Inguinal Hernia

What Is An Inguinal Hernia?

Multiple factors can contribute to inguinal hernia formation.

• Gender: Inguinal hernias can present in males and females but they are more prevalent in male patients.
• Obesity: Excess weight is not only a risk factor for developing inguinal hernias but also for recurrence after repair.
• Heavy lifting: Heavy work or heavy sports (CrossFit, Football).
• Coughing: Patients with emphysema or COPD, smokers or chronic allergies.
• Genetics: Many patients have close family members with a history of hernias. 
• Prior Hernias: Personal history of other hernias.

Many patients with an inguinal hernia have no symptoms. This is particularly true for small hernias. Hernias tend to enlarge over time and symptoms can develop. The most common symptom associated with an inguinal hernia is groin pain.

Symptoms can be more pronounced during certain activities. Most patients complain of pain during lifting, coughing, jumping, reaching or standing/walking for long periods of time. The pain is usually described as a burning sensation that goes down into the scrotum or the medial aspect of the upper thigh.

If a hernia becomes strangulated the pain can get severe. The patient can also develop abdominal pain, abdominal distention, nausea and/or vomiting. Lack of flatus or bowel movements can also be present if a portion of the bowel is incarcerated or strangulated. If any of these symptoms develop rapid medical attention is needed.

The diagnosis of an inguinal hernia is usually very straight forward. A good history and physical exam is normally the only thing needed to make an accurate diagnosis. 

In more complex cases radiologic evaluation might be needed. A CT scan is the test of choice for most surgeons. CT scans are very sensitive at diagnosing hernias but unfortunately, very small hernias are difficult to visualize. 

An MRI can also be useful, especially in the diagnosis of sports hernias. Sports hernias have different pathophysiology and we will discuss them in another section. 

Many physicians will obtain an ultrasound as the first test but the sensitivity is low and is highly dependent on the sonographic technologists. 

Open Inguinal Hernia Repair

The decision to go with an open approach is made base on the hernia size and/or the patient’s medical condition. An open inguinal hernia repair can be done with minimal intravenous anesthesia and local anesthesia. An 85 years old patient with multiple medical problems is better suited for an open repair with minimal anesthesia, this will limit the possibility of having complications from general anesthesia.

A giant incarcerated inguinal hernia is also better suited for an open approach were reducing the intestine back into the abdominal cavity can be a significant challenge.

Previous surgical history can also be a factor in determining the surgical approach. Patients with a previous radical prostatectomy can be better treated with an open approach to prevent injuries due to scar tissue from prostate surgery.

Not every surgeon has adequate skills to perform inguinal hernia repairs laparoscopically. Every patient should do their research regarding their surgeon. Dr. Angel Caban has done hundreds if not thousands of these procedures laparoscopically.  If you are looking for a surgeon to get your hernia repaired laparoscopically, look no further.

Robotic Inguinal Hernia Repair

The decision to go with a robotic approach is mainly surgeons preference. Patients that had prior lower abdominal surgery are better candidates for a robotic approach than a laparoscopic approach. One example can be a female patient after a C section or a hysterectomy. Many times a laparoscopic extraperitoneal approach is not an option but a robotic transabdominal approach is a feasible option. 

Dr. Angel Caban is highly trained in minimally invasive techniques including the DaVinci Robotic System. In North Central Florida no other surgeon can perform this procedure better than Dr. Caban.

Dr. Caban has taught other surgeons in national meetings on how to perform these procedures safely and effectively.

An inguinal hernia repair is an ambulatory surgery in most instances. The surgery takes between 30 – 60 minutes. After surgery, the patients will go to the recovery room for approximately 1-2 hours. You will be given a prescription for pain medications and other instructions will be given prior to going home.

You will follow up with Dr. Caban in 2-3 weeks and then on as needed basis.

Most patients that have office type job can expect to return to work after several days. For those of you that have a heavy job were heavy lifting more than 15-20 pounds is necessary, you should account for 4-6 weeks out of work or sooner if light duty is an option.

Other activities like playing golf, pickleball, bowling or any other sports were using the core muscles is necessary should be postponed for 4-6 weeks. Swimming should be limited until the incisions are completely healed.