​What is Surgery – Inguinal Hernia Pain

​What is Surgery – Inguinal Hernia Pain 


INGUINAL HERNIA 

DEFINITION
 A peritoneal sac protrudes abnormally due to a weakening in the inguinal area. Indirect (60%), direct (35%), and a combination 'pantaloon' (5 percent ). Hesselbach's triangle (medially the lateral boundary of the rectus, laterally the inferior epigastric vessels, and interiorly the inguinal ligament) is where direct hernias appear. Reducible, irreducible (incarcerated), and strangulated hernias are the three types of hernias.

Direct: Hernial sac protrusion through the transversalis fascia and posterior wall of the inguinal canal, immediately medial to the inferior epigastric vessels.

Indirect: Hernial sac protrusion through a deep inguinal ring with spermatic cord coverings, following the course of the inguinal canal. 

AETIOLOGY
Congenital: A persistent processus vaginalis allows abdominal contents to enter the inguinal canal. Intra-abdominal pressure, as well as muscle and transversalis fascia weakening, were acquired.
RISK FACTORS/ASSOCIATIONS Prematurity, age, and elevated intra-abdominal pressure, e.g. persistent cough, constipation, and bladder outflow blockage 

EPIDEMIOLOGY
 Common. In 4% of male births, there are congenital indirect inguinal hernias. Adults reach their peak between the ages of 55 and 85. The ratio of men to women is 9 to 1. Every year, ten elective repairs per 10,000 people are carried done in the United Kingdom. 

HISTORY 
The patient may be asymptomatic, or he or she may notice a lump or swelling in the groin. Discomfort or pain may be present, as well as irreducibility, a change in size, or indications of consequences. 
EXAMINATION 
A mass in the groin that may expand to the scrotum. Emerges above and medial to the pubic tubercle, distinguishing it from femoral hernias. Examine the patient while he or she is standing; the hernia is linked to a cough reflex. Pressure applied to the deep inguinal ring can help reduce indirect hernias. Auscultation of the hernia might reveal bowel noises. If incarcerated, the hernia may be irreducible, and if strangulated, it may be exceedingly tender. It may also be associated with indications of problems, such as bowel obstruction and systemic distress, pyrexia, and tachycardia. 

INVESTIGATIONS 
If you have a  acute painful irreducible hernia, you should: If operational intervention is likely, blood tests include FBC, U&Es, CRP clotting, and G&S. ABGs can be used to detect the existence of intestinal ischaemia (metabolic acidosis, lactate) within the hernia. In emergency situations, erect CXR and AXR. Hernias can be diagnosed by an ultrasound or a herniogram, and other explanations of groin lumps can be ruled out. 

MANAGEMENT
 An inguinal truss, a type of belt that restricts the decreased hernia from protruding, can be used to treat patients who are deemed unfit or reluctant to undergo surgery. Surgical: Surgical repair of simple hernias is an option. Local, epidural, spinal, or general anaesthesia can all be used. Surgical repair comes in a variety of forms. Mesh repair (Lichtenstein): Above the inguinal ligament, an oblique incision is made, with the external oblique aponeurosis opened and the spermatic cord gently loosened. The contents of an indirect sac are reduced after it is separated from the cord and opened (herniotomy). The sac is removed, and the defect in the transversalis fascia is fixed with a mesh to reinforce the defect. This is the most usual method of treatment. 

The Shouldice repair, which employs non-absorbable sutures to strengthen the defect, and the Stoppa repair are two more open procedures. The use of completely extraperitoneal (TEP) and transabdominal pre-peritoneal (TAPP) methods for laparoscopic mesh repair is now popular.

 In general, laparoscopic surgery allows patients to heal faster and resume normal activities sooner. For bilateral and recurring hernias, this is the method of choice. In an obstructed or strangulated hernia, emergency surgery is required. If gangrenous bowel is present within the hernia, a laparotomy with intestinal resection may be recommended. In this scenario, mesh insertion may not be appropriate. 

Herniotomy is used to repair indirect hernias caused by a patent processus vaginalis (PPV). The PPV is ligated and the contents are decreased, thus this isn't a mesh repair. 

COMPLICATIONS Maydl's hernia (strangulated Wshaped small-bowel loop), Richter's hernia (strangulation of only part of the bowel wall circumference), Amyand's hernia (acute appendicitis in a right inguinal hernia), Richter's hernia (strangulation of only part of the bowel wall circumference), Richter's hernia (strangulation of only part of the From the operating room: Pain, wound infection, haematoma, penile or scrotal oedema, nerve injury or neuroma formation, osteitis pubis, mesh infection, testicular ischaemia, and recurrence are all possible complications. 

PROGNOSIS
 If left alone, they have a tendency to grow slowly. Strangulation risk is 0.3–3% each year. Surgical mesh repair has a good success rate, with recurrence occurring in only 1% of patients.