Undoubtedly, the most frequent consultation in surgery is the pathology of the abdominal wall and more specifically, inguinal hernia. We will define it as the appearance of a lump in one or the two English, usually after a violent physical effort, cough, constipation and obesity fundamentally. As can be deduced, patients with professions that require the management of weights, those chronic coughs (pulmonary emphysema, smokers) or those who need an important defining effort, are more likely to suffer from it.

Another group is the one that affects healthy patients with excessive sports activity, what we call the athlete's hernia and that entails a progressive weakening of the inguinal channel, which is subject to traction in the opposite direction of the abdominal musculature and the adductor of the thigh with the consequent tear of it and the appearance of chronic pain especially after exercise. The main diagnostic is the physical exploration, in which the increase in volume of the groin and the displacement of the abdominal content through the broken area in direction at the hand of the explorer is perceptible. In case of doubt, ultrasound will provide sufficient data to confirm the diagnosis.

When to operate?

In general, it is accepted that in a patient in good physical condition, surgery should be recommended since this is the treatment of choice.
Now, in case of asymptomatic hernia (no pain, it does not limit activity) of small or medium size, the clinical and evolutionary observation of the patient is accepted as a treatment to consider, although the information to the patient must be exhaustive in terms of to alarm symptoms (pain, hardening of the area, etc.) that would go in favor of complication with what the surgical intervention would be the first option.

Operation yes, but which one?

As for the type of surgical intervention, the techniques are multiple and varied and depend a lot on the surgical team that carries them out.
In what if there is world consensus is that reinforcement mesh should always be used, since its employment has significantly decreased the recurrence index.
Very different issue is the surgical approach, in it, the experience and habit of the team feels the basis of appropriate management.

The indications of the abdominal wall unit of the HLA Vistahermosa de Alicante are :
 

• If the hernia is unilateral and not reproduced, we use the previous route, consisting of an incision on the inguinal channel, repair of the defect by sutures and placement of a reinforcement mesh.
• If the hernia is double or reproduced, we propose laparoscòpic approach which consists of access to the abdominal cavity through the navel with a camera that allows the exploration of both English at the same time by their posterior face, proceeding to reduce the hernia content and location of a mesh whose fixation is made with resorbable staples.

 

Apart from the aforementioned athlete, this is presented in young patients who practice intense exercises with great muscle requirement and that fundamentally requires or laparoscopic repair even if it is unilateral or open with the collaboration of the traumatologist in which we combine the suture of The weakened musculature through an inguinal incision with a section of the tendon of the adductor muscle practiced below the pubic bone (Tenotomy).

 

 

In both cases, the stay is 24 hours in the hospital and the instructs at discharge are very clear in terms of the activity to be developed in the immediate postoperative period.
This includes recommendations that can or not do during the first 10 to 15 days after the intervention including sports activity if the patient is practicing in which case it refers to physiotherapy with specific exercises for 5 weeks

Mesh yes, but which one?

There are multiple varieties of reinforcement mesh for the treatment of inguinal hernia, we divide them into reabsorbable and not resorbable; The first ones are used quite less since they are prostheses that are degraded over time and end up disappearing from the organism, so that the risk of recurrence is higher compared to those of the second group, these are of different materials, being the polypropylene the most Commonly used and with excellent tolerance, offering magnificent results in recurrence and quality of life.
It also influences the type of mesh to use the experience and affinity of the surgical team with the material since it is a personal decision of the surgeon the prosthesis to implement.

What problems can cause a mesh?

As is evident, the surgical mesh is a foreign body inserted in the body which will cause an inflammatory response to it, that more than 95% of cases is minimal but in a small group of patients it can manifest with remarkable inflammation , although the rejection index of the same that forces to expand it, does not exceed 2 per thousand.
This inflammatory reaction is conservatively controllable being exceptional to specify a reintervention for this reason.

Is it necessary to track?

In principle, the monitoring by the surgical team is established in a protocol manner, over 8 to 10 days for suture withdrawal, on the month for healing control and depending on the type of intervention, quarterly revision until the year of it.

What precautions should I have?

The recommendation usually is aimed at avoiding over -affault, cough, constipation and obesity that are determining factors in the possible reproduction of it.
In the group of athletes, specific precautions are indicated as far as exercises are concerned with what we have a physiotherapy service to advise and guide these patients.

The abdominal wall unit and sutures of the HLA Vistahermosa hospital has the most modern technology and professional experience for the treatment of inguinal hernias and their surgical medical management