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Inguinal (Groin) Hernia Repair

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What is an inguinal hernia?

An inguinal hernia is a defect (hole) that develops in the muscle and tissues of the abdominal wall, which allows abdominal contents such as the small intestine, colon, or fat to protrude through the defect.  Most inguinal hernias are congenital and exist from birth, but they become larger and cause symptoms later in life.  Inguinal hernias are more common in men, but they are seen in women as well.  Patients with an inguinal hernia usually develop a bulge in one or both sides of the groin that is often initially asymptomatic, but becomes symptomatic over time.  The most common symptoms of an inguinal hernia are bulging, pressure, burning, and pain.  Factors that can cause a hernia to develop or worsen include weight gain, excessive straining, chronic coughing or sneezing, pregnancy, and heavy lifting.  While most inguinal hernias are not dangerous, they will never resolve without surgery.  If left untreated, inguinal hernias can become incarcerated or strangulated — a term used for tissues or intestine that become trapped in the hernia with compromised blood flow as a result.  An incarcerated or strangulated inguinal hernia can be a life threatening condition that often requires emergency surgery.  To resolve patients' symptoms and prevent incarceration/strangulation, most surgeons recommend surgical repair for all healthy patients that have a symptomatic inguinal hernia.

How is an inguinal hernia repair performed?

The traditional technique for repairing an inguinal hernia for over a century was to make a large incision in the inguinal area and use sutures to close the hernia defect.  These hernia repairs were under tension and had high recurrence rates, causing many patients to undergo redo surgeries.  In the early 1960s, synthetic mesh began to be used to perform open inguinal hernia repairs that were tension free and had lower recurrence rates.  From the 1960s to the 1990s, open inguinal hernia repairs with mesh were the standard, and various improvements in mesh and techniques have continued to the present day for those patients who are not candidates for minimally invasive hernia repairs.

In the early 1990s, laparoscopic inguinal hernia repairs with mesh began to be commonly performed.  These repairs are performed using three small abdominal incisions through which a small video camera and thin instruments are inserted. These instruments repair the inguinal hernia by placing the supporting mesh beneath the hernia defect.  Patients undergoing laparoscopic inguinal hernia repairs have less pain and faster recovery times than patients undergoing open inguinal hernia repairs with mesh.

The FDA approved a new device to perform robotic assisted surgery in 2000, and initially these robots were primarily used by urologic surgeons to perform prostate removal surgeries.  Over the last decade, the benefits of robotic assisted surgery have been widely published, and the technology is now commonly used for general surgery cases, including inguinal hernia repairs.  A robotic assisted laparoscopic inguinal hernia repair is very similar to a standard laparoscopic inguinal hernia repair, as three small (less than ½ inch) incisions are made through which a small video camera and thin instruments are used to repair the hernia by placing a mesh under the hernia defect. The robot holds these thin instruments, but the robot is always under complete control by the surgeon.  The advantages of a robotic assisted laparoscopic inguinal hernia repair over a standard laparoscopic inguinal hernia repair are the following: a three dimensional high definition view of the hernia and surrounding tissues, much more precise instruments that can rotate 360 degrees rather than simply open and close, and the ability to better secure the mesh in position. In addition, patients who undergo a robotic assisted laparoscopic inguinal hernia repair also experience a faster recovery, less pain after surgery, and require significantly less narcotic pain medication compared to those undergoing a standard laparoscopic inguinal hernia repair. Dr. Mueller performs a high volume of robotic assisted laparoscopic inguinal hernia repairs at Northwestern Memorial Hospital and continues to observe excellent patient outcomes. 

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