|What is an inguinal hernia?|
Inguinal hernia or groin hernia is an abnormal outpouching in the area of the groin. Although often highlighted in athletes and sportsmen, it is a problem that can happen at all ages, in both men (where it is most common) and women.
The hernia can be a small lump that is asymptomatic (causes no pain or discomfort) or it can be painful and troublesome, especially during physical activity. The cause of inguinal hernias is still not fully known but it is a very common problem affecting about 1 in 4 men during their lifetime. In women it is much less common with only 2 in every 100 women developing a hernia in the inguinal area.
The hernia is caused by the contents of the abdomen (such as the bowels) pushing through a weakness or hole that is not normally there in the abdominal wall. It forms a small pouch that can be felt or seen. Sometimes they are small and sometimes they can be larger.
|Do I need to see a doctor?|
Yes. If you suspect you have an inguinal hernia it is advisable to see a physician as soon as possible so they can make an assessment on your condition.
|Do I need surgery?|
Not everyone with an inguinal hernia needs surgery. Some hernias, if not troublesome can follow what is called "watch and wait". Your physician will be able to examine you and determine if you require surgery or not. However the majority of hernias may require a surgical intervention.
|What are the surgical options?|
Today there are a wide variety of surgical options to treat inguinal hernia. The options offered will depend on your needs and wishes, as well as the clinical condition of your hernia, your physical health and the procedures offered by the surgeon. Generally inguinal hernia operations fall into two categories:
Keyhole or Laparoscopic
What's the difference?
|What are meshes and are they safe?|
The most common option today (either keyhole or open) is to use something called a "hernia mesh" or "hernia implant".
Historically to fix the hernia, the surgeon would make an incision, then dissect (free up) the hernia pouch and return it to the abdomen. They would then close the hole in the abdominal wall by using sutures to stitch the hole together. The problem with this was that it put those tissues under a lot of tension and this would cause a lot of pain and discomfort to patients. Also in many patients the tissue being sewn together was not very strong so the hernia would come back (recurrence). This led surgeons to think about "reinforcing" the groin area with a patch.
The advantages of placing a patch were the reduction in tension (sometimes called a tension free repair) and the patch would help to reinforce the groins natural tissues - like putting a patch on the elbow of a sweater.
The mesh can be placed either on top of the hernia, underneath the hernia or both. In a keyhole repair the mesh is generally placed below the hernia hole (underlay), in open it is placed above (onlay or Lichtenstein). The mesh can also be formed into a small cone called a "plug" which can be placed into larger holes to fill them.
Are they safe?
However they do carry risks that are different to not using a mesh. Meshes have a higher risk of becoming infected. They also carry a risk of a foreign body reaction, which can include pain, fever, discomfort, sensation of the foreign body, rejection of the foreign body and other side effects your doctor can discuss with you in detail - but make sure before deciding to have a mesh or implant that you discuss fully with your doctor.
|What does the FDA say?|
Please read this advice from the FDA and consult fully with your doctor.
Food & Drug Administration, The Food and Drug Administration (FDA) is an agency within the U.S. Department of Health and Human Services. The core functions of the agency: Medical Products and Tobacco, Foods and Veterinary Medicine, Global Regulatory Operations and Policy, and Operations.
Please follow this link to the FDA
Information on Surgical Mesh for Hernia Repairs
Hundreds of thousands of hernia repair operations are performed each year both with and without surgical mesh, and patients generally recover quickly and do well after surgery.
However, FDA has received reports of complications associated with the mesh. The complications include adverse reactions to the mesh, adhesions (when the loops of the intestines adhere to each other or the mesh), and injuries to nearby organs, nerves or blood vessels . Other complications of hernia repair can occur with or without the mesh, including infection, chronic pain and hernia recurrence.
Most of the complications reported to us so far have been associated with mesh products that have been recalled and are no longer on the market. For further information on the recalled products, please visit the FDA Medical Device Recall website.
We are continuing to analyze and evaluate incoming reports of adverse events, and are speaking with patients, surgeons and researchers. We will inform the public as new information becomes available.
Talking to your doctor
There are also certain questions you should consider asking your surgeon:
What are the pros and cons of using surgical mesh in my particular case?
You can report any problems to the FDA's MedWatch Adverse Event Reporting program either online, by regular mail or by FAX.
Online : MedWatch Online Voluntary Reporting Form (3500)
|What are the common problems with hernia surgery?|
In general hernia surgery is very safe, it is one of the most performed surgeries and is considered a minor operation. However like all surgery it carries certain risks, that you should discuss with your physician.
There are risks associated to all surgery, such as complications with anesthesia, infection, bleeding etc.
Males can get pain or swelling of the testicles, or in very rare cases even loss of a testicle. This is because the surgery is performed around the chord that comes from the testicles.
Post operative pain and or discomfort is one of the most frequent problems associated with hernia repair procedures. In the early days this can be caused by the incision (in an open repair) or by the actual operation itself, especially if it was a large hernia. This is an "acute" pain generally associated to the fact you've been operated on. But you doctor can help by prescribing pain killers to take in the weeks after surgery. The level of pain is very patient dependent.
Of more concern is long term pain and discomfort. There are many reasons this can happen. The nerves in the groin can be touched, inflamed or damaged during surgery. Your surgeon will take every care to avoid those nerves, but each patient has them in different places so avoidance cannot be guaranteed. Long lasting nerve pain will need to be treated by your doctor and could include second procedure to treat the nerves.
Although the above complication and problems are rare, it is vital before deciding to have a permanent implant, to weigh up the risks and benefits and have a direct and clear conversation with your physician about all the options.
|What is the Freedom Inguinal Hernia System?|