This is the commonest type of hernia and most commonly appears as a lump in the groin. These can occur at any time in life from infancy to old age. 95% occur in men and patients often present with a lump in both groins.
Signs & Symptoms
- Pain in groin can be worse with exercise
- Intermittent lump in groin often slowly increasing in size over time
- Discomfort in testicle
- Rarely, an internal organ can become trapped within the hernia causing pain and sometimes vomiting. This is known as strangulation and requires emergency surgery.
The natural history of these hernias is that they tend to increase in size over time and occasionally are at risk of strangulation. Surgery is therefore usually recommended.
Surgery has been performed to repair groin hernias for nearly 150 years and many procedures have been described. Today the options are between open and laparoscopic procedures and almost always employ the use of prosthetic mesh (link to mesh )
Open mesh repair – this is the most widely employed technique in the United Kingdom. It requires an incision in the groin and the use of usually plastic mesh to repair the defect. This operation carries the advantages that it is simple to undertake, requires minimal technology and if necessary can be performed under local anaesthetic.
Laparoscopic procedures - these minimally invasive procedures carry the advantage of rapid post operative recovery. Patients often experience minimal discomfort following surgery and can therefore resume normal activities rapidly. Laparoscopic operations carry the significant advantage that patients with hernias on both sides can be treated at the same time with minimal additional discomfort. Some patients present with recurrent hernias following failure of a previous operation. Laparoscopic repair is the procedure of choice in these patients as the risk of damaging nerves and blood vessels supplying the testicle are lower than a second open operation.
TEP (totally extra-peritoneal) this is an advanced laparoscopic procedure. The surgery is performed through very small incisions whilst visualisation is accomplished with the use of a telescope and high resolution camera. The abdominal cavity is not actually entered and the surgery is undertaken between the peritoneum and abdominal wall muscles. Following reduction of the hernia prosthetic mesh is placed behind the defect to prevent recurrence.
TAPP (trans-abdominal pre-peritoneal) this is similar to TEP but the abdominal cavity is entered before the hernia is reduced. Consequently patients can experience shoulder pain because of gas within the abdominal cavity and there is a theoretical risk to internal abdominal organs.
Complications of surgery are rare and in competent hands there is probably no difference between laparoscopic and open operations although there is some evidence that the incidence of chronic groin discomfort following lap repair is lower than following open procedures.
- Hernia recurrence
- Continuing pain in the groin
- Urinary retention
Recovery is usually rapid and many patients return home on the same day as their operation. Studies suggest that patients resume all normal activities one to two weeks faster following laparoscopic operations. Most people are back to normal within two weeks of surgery.