A groin hernia occurs if contents of the abdominal cavity protrude through the inguinal canal, often perceived as a bulge in the groin. The inguinal canal is a weak spot, containing spermatic cords (men) or the round ligament of the uterus (women). Men are more susceptible to inguinal hernia because the muscles and tendons above the inguinal ligament will get weaker and thinner during their life.
If the protrusion forms below the inguinal ligament, it is called femoral hernia, more common in women. A femoral hernia is sometimes more difficult to diagnose.
Inguinal as well as femoral hernias are groin hernias.
Symptoms groin hernia (bulging in the groin)
A groin hernia is often perceived as a distinctive protrusion in the groin that can be pushed back. Pain or a burning sensation in the groin often emerge when the hernia has grown big enough to pull/stretch the belly. Sometimes it is not easy to differentiate between groin pain caused by a groin hernia or an irritation of the muscles or tendons attaching to the pubic bone. The latter is treated best without surgery but by having a break from sports and taking antiphlogistic (anti-inflammatory) drugs.
Diagnostics groin hernia (bulging in the groin)
The medical history, symptoms and a physical examination while standing and also lying are crucial steps in diagnosing a groin hernia. Radiological examinations are performed rarely. But given certain circumstances, an ultrasound examination while exhaling on exertion can be beneficial to diagnose a groin hernia.
Treatment groin hernia (bulging in the groin)
Babies or infants suffering from a (pediatric) groin hernia should be operated soon because of the possibility of intestinal (bowel) entrapment. The hernia sack is removed and stitched up.
Adults need additional measures to reinforce the abdominal wall in the groin. Eduardo Bassini developed a surgical procedure in 1884 that aimed at the reinforcement of the posterior wall of the inguinal canal and that was a standard procedure for about 100 years. Shouldice attained the reinforcement by a suture repair using two separate sutures (transversalis fascia) and Lichtenstein by the placement of a mesh made of polypropylene. Both methods contributed to reduce the relapse rate from 10-20% to 1-8% in the 1980s and 1990s.
New techniques like laparoscopy (endoscopic surgery) and minimally invasive surgery have emerged since then. The so-called TEPP (totally extraperitoneal) and TAPP (transabdominal preperitoneal) repair are state-of-the-art now. Simply put, the difference between those two is the way a surgeon enters the body. During TAPP surgery, the surgeon enters the body through the peritoneal cavity, whereas TEPP does not. Both procedures use mesh to strengthen the abdominal wall.