INGUINAL HERNIA

Definition

• Inguinal hernia is the protrusion of abdominal contents through a weakness in the inguinal region of the abdominal wall.
• It occurs above the inguinal ligament in the groin area.
• It is not related to the navel.

Anatomy of Inguinal Canal

• A short oblique passage in the lower anterior abdominal wall.
• Extends from internal (deep) inguinal ring to external (superficial) inguinal ring.
• Contents:
  • Male: spermatic cord
  • Female: round ligament
• Boundaries:
  • Anterior wall: external oblique aponeurosis
  • Posterior wall: transversalis fascia
  • Roof: arching fibers of internal oblique and transversus abdominis
  • Floor: inguinal ligament

Types of Inguinal Hernia

1. Indirect Inguinal Hernia

• Most common type.
• Hernia sac enters through the deep inguinal ring.
• Passes through inguinal canal.
• Lies lateral to inferior epigastric vessels.
• Often congenital.
• Common in young males.

2. Direct Inguinal Hernia

• Hernia protrudes directly through posterior wall of inguinal canal.
• Occurs in Hesselbach’s triangle.
• Lies medial to inferior epigastric vessels.
• Usually acquired.
• Common in elderly.

3. Femoral Hernia

• Protrudes through femoral canal.
• Lies below and lateral to pubic tubercle.
• More common in females.
• High risk of strangulation.

Causes / Risk Factors

• Congenital weakness of abdominal wall.
• Increased intra-abdominal pressure:
  • Chronic cough
  • Constipation
  • Straining during micturition
  • Heavy lifting
• Aging and muscle weakness.
• Obesity.
• Family history.

Clinical Features

Symptoms

• Groin swelling.
• Pain or discomfort in groin.
• Dragging or heavy sensation.
• Pain increases on coughing, lifting, or straining.

Signs

• Visible or palpable groin lump.
• Cough impulse present.
• Reducible swelling (early stages).

Investigations

• Clinical examination is most important.
• Ultrasound of groin.
• CT scan or MRI in doubtful cases.
• Imaging helps to identify type and complications.

Complications

Immediate Complications

• Incarceration:
  • Hernia becomes irreducible.
• Strangulation:
  • Blood supply compromised.
  • Severe pain, vomiting, tenderness.
• Intestinal obstruction.

Late Complications

• Adhesions.
• Recurrence after surgery.

Management

Conservative Management

• Only for unfit surgical candidates.
• Avoid heavy lifting and straining.
• Use of truss (temporary and not definitive).

Surgical Management

• Definitive treatment.

1. Open Hernia Repair

• Herniotomy.
• Herniorrhaphy.
• Hernioplasty with mesh.

2. Laparoscopic Hernia Repair

• TEP (Totally Extraperitoneal).
• TAPP (Transabdominal Preperitoneal).

3. Robotic Hernia Repair

• Advanced minimally invasive approach.

Blood Supply

• Inferior epigastric artery.
• External iliac artery branches.
• Femoral artery (for femoral region).

Nerve Supply

• Ilioinguinal nerve.
• Iliohypogastric nerve.
• Genitofemoral nerve.

Differential Diagnosis

• Femoral hernia.
• Hydrocele.
• Undescended testis.
• Lymphadenopathy.
• Varicocele.

Homoeopathic Therapeutics

• Arnica: pain and soreness.
• Nux vomica: hernia with constipation and straining.
• Lycopodium: right-sided hernia.
• Calcarea phosphorica: hernia in children.
• Pulsatilla: hernia in women.
• Hypericum: nerve pain.

Important Points

• Indirect hernia is most common.
• Direct hernia occurs due to weakness of posterior wall.
• Surgery is the treatment of choice.
• Early surgery prevents strangulation.