. After timely surgical treatment, most patients can fully recover. However, if not treated in time, the mass may gradually increase in size, and even become incarcerated and strangulated, leading to serious consequences such as intestinal necrosis. Therefore, once a reducible mass is found in the inguinal area, it should be examined and treated by a doctor in time.

The key to preventing inguinal hernia is to strengthen the abdominal wall muscles and reduce abdominal cavity pressure. For the elderly, they should avoid behaviors that increase abdominal pressure, such as standing for long periods of time, coughing, and constipation. They should also do appropriate physical exercise to strengthen the abdominal wall muscles. For children, especially premature infants and children with congenital abdominal wall development defects, regular examinations should be conducted to promptly detect and treat potential hernia risks.

In addition, with the continuous advancement of material science, the performance of hernia repair patches is also being continuously optimized. Both synthetic materials and biological materials have greatly improved surgical safety and postoperative comfort. In the future, with the continuous development of medical technology, the treatment of inguinal hernia will be more accurate, effective and humane.