WHAT IS A HERNIA?

The groin area has natural orifices at the root of the thigh to let anatomical elements pass into the lower limb and, among men, into testicles. An anatomical loosening of these orifices can be lead to the formation of a hernia in the groin, either inguinal or crural. It derives from part of the contents of the abdominal cavity coming through an enlarged natural orifice, of a A hernia is usually identified as a localised swelling of the groin and is increased by standing up and exercising. Hernias can appear at any age. Inguinal hernias are more common among men, crural hernias are more common in women. Among children, hernias result from a spe-cific congenital anomaly.

WHAT ARE ITS CONSEQUENCES ?

Once the hernia is formed, it will progressively increase in size, although at variable speeds from one individual to another. Healing without surgery is not possible and hernias tend to cause increasing discomfort with time. Hernia strangulation is the major evolutionary risk: it occurs when the intestine is incarcerated into the hernia. The hernia becomes irreducible and very painful. This requires emergency surgical consultation. The risk of strangulation depends on the anatomical type of the hernia: it is low for inguinal hernias in its common variety, and higher for crural hernias. This risk should be discussed with the surgeon during the consultation. Some hernias can cause local pain even in the absence of strangulation. This pain may be related to other pathologies and may persist after the hernia has been repaired.

HOW ARE GROIN HERNIAS TREATED ?

Treatment for groin hernias is surgical. Nowadays, reducing the hernia and attempting to maintain it with a hernia bandage is not an option we recommend. Therapeutic abstention can only be considered after surgical consultation.

HOW ARE HERNIAS REPAIRED?

AMONG ADULTS : Two types of procedures have been developed : :

• Wall reconstruction with seams using anatomical tissues.
• Wall reinforcement using synthetic fabric (this is referred to as mesh repair)

There are two different ways of proceeding with surgery : :

• Direct anterior approach (with a single incision in the groin),
• Lateral laparoscopic approach (mini-incisions around the navel).

Several types of anaesthesia are possible. The definitive approach is validated at the end of the anaesthesia consultation. The laparoscopic approach requires general anaesthesia. The anterior approach is possible under local or loco-regional anaesthesia. In both cases, the post-operative period of definitive consolidation is three to four weeks, during which it is advisable to avoid significant physical effort (carrying more than 5kg). Among children, congenital her-nias do not require prosthetic reinforcement.

WHAT ARE THE RISKS OF HERNIA SURGERY?

  Rare complications related to any abdominal surgery : :

• Thromboembolic complications (phlebitis, pulmonary embolism)
• Hemorrhagic complications (vascular wounds, hematomas)
• Infectious complications on incisions, catheters, drains and probes
• Digestive wounds and secondary bowel obstruction
• Bladder wounds, postoperative urinary retentions

There are also rare complications related to laparoscopy : :

• - Such complications can occur when inflating the abdomen or when introducing the first trocar at the beginning of surgery. This can lead to conversion into a large opening (lapa-rotomy).
• - Large vessel injuries, such as the abdominal aorta, or injuries to organs near the operative site, mainly digestive (intestine) or urinary (ureter, bladder). These accidental injuries can be facilitated by the complexity of the procedure or unforeseen anatomical cir-cumstances. Their immediate identification generally allows for a repair without sequelae, but they can sometimes go unnoticed during the procedure and cause peritonitis or postoperative abscesses. More rarely, they can lead to death.

Specific early complications : :

• Seromas (bumps filled with clear fluid) and bruises that can spread in the tissues of the penis and testicles (between 5 and 10% of cases).
• Impact on the volume and sensitivity of the testes and bursae due to dissection of the spermatic cord, which may lead to ischemic atrophy of the testes (less than 1% of cases).
• Rare infections of the prosthesis, improperly called "rejects », which may require re-intervention for ablation (less than 0.35% of cases).

Late specific complications :

• Prolonged pain, most often regressing within two years after the procedure and which would appear to be more frequently observed as a consequence of direct anterior ap-proach. Residual inflammation is often suspected, but the mechanism involved is not al-ways identifiable.
• Recurrence of the hernia (around 2% after wall reinforcement with prosthetic mesh)