A bilateral inguinal hernia is a common medical condition that not many people are familiar with. What exactly is it? What causes it? How does it occur? Who is affected by it? What kind of procedure is performed for its repair? This research paper aims to answer all of these questions. In general, hernia is a deficiency which involves the inmost stratum of the fascia of the wall of the abdomen (Booras; Shikiar). This deficiency is usually an opening or tear in the abdominal wall (Goodyear; “Repair”). When hernia is present, contents of the abdomen will pass through this opening to penetrate the subcutaneous tissue (Shikiar).
One of the contents of the abdomen that could may enter through the opening is the intestine (Goodyear) As a result, a part of the intestine will protrude to form a bulge (Booras; Mayo Clinic; Milton College; WebMD 1). There are many types of hernia; the list of hernia types includes diaphragmatic, hiatal, lumbar, obturator and incisional hernias (Shikiar). There are two types of hernias which occur in the groin: femoral hernia and inguinal hernia. However, the focus of this paper will be on inguinal hernia. Inguinal hernia is the type of hernia which occurs in the inguinal canal (Shikiar).
In men, this is the canal which holds the spermatic cord in men; in women, this canal holds a ligament which is connected to the uterus (Milton College). The internal ring refers to the entry point of the canal, which is located inside the abdomen (Shikiar). The exit point, referred to as the external ring, is located in the scrotum in men or in the labia majora in the case of women. Hernias which follow the same direction as the spermatic cord into the internal ring are considered as indirect inguinal hernias. Hernias which enter the fascia of the abdomen to penetrate the canal are considered direct inguinal hernias (Shikiar).
Adult men usually suffer from direct inguinal hernia (Shikiar). Inguinal hernias occur in both men and women, but it occurs more frequently in the former (Booras; Goodyear; Milton College). Both children and adults can suffer from this type of hernia (Milton College). Inguinal hernia can either be congenital or acquired (Goodyear). The congenital type of hernia is that which has been present from birth, as caused by a weak abdominal wall (Booras; Goodyear). In the case of males, when the abdominal area incorrectly closes during the womb development, inguinal hernia occurs (Borras).
Most congenital hernias are indirect (Booras; Goodyear). More often than not, inguinal hernia in children is congenital (Booras). The acquired kind of hernia occurs due to several reasons, mostly due to pressure or strain which affect the walls of the abdomen in the inguinal section; this condition is usually progressive (Goodyear; Milton College). In some cases, patients have hernia may not be aware of their condition as it only becomes noticeable late in life (Booras; Shikiar). The condition is only exacerbated by aging or physical exertion (Booras).
Even though people can live a long time with this condition, hernia can only disappear through treatment (Booras). Inguinal hernia is influenced by many factors. There are several risk factors to consider regarding inguinal hernia. Family history is one risk factor; one could acquire it if a relative has it (Mayo Clinic). Premature birth also causes inguinal hernia because of the incomplete development in the womb. Other factors are characterized by strain or pressure. Medical conditions, such as lung damage, may result in inguinal hernia.
Such condition results in strenuous coughing, which may cause hernia. Constipation also causes inguinal hernia due to strain. Meanwhile, pregnancy and being overweight can also cause inguinal hernia due to the added abdominal pressure (Mayo Clinic). Inguinal hernia is situated in lower part of the abdomen, located in the area above the crease of the leg and in close proximity to the pubic section (Goodyear). This kind of hernia may occur either in the left or right side (Goodyear). It could also occur in both sides of the groin, which is referred to as bilateral hernia (Booras; Goodyear; Milton College).
Eight to ten percent of inguinal hernia patients suffer from the bilateral kind (Goodyear). Hernias usually occur on both sides of the groin because stresses which develop on the body occur symmetrically (Balentine 4). When a person detects a bulge in one side of the groin, it is possible that a physician may also detect a small one on the other side. There are two other kinds of inguinal hernia: reducible and non-reducible hernia (Milton College). In the case of reducible hernia, the protruding part of the intestine can be returned to its original state through pushing (Milton College).
