Groin Or Inguinal Hernia

An inguinal hernia occurs when internal organs – commonly part of the intestine – protrude through a weak area in your lower abdominal wall (groin) producing a bulge under the skin.

Inguinal hernias can occur at any age and seem to be more common in men than in women. Most hernias occur as a result of a pre-existing weak area in the abdominal wall and an increased pressure within the abdomen. An inguinal hernia may develop at birth because the abdominal lining (peritoneum) does not close properly leaving a weak area through which intestines can protrude. Alternately, the weakness develops later in life as a result of aging, an injury or certain operations in the abdominal cavity. Regardless of whether or not you have a pre-existing weakness, increased pressure in your abdomen can cause a hernia. This pressure may result from straining during bowel movements or urination, from heavy lifting, from fluid in the abdomen (ascites), and from pregnancy or excess weight. Even chronic coughing or sneezing can cause abdominal muscles to tear.

Groin or inguinal hernia

Some people may not have any symptoms from an inguinal hernia and the hernia is discovered only during an examination by a doctor. More often, however, you can see a bulge in the groin that becomes more prominent on standing, coughing or straining. Other symptoms from an inguinal hernia include pain or discomfort in the groin while bending, lifting heavy objects or straining at the time of bowel movements. There may also be a dragging sensation in the groin. Occasionally, you may notice a swelling around the testicle when the hernia becomes large and the intestines descend into the scrotum. Pain in a swelling in the groin that does not reduce in size on lying down or upon applying pressure is a serious symptom and may indicate that part of the intestine has become stuck in the hernia.

Blocked intestines in an obstructed hernia

An inguinal hernia is usually diagnosed by the doctor by performing a physical examination. You will have to undergo certain laboratory tests, x-ray of the chest and ECG as a part of workup before surgery when this is suggested by your doctor.

An inguinal hernia once formed never goes away or becomes smaller on its own. Large hernias can extend into the scrotum, put pressure on surrounding tissues and become painful. Most serious complications of an inguinal hernia are strangulation or incarceration. When a part of the intestine or other internal organ gets caught in the hernia and become pinched the bulge in the groin becomes prominent and it does not go back in. As the blood supply of that tissue becomes compromised the person experiences severe pain. It may be accompanied by nausea or vomiting. This is a serious complication and the trapped tissues will die if surgery is not performed promptly.

There are no medicines that can treat an inguinal hernia.
A truss is a belt with a large pad on it that applies pressure to the site of the hernia with the aim of keeping the bulge from popping out. Overall, a truss is not a good idea because it does nothing to repair the hernia. It just minimizes symptoms by preventing significant herniation. As a result, the hernia continues to get larger. In addition, there will be scar tissue formed that provides no strength to the area. Both of these factors, enlargement of the hernia and scarring, make the surgical repair of the hernia more difficult and later recurrence more likely. Therefore, a truss should never be used as a treatment for an inguinal hernia.
The only definitive treatment for an inguinal hernia is surgery.

This technique of hernia repair is performed under general anaesthesia. Your surgeon will make a small (1cm) cut near the navel and introduce a cannula
(a tube-like instrument) inside the abdomen or between the muscles of the abdomen. He will insert a laparoscope (a telescope) attached to a miniature video camera through the cannula that gives him and the operating team a magnified view of your internal organs on a video monitor. He will then place two additional cannulas through tiny (5mm) cuts to accommodate special long instruments. The surgeon will pull the hernial sac back into the abdominal cavity and expose the weak area in the abdominal wall from inside. This area is covered with a mesh that is fixed to the abdominal wall. Following the repair, the surgeon will close the small incisions with stitches.

Mesh being placed over the weak area

Long incision of open hernia repair

Tiny incisions of laparoscopic hernia repair

How soon you are allowed to drink liquids and eat food after your hernia operation depends on the type of anaesthetic used. If you have had an open operation using local anaesthesia, you will be allowed to eat and drink soon after the operation. You may have be kept fasting for up to six hours if the operation was carried out under spinal or general anaesthesia. You may be given a saline drip for a few hours. In the first few hours after recovery you may experience some nausea, but this soon passes away.

After any hernia operation there is some pain at the site of the cut for a few days. With the laparoscopic operation this is much less as compared to the open repair. You will be prescribed medicines to control the pain. Also, you will be encouraged to get out of the bed soon after the operation despite the slight discomfort. Over a period of time the pain will gradually reduce and become almost negligible.

This depends very much on the nature of the job you do and the type of operation you have had. With the open repair you may be advised take it easy for up to six weeks and you will not be allowed to lift heavy objects for up to three months. If you have a laparoscopic repair you can return to light desk job work within 8 – 10 days after surgery and almost all activities will be permitted after about 15 days after surgery. Lifting of heavy weights (> 10 kg), however, should be delayed till around 8 weeks after surgery.

