What is Inguinal Hernia Surgery?

Inguinal Hernia Surgery is a surgical procedure done to repair a hernia in the groin (area of the hip between the stomach and thigh). A hernia is a bulge in the abdominal wall caused by a weak area. An inguinal hernia is a type of hernia in the groin. This can be present since birth (indirect inguinal hernia) or develop later in life due to the weakening of the abdominal muscles (direct inguinal hernia).

Anatomy and Physiology Inguinal Region

The inguinal region, also known as the groin of the body is the area where the upper thighs meet the lowest part of the abdomen. Normally, the abdomen and groin are separated by a wall of muscle and tissue. The only wall openings are small tunnels called the inguinal and femoral canals. The inguinal canal comprises a floor, anterior wall, posterior wall, and roof.

1. Roof: formed by muscles: internal oblique, transversus abdominis
2. Anterior: formed by aponeuroses: internal oblique, external oblique
3. Floor: formed by ligaments: inguinal ligament, lacunar ligament
4. Posterior: formed by tendon and transversalis fascia

Generally, In males, these canals allow the spermatic cord and ilioinguinal nerve to pass between the abdomen and the groin area. Whereas in females, these canals allow round ligament of the uterus and ilioinguinal nerve to pass between the two regions.

Conditions treated with Inguinal Hernia Surgery

Inguinal hernia surgery is mainly considered when the patient has the following types of hernia.

1. Direct Inguinal Hernia: This type of inguinal hernia penetrates directly through the wall of the inguinal canal. This generally occurs in adults over time.
2. Indirect Inguinal Hernia: This type of inguinal hernia enters the inguinal canal through the top. This usually occurs in newborn babies as a birth defect.
3. Strangulated Hernia: A type of hernia in which the contents of the hernia are ischemic due to a compromised blood supply.

Who needs Inguinal Hernia Surgery?

A doctor may recommend inguinal hernia surgery to a patient if he/she experiences:

1. Swelling in the scrotum (the sac-like structure holding the male testicles)
2. Pain in the groin area which gets aggravated while coughing, exercising, or lifting any object
3. A bulge in the groin (the area where the upper thigh and the lower abdomen connect)
4. Weakness or pressure in the groin area.

Benefits of Inguinal Hernia Surgery

Inguinal hernia surgery is a safe procedure as it helps relieve the symptoms of a hernia and improve the quality of life of an individual. Below mentioned are some of the benefits of inguinal hernia surgery.

1. Remove any bulge or lump
2. Prevent complications
3. Help reduce pain and discomfort
4. A quicker return to work and a shorter recovery time (days instead of weeks)

How is Inguinal Hernia Surgery performed?

Inguinal hernia surgery involves repairing the posterior (rear) wall of the inguinal canal. The procedure is generally performed under anaesthesia (local or general) based on the severity of the hernia. The procedure usually takes 30 to 45 minutes to complete depending on the patient’s age, other comorbidities and the severity of the condition. The following steps are involved in the procedure:

1. The patient will be administered anaesthesia (local, regional or general). The type of anaesthesia will be decided by the doctor/surgeon based on the results of the pre-anaesthesia evaluation of the patient.
2. The surgeon will then check the vital measures of the patient such as the heart rate, oxygen concentration, and blood pressure throughout the procedure.
3. The surgical area will also be cleaned using an antiseptic solution.
4. Once the patient is stable after administering the anaesthesia, the surgeon conducts the procedure.
5. Surgery for repairing an inguinal hernia can be performed in three ways:
   1. Open surgery:
      1. Local anaesthesia or a regional anaesthetic is commonly used during open inguinal hernia surgery. It is injected into the spine. In some cases, general anaesthesia may be given.
      2. The surgeon will make a single incision of 6 to 8 centimetres over the hernia.
      3. Following this, the surgeon will place the fatty lump of tissue or bowel loop back inside the incision site.
      4. The surgeon will implant a mesh at the weak area where the hernia developed to strengthen the abdominal wall.
      5. The surgeon will use stitches to close the surgical site after the repair is done.
      6. In the case of strangulated hernia, the damaged part of the bowel may be removed, followed by joining the two healthy ends of the bowel.
      7. Open surgery is preferred in the case of larger hernias.
   2. Laparoscopic surgery:
      1. During this surgery, the patient will be placed under general anaesthesia.
      2. Instead of a single big incision, the surgeon will create 3 to 5 small incisions in the lower abdomen during the surgery.
      3. The surgeon will insert a laparoscope (a narrow tube with a tiny video camera attached to it) through one of the incisions.
      4. Other incisions will be used to insert the instruments to repair the hernia.
      5. The surgeon will then use a piece of mesh to seal and strengthen the abdominal wall.
   3. Robotic surgery:
      1. It is performed in a similar way as laparoscopic surgery.
      2. In robotic surgery, the surgeon will sit at a console in the operating room and control the surgical instruments from there.
      3. Robotic surgery is a newer technique and can be utilised to repair some minor hernias and rebuild the abdominal wall.
6. Once the surgery is performed, the patient is taken to a recovery room. Here the patient is monitored until his or her health condition becomes stable.

Cost of Inguinal Hernia Surgery

The cost of inguinal hernia surgery ranges from ₹35,000 to ₹1,20,000. The cost varies based on the following factors:

1. Age of the patient
2. Type of the procedure done
3. Technique and equipment used
4. The medical condition of the patient
5. The type of hospital facility availed – individual room or shared.