Every person has what is known as the groin area, which is located between the pelvis and the thighs on the front of the body. This area contains important anatomical structures, including the inguinal lymph nodes, nerves, blood vessels, muscles, and tendons. The groin area serves a variety of functions, including stabilizing the body, supporting leg movements, controlling body weight, and maintaining posture. The muscles and tendons in the groin play a key role in the movement of the legs and pelvis, as do the blood vessels, while the lymph nodes play a vital role in supplying the legs and facilitating lymphatic drainage. The editorial team at Leading Medicine wanted to learn more and took the opportunity to speak with Dr. Volker Fackeldey, a specialist in hernia surgery at Klinik Kitzinger Land, primarily to find out what happens when a hernia develops.
An inguinal hernia occurs when a portion of the peritoneum—and possibly intestinal tissue—protrudes through a weak spot in the abdominal wall into the inguinal canal or the scrotum. This weak spot may be congenital or may develop over the course of a person’s life due to physical strain or other factors. Inguinal hernias are more common in men than in women, as the inguinal canal is a natural weak spot in the abdominal wall. Risk factors for developing an inguinal hernia include chronic constipation, heavy lifting, constant straining during bowel movements, obesity, or pregnancy.
“The problem with an inguinal hernia is that abdominal contents can be forced through the resulting gap in the abdominal wall. The patient typically experiences a pulling pain that can be felt in the groin or in the area of the scrotum. This pain can intensify when coughing, sneezing, or lifting heavy objects, which is why patients usually seek medical attention early on to be examined,” Dr. Fackeldey begins our conversation, adding: “Another typical symptom is a bulge in the groin area, caused by tissue protruding from the abdominal cavity into the inguinal canal. This bulge can also become more pronounced when straining during a bowel movement or exerting oneself. A general feeling of pressure or tightness may also occur, or the hernia may cause nausea, which usually happens when parts of the intestinal tissue become trapped in the hernia and bowel function is impaired as a result.” However, it is important to note that an inguinal hernia can also be asymptomatic and, in some cases, is discovered by chance during a routine examination.
“The physical examination is performed with the patient standing and lying down. The affected area is palpated to check for a bulge. An ultrasound is an optional supplement to locate the hernia and determine its size and shape. “Magnetic resonance imaging (MRI) or computed tomography (CT) scans are not necessary,” explains Dr. Fackeldey. In some cases, it can be difficult to diagnose an inguinal hernia, especially if it is small or does not present typical symptoms.
The treatment of an inguinal hernia depends on various factors, such as the size and severity of the hernia, the patient’s age and overall health, as well as other individual factors. Inguinal hernias should generally be treated surgically, especially if they cause symptoms or grow larger. If left untreated, an inguinal hernia can lead to serious complications, such as intestinal obstruction or impaired blood supply. The surgery to repair an inguinal hernia is called hernia repair and can be performed in two ways: open hernia repair or minimally invasive laparoscopy. “The use of so-called hernia trusses is obsolete, as they really don’t help at all. This form of treatment actually dates back to the Middle Ages. If the patient is not a candidate for surgery, it is best to leave everything as it is. However, since surgical treatment can be performed without general anesthesia, surgery is always the primary treatment option,” explains Dr. Fackeldey, emphasizing that 97% of surgical procedures are performed using mesh.
An inguinal hernia can cause various complications if left untreated or if treatment is unsuccessful. Some of the possible complications of an inguinal hernia include:
Incarceration: If a portion of the intestine or other organs becomes trapped in the inguinal canal, this can lead to a disruption of blood supply and tissue necrosis. This is a medical emergency and requires immediate medical attention.
Strangulation: A rare but serious complication of an inguinal hernia is strangulation. In this condition, the hernial canal becomes so narrow that the intestine or other organs are constricted, cutting off the blood supply. This can lead to immediate tissue death.
Recurrence: After treatment for an inguinal hernia, the hernia may reappear, a condition known as recurrence. This can be due to various reasons, such as inadequate repair of the hernia or weakening of the tissue at the surgical site.
Infection: An infection may occur after surgery to repair an inguinal hernia if bacteria enter the surgical wound, leading to pain, swelling, fever, and other symptoms.
Chronic pain: In some cases, chronic pain may occur in the area of the inguinal hernia, even after successful treatment of the hernia. The exact cause of this pain is not always known.
Inguinal hernia surgery using a mesh is a relatively safe procedure with a low complication rate.
A special mesh is placed over the hernia site. The mesh serves to reinforce the weak spot in the abdominal wall and prevent a recurrence of the hernia. “In children and young women, surgery is also possible without the use of a mesh, as hernias in this patient group are usually rather small. In Germany, we have very high-quality mesh in terms of material, sourcing, and mesh size. Most meshes are pre-configured, making them very easy to insert and well-tolerated by patients,” says Dr. Fackeldey, who reassures patients that they generally spend only one night in the hospital after surgery. “Once the patient has left the hospital, they should take it easy for about three weeks. After that, everyone can return to their normal daily routine,” explains the hernia specialist.
Although there is no sure way to completely prevent an inguinal hernia, there are some measures that can reduce the risk of developing one. These include avoiding being overweight, which increases the risk of a hernia because it increases pressure in the abdominal cavity and thus also the strain on the groin and the inguinal canal. Lifting heavy objects can also increase pressure in the abdominal cavity and thereby raise the risk of a hernia. “In most cases of inguinal hernia, however, one can simply say that the person just had bad luck. It’s clear, though, that an overweight person with asthma is at greater risk than others,” explains Dr. Fackeldey, whose clinic performs approximately 600–750 hernia surgeries per year.
Preventive Measures
Regular physical activity, such as walking or swimming, can help strengthen the abdominal muscles and reduce the risk of an inguinal hernia. A high-fiber diet and adequate water intake can also help, as they prevent constipation, which can lead to excessive straining during bowel movements. And, of course, smoking is also a factor here, as it can reduce blood flow to the various tissues in the abdominal cavity.
Dr. Fackeldey, Chief of the Department of General, Vascular, and Visceral Surgery, founded the Hernia Center in Kitzingen and is a member of the German Hernia Society and the Surgical Working Group on Hernias of the German Society for General and Visceral Surgery. He concludes our conversation on a positive note: “It’s worth noting that we’re able to perform hernia surgery at a very high level. Laparoscopic surgery was a major breakthrough many years ago and allows patients to undergo a much less invasive procedure with a faster recovery time.”
Dr. Fackeldey, thank you very much for the pleasant conversation and your optimistic outlook on hernia surgery!