Only after a thorough examination can your surgeon determine whether laparoscopic hernia repair is right for you. The procedure may not be best for you if you have had previous abdominal surgery or have underlying medical conditions due to which you cannot be given a general anaesthetic.

The cost of a laparoscopic repair of an inguinal hernia tends to be higher than the open repair as a special instrument (tacker) is used to fix the mesh from inside. However, the increased cost is more than offset by savings in terms of an earlier return to activities, to work and reduced disruption of the routine of the family caring for the patient in the hospital.

  1. Less pain from the incisions after surgery
  2. Shorter hospital stay
  3. Shorter recovery time
  4. Faster return to normal diet
  5. Faster return to work or normal activity
  6. Better cosmetic healing
  7. Ability to repair of hernias on both sides through the same small incisions (instead of a long cut on each side)
  8. Operation through an area undisturbed by previous surgery in cases of recurrent hernias
  9. Less chance of chronic groin discomfort as compared to an open operation

Publications and abstracts

  1. Bhandarkar DS, Date RS, Tamhane RG. Irreducible tubo-ovarian inguinal hernia. J Indian Med Assoc 1993; 91: 186.
  2. Bhandarkar DS. Randomized clinical trial of laparoscopic versus open inguinal hernia repair (Letter). Br J Surg 1999; 86: 1226-27.
  3. Bhandarkar DS, Katara AN, Shah RS, Udwadia TE. Transabdominal preperitoneal repair of a port-site incisional hernia. J Laparoendosc Adv Surg Tech 2005; 15:60-2.
  4. Bhandarkar DS, Shankar M, Udwadia TE. Laparoscopic surgery for inguinal hernia – current status and controversies. J Minim Access Surg 2006; 2:178-86.
  5. Mittal G, Bhandarkar DS, Katara AN, Udwadia TE. Temporary obturator nerve paresis following spray of local anaesthetic during laparoscopic extraperitoneal hernia repair (Letter). Surg Laparosc Endosc Percutan Tech. 2010;20:357
  6. Salgaonkar H, Gouda V, Behera RR, Katara A, Bhandarkar DS. Encapsulated seroma following abdominal incisional hernia repair. Abdominal Wall Repair J 2013;1:1:11-14.

Book chapters

  1. Bhandarkar DS. Laparoscopic surgery for groin hernias – controversies and results. In, Introduction to Endohernia Surgery – A Monograph, 2005

Presentations, invited lectures & videos

  1. Bhandarkar DS, Punjani RM. Hernioscopy – laparoscopy via the hernial sac. Annual Conference of Maharashtra Chapter of ASI, Nasik, 2002.
  2. Bhandarkar DS, Mittal G, Katara A, Udwadia TE. Laparoscopic repair of incisional hernias at unusual locations. Annual Conference of International College of Surgeons – Indian Section, Amritsar, 2009.
  3. Mittal G, Bhandarkar DS, Katara A, Kochar R, Udwadia TE. Laparoscopic repair of non-midline hernias. ASICON 2010, New Delhi, 2010.
  4. Katara AN, Bhandarkar DS, Behera R, Udwadia TE. Laparoscopic management of non-midline ventral hernias: a customized approach. Annual Conference of APHS, Bangkok, 2012.
  5. Bhandarkar DS, Behera RR, Katara AN, Udwadia TE. Laparoscopic management of non-midline ventral hernias: a customized approach. AMESCON 2012, Dubai, 2012.
  6. Bhandarkar DS. Transabdominal preperitoneal repair of inguinal hernia. How I do it? Hernia Symposium, Surgical Society Thane, 2007.
  7. Shankar M, Bhandarkar DS, Shah RS, Udwadia TE. An all-suture technique for fixation of mesh in laparoscopic repair of paraumbilical hernia. ASIAPACIFICON 2005, Mumbai, 2005.
  8. Katara AN, Bhandarkar DS, Shankar M, Kochar R, Udwadia TE. Transabdominal preperitoneal repair of a port site hernia. ELSA 2007, Hyderabad, 2007.
  9. Bhandarkar DS, Katara AN, Kochar R, Udwadia TE. Laparoscopic ventral hernia repair – all sutures technique. MASICON 2008, Kolhapur, 2008.
  10. Bhandarkar DS. Managing non-midline ventral hernias – tricks of the trade. Annual Conference of Hernia Society of India, Indore, 2009.
  11. Bhandarkar DS. How I do it? Transabdominal preperitoneal repair of inguinal hernia. Continuing Surgical Education Program, Rajkot Surgical Society, Rajkot, 2012.
  12. Behera RR, Salgaonkar H, Katara AN, Bhandarkar DS. Trans-abdominal partially extraperitoneal (TAPE) repair of a peri-inguinal hernia. AMASICON 2013, Indore, 2013.

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