In this kind of hernia, the protruding part is only eminent when the person is at a standing position; when the person is lying down, the protrusion could disappear (Booras; Milton College). Non-reducible hernia is that which cannot be treated through pushing (Milton College). This is because the intestine has been stuck in the inguinal canal. Because the intestine is stuck in its position, there is a hindrance in the passage of intestinal fluids and supply of blood eventually causing the death of the tissues (Booras; Milton College).
The strangulation of the intestine may cause vomiting and loss of appetite among others; this condition necessitates urgent surgery (Booras). Extreme cases of inguinal hernia require immediate treatment through surgery. Treatment of inguinal hernia through surgery is referred to as repair (Mayo Clinic). Repair is needed to eliminate the pain of inguinal hernia, as well as to avoid its complications. Surgical repair of inguinal hernia has two specific objectives (Hospital). The first objective is to remove the portion of the intestine from the opening or tear.
The second objective is to close the opening or tear (Hospital). Surgical repair of inguinal hernia consists of two types. The first type of hernia repair is herniorrhaphy (Mayo Clinic; Milton College). This repair is performed by making an incision in the groin area and pushing the bulging intestine into place (Mayo Clinic). Afterwards, the muscle is repaired through sewing. Recovery from such procedure may take a while (Milton College). Before a patient may engage in daily activities, it may take a month or more to do so (Mayo Clinic). The second type of inguinal hernia repair is hernioplasty (Mayo Clinic).
This procedure resembles tire patching; it involves the insertion of synthetic mesh to envelope the inguinal area, covering all possible openings of hernia (Mayo Clinic). The mesh is held in place with either “sutures, clips or staples” (Mayo Clinic). This surgical method can be done in two ways (Mayo Clinic). Hernioplasty could be done like heniorrhaphy, with one lengthy incision (Mayo Clinic). The other procedure is through laparoscopic repair (Mayo Clinic). With the application of this kind of repair, hernia repair had been revolutionized forever (Macintyre).
In this method, instead of a big singular incision, small incisions are made (Mayo Clinic). A “fiber-optic” tube with a small camera called the laparoscope is placed through one of the incisions, while small instruments are placed in the other incisions, which measure from a quarter of an inch to an inch, to put the intestine back in place and restore the wall of the abdomen (Mayo Clinic; Milton College; “Repair”). The surgeon effectively performs the procedure because the camera guides the surgeon by allowing him a better view of the abdomen (Mayo Clinic; Milton College).
The procedure will result in three to four tiny scars (“Repair”). Laparoscopic hernia repair is tension free (Goodyear). This means that the procedure eliminates the possibility of tissue tension and does not perform any tasks that would render ay more tensions on the muscles. The mesh used is very thin and flexible, effectively covering the area of the hernia and the entire weakened area. This mesh will serve as a “scaffolding” to enable the growth of new tissue (Goodyear). The in growth of tissue will give way to the healing of the opening or tear.
Because the mesh is flexible and elastic, the patient will not feel discomfort after it is inserted (Goodyear). Laparoscopic hernia repair spares the patients from much discomfort and lessens the possibility of scarring (Balentine 3; Mayo Clinic). This kind of repair also promises faster recovery, allowing the patients to resume in their regular routine in a short period of time (Mayo Clinic). The patient can be released the same day as the surgery (Milton College). This procedure is recommended for those with recurring hernias and bilateral inguinal hernias (Mayo Clinic; “Repair”).
Nonetheless, this procedure is not recommended for those with bigger hernias, as well as those who have undergone pelvic surgery like prostatectomy (Mayo Clinic). There are several kinds of anesthesia used for inguinal hernia repairs (Balentine 3). General anesthesia may be used and is often considered safe. Local or regional anesthetics are also used, which can be simultaneously utilized with other sedating medications (Amid, Shulman and Lichtenstein 249; Balentine 3). For laparoscopic repair, general anesthesia is used (“Repair”).
However, the anesthetics given depend on the physician’s assessment of the patient’s individual needs (Balentine 3). Bilateral inguinal hernia is a common condition that many people are not aware of. Hernia, for one thing, is a common defect either from birth or acquired through extreme strain and pressure in the body. Bilateral inguinal hernia is a specific problem which requires specific treatment. While there are revolutionary procedures such as the laparoscopic repair which help solve the problem, it is crucial that people develop awareness of such condition to avoid the problem completely.
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