Hernia Surgery from Guidelines to Clinical Practice

The inguinal hernia is the escape of bowels from the normal site through a hernial gate appearing in the pelvic area. In common opinion, the inguinal hernia is a trivial problem, since it is often treated with a routine intervention, in day hospital or outpatient. But frequently the inguinal hernia is annoying, often disabling and even fatal if strangled and untreated.

It is also calculated that 10% of the hernia already treated are relapsing. Considering that the number of interventions exceeds 100,000 per year, the social cost of this process is transparent, furthermore, during pre-surgery for recurrence, the risk of lesion of the testicular vessels increases.

The inguinal hernia is, therefore, not to be underestimated. In medicine, the issue is very much felt, so much to lead to the development of well over 80 methods to solve the problem satisfactorily.

What Is the Inguinal Hernia?

The inguinal hernia is the escape, at the level of the groin and precisely in the direction of the so-called inguinal canal, of an abdominal bowel. In general, the abdominal bowel that is the protagonist of the inguinal hernia is the intestine; more rarely, it is the bladder or a portion of adipose tissue located close to the abdominal organs bordering the inguinal canal.

Inguinal Hernia: How Common Is It?

Among the various types of hernia ( disc, Hiatal, crural, umbilical, diaphragmatic, etc.), the inguinal hernia is the most widespread by far (between 70 and 80% of all episodes of hernia are cases of hernia inguinal).

Men suffer the most: according to some estimates, the male population, compared to the female one, would be 7 to 10 times more at risk of developing an inguinal hernia. The inguinal hernia is typical of middle-aged adults, but it can also occur in children and the elderly.

In most cases, the inguinal hernia appears on the right side of the human body; more rarely, it forms on the left or both sides (bilateral inguinal hernia ).

Where Is the Inguinal Hernia?

The inguinal hernia is formed in the anatomical point where the inguinal canal resides; as the name suggests, the inguinal canal resides at the groin level, i.e. in the border space between the abdomen and lower limbs.

Not all inguinal hernias are detectable in the same position within the confines of the groin; the exact location, moreover, varies depending on where the abdominal bowel reaches inside the inguinal canal, once it has come out.

Symptoms

Hiatal hernia (as described in the Medscape article ), as such, does not cause particular disturbances but creates the conditions for the development of other pathologies.

The initial symptoms may be similar to those of esophagitis: intense salivation, hoarseness, repeated belching, especially after large meals, feeling of weight in the stomach, acid regurgitation, intense and persistent burning behind the sternum (retrosternal heartburn).

Sometimes the pain radiates from the stomach (epigastric area) to the neck and back between the shoulder blades, so much so that, in intensity and duration, it can be completely similar to the pain of heart origin such as an anginal crisis. In particular, these symptoms can worsen during intense exertion or during pregnancy, situations that increase intra-abdominal pressure.

Typical is the aggravation of symptoms when assuming the horizontal position or leaning forward, as when tying shoes. Image showing hiatal hernia seen with radiography simplifying the symptoms they can be divided into three categories: digestive, cardiorespiratory and general.

Digestive Symptoms

Difficulty indigestion, regurgitation, belching, retrosternal burning. In some cases, there may be constipation, diarrhoea, pain in the mouth of the stomach (epigastric site) and, more rarely, vomiting.

Cardiorespiratory Symptoms

Dyspnoea (laboured breathing), a sudden change in heart rate which slows (bradycardia) or accelerates (night tachycardia), pain in the heart area (angina pectoris), dizziness.

General Symptoms

Anaemia due to gastric malabsorption of iron or due to lesions of the gastroesophageal mucosa that causes bleeding (blood loss).

The severity of the symptoms varies according to the type and size of the hernia. Often, precisely because of the multiplicity of symptoms, when you have a stomach ache or digestion is severe, you tend to blame the hiatal hernia.

But it’s not always his fault. Hiatal hernia usually does not cause severe pain which can instead be caused by other pathologies, such as a peptic ulcer or even heart disease.

When you suffer from pain in the upper part of the stomach or poor digestion, you should not immediately blame your hiatal hernia, but instead go to the doctor for a thorough check-up.