The groin is a weak point of the abdominal wall, because it is the passageway of diverse elements from the abdomen to the thigh, including major blood vessels and the spermatic cord in males. Thus, this type of hernia is more frequent in males than in females. It can occur at any age, in infants, in adults, even in athletic men, as well as in older people.
The diagnosis is essentially based on physical examination. In most cases, an experienced surgeon does not need any complementary exam. The hernia forms a bulge in the groin, which is easily reduced by gentle manual pressure, sometimes with a gurgling noise.
The treatment of an inguinal hernia consists of reinforcing the abdominal wall by closing the hernia orifice, while preserving the passageway for the spermatic cord in male patients.
Traditional suturing methods, such as the well-known Shouldice technique, induce tension on the suture line, which is responsible for intense postoperative pain and the risk of tearing and recurrence. Consequently, they are abandoned today.
Nowadays, the hernia orifice is patched with a thin, but strong net of synthetic material, which achieves a tension-free repair, thus minimizing postoperative pain as well as the risk of recurrence.
The patch can be placed either onto the outer surface of the muscular wall (onlay), or on the inner aspect of the wall (sublay).
The onlay patch technique (Lichtenstein method) is the most commonly used because it is the easiest, but this technique entails some drawbacks. As a matter of fact, since the patch tends to be separated from the abdominal wall by the intra-abdominal pressure, strong fixation by sutures or staples is required. Entrapment of the small sensory nerves running in the inguinal canal, or even the simple irritation induced by the contact between the patch and the nerves, can induce long-lasting (chronic) pain. With the Lichtenstein technique, the mean incidence of chronic pain is 10 to 12%, and pain can be disabling in 2 to 6% of the cases, impairing quality of life.
On the contrary, the sublay patch, placed between muscle and peritoneum, in the deep location, does not contact the nerves running on the other side of the muscular wall and does not require fixation, because the intra-abdominal pressure tends to apply the patch to the abdominal wall instead of separating it. Therefore, the incidence of chronic pain is reduced to a minimum, as evidenced by comparative studies.
At the Hernia InstituteParis we use laparoscopy to place the patch in the sublay location, by three small holes – five and ten mm – without any incision in the groin. Damage to the abdominal wall is thus minimal, pain is quite nil, return to full activity is allowed in a few days, and the short scars rapidly become invisible.
The site where femoral hernias protrude in the groin is a little bit lower, than that of inguinal hernia, close to the femoral vessels.
This type of hernia is less frequent than inguinal hernia and it is more frequent in females than in males. Femoral hernias are generally small, and in some cases the diagnosis may be difficult.
The treatment of femoral hernias is very similar to that of inguinal hernia. At the Hernia InstituteParis we usually perform laparoscopic repair with a patch.
Due to the small size of the hernia orifice of femoral hernia, the risk of strangulation is much higher than for inguinal hernia. This complication can be life-threatening, particularly in older people, when intestinal resection is necessary. Therefore, every femoral hernia diagnosed should be operated, to prevent the risk of strangulation.