Hernia results when there is a weakness of the wall of the abdominal cavity. The most common of these (inguinal hernia) occur down in the groin. These result when there is a weakness next to where the testicular blood vessels and the vas pass through the muscle. At times this weakness stretches allowing the hernial sac to push through this to form a hernia. This hernial sac is part of the peritoneum (the lining of the abdominal cavity) with time this hernial sac enlarges and elongates. When a person is lying down most often there are no contents in the sac and the hernia will reduce and is not evident. On standing or coughing contents push in to the sac causing the hernia to become obvious. It is usually when the hernia is full that symptoms arise. In some instances the contents can get stuck which means the hernia does not reduce on lying down.

Other common sites for hernia are the umbilicus or the line running from the navel to the breastbone. Hernias are very commonly associated with previous surgical scars. Repair of hernias involves demonstration of the sac and the muscle weakness; the sac is then reduced back through the muscle. Repair of the defect is then formed by sutures or permanent mesh.

Repair of inguinal hernias can take basically three forms. A repair can be performed by an external approach or a laparoscopic approach or by positioning mesh behind the muscle via a small muscle splitting incision. A Kugel Mesh repair is performed by an incision up close to the pelvic bone just above the hernia. The muscles are split allowing access to the space between the peritoneum and the muscle wall. This allows the hernial sac to be reduced and a Kugel Mesh is then placed in this space overlying the muscle defect. Sutures are placed to hold the mesh. Fixation occurs though due to inflammation and scar tissue. This may take up to 4 to 8 weeks to strengthen. For this reason heavy lifting should be avoided for that time period. After the mesh is placed the muscle is then closed with sutures and the skin is also sutured close.

More information about the procedure is contained in the RACS patient education pamphlet.
Picture courtesy of RACS and MI-tec Publishing. The complete patient education pamphlet is available from your surgeon.