Inguinal Hernia

The inguinal canal is a short passage that is about four to six centimeters in length located just above the inguinal ligament and extends