Inguinal Hernia

DESCRIPTION

An inguinal hernia occurs when a small tissue bulges through an opening in the muscle. Any part of the abdominal wall can weaken and develop a hernia, but the most frequent places are the groin, the navel, or the site of a previous surgical incision.

What Are The Common Symptoms?

A lump visible in the scrotum or groin area, especially when coughing or when straining and pain or pressure at the site of the hernia

Treatment Options

Surgical Procedure Open operation of the hernia-An incision is made on the site, and the hernia is repaired with a mesh or, less often, closing the muscle with sutures.

Laparoscopic hernia repair-The hernia is repaired with mesh or sutures using instruments placed inside small incisions in the abdomen.



TEP Technique

The classical TEP technique is the laparoscopic technique considered closest to ideal for inguinal hernia repair, but the technique has several drawbacks such as limited space for dissection and mesh placement, restricted port placement, a low tolerance of accidental pneumoperitoneum, and difficulty in teaching and learning the technique.

These disadvantages may explain the low implementation of the technique outside the circle of experts. We describe an extended-view modification, the eTEP technique, which overcomes several of these drawbacks.

The eTEP technique is based on the premise that the extraperitoneal space can be reached from almost anywhere in the anterior abdominal wall.

The eTEP approach can quickly and easily create an extraperitoneal space, enlarge the surgical field, provide a flexible port setup adaptable to many situations, allow unencumbered parietalization of the cord structures (proximal dissection of the sac and peritoneum), ease the management of the distal sac in cases of large inguinoscrotal hernias, and improve tolerance of pneumoperitoneum, which is a common complication.

We believe that the eTEP technique has a place in the armamentarium of the hernia surgeon. Residents and surgeons in training will find this technique easier to master.

The eTEP can expand the traditional indications of the extraperitoneal approach to patients with difficult body habitus, a short umbilicus-pubis distance, and previous pelvic surgery, and as experience is gained, the indications for traditional TEP can expand to more complex cases.

Benefits and Risks

The only way to repair a hernia is an operation. You can return to your normal activities and, in most cases, you will not experience more discomfort.

Risk of not having surgery- The pain and the size of your hernia may increase. If your bowel is trapped in the pocket of your hernia, you will experience sudden pain, vomiting, and require immediate operation. Possible complications will include the reappearance of the hernia, infection, damage to the bladder, blood vessels, intestines, or nerves, difficulty urinating; continuous pain and swelling of the testicles or the groin area.

Expectations

Before your operation – The evaluation may include blood tests and urinalysis. Your surgeon and the anesthesia provider will discuss your health history, what home medications you should take on the day of your operation, and your options for pain control.

The day of your operation-You should not eat or drink for six hours before the operation. Usually, you will take your regular medications with a sip of water.