Page 122 - International guidelines for groin hernia management

Hernia

Postoperative instructions Hernia ‘‘strangulation’’
Postoperative pain can be reduced by paracetamol, NSAIDs, Strangulated hernias are those that don’t have proper blood
or selective COX-2 inhibitors. The combination of parac- supply. This means that whatever is in the hernia bulge
etamol and an NSAID may be particularly effective. may begin to die. Hernias that are suddenly far more
A period of rest or a lifting restriction is not necessary painful than usual, red or larger than usual are likely to be
after an IH operation. Patients can do what they feel cap- strangulated. Vomiting or the inability to move one’s
able of doing. bowels can also mean that a hernia is strangulated.
When to see a doctor
Immediately see a doctor if your groin hernia, that nor-
mally goes easily back into place, suddenly does not. Seek
Chapter 31 immediate medical attention if you have a groin hernia and
develop any of the ‘‘strangulation’’ signs listed above. Do
not eat or drink before leaving for hospital. Immediate
Groin hernias: a patient’s perspective surgery may be required.

N. van Veenendaal, M. P. Simons, M. D. Burg Groin hernia diagnosis
Your medical history (what you tell the doctor) and the
Groin hernia: definition and some general comments physical examination are usually all that are required to
diagnose a groin hernia. An ultrasound or other testing can
Groin hernias occur due to muscular weakness in the lower be done if the diagnosis is not obvious.
abdominal wall in the general area of the crease between
one’s leg and abdomen. This weakness results in abdomi- Groin hernia treatment
nal contents (abdominal organs, fat or bowels/intestines) Groin hernias do not disappear without treatment; in fact,
bulging through the weak area. they often get larger and more painful with time. If you
Men and women can develop groin hernias but they are suspect that you have a groin hernia, see your general
far more common in men. physician or surgeon. Your surgeon can discuss treatment
A bulging or swelling in the groin region is often the options.
first sign of a groin hernia. Pain or vague discomfort can If you’re a man with a groin hernia that causes few or no
occur but is not always present. Pain and bulging may symptoms then a ‘‘watch-and-wait’’ approach may be
worsen with coughing, sneezing, lifting, straining or pro- reasonable. This is because the risk of serious complica-
longed standing. Occasionally, groin pain without bulging tions—incarceration or strangulation—is low, making
or swelling may indicate that a groin hernia is present. watchful waiting a safe strategy. Realize, however, that
Sometimes, a groin hernia may be found by your health- over time, many groin hernias without symptoms may start
care provider on a routine physical examination. causing problems—mostly pain—and require surgery.
Certain individuals are at increased risk for the devel- Women with groin hernias are often operated upon
opment of a groin hernia. The list below contains certain semi-urgently—even if they do not have symptoms—be-
features that may make groin hernia development more cause their risk of hernia strangulation is higher than men.
likely. Surgeons will tailor their treatment of your groin hernia
• Male gender based on a variety of factors including: their expertise, your
• Those with family members who have groin hernias medical history, the hernia itself, local (hospital and other)
• So-called ‘‘impaired collagen metabolism’’ (collagen is resources, and other considerations, including your wishes.
a protein in many body tissues like muscle)
• Those with a previous hernia Groin hernia operations: types and details
• The elderly Groin hernia surgeries are incredibly common. Worldwide,
• Those who’ve undergone removal of the prostate gland more than 20 million people have groin hernia repairs each
• The obese year! It is important to realize that with groin hernia sur-
• Those who are extremely thin (so-called ‘‘low body gery, ‘‘one size does NOT fit all’’ and one repair technique,
mass index’’). suitable for every situation, does NOT exist.
There are many different repair techniques in routine use
Hernia ‘‘incarceration’’
with varying advantages and disadvantages. Your surgeon
Some groin hernias are ‘‘incarcerated’’ or trapped in their
will discuss these and other issues with you and your
abnormal locations. The hernia contents then cannot return
family before proceeding.
to their proper position in the body.
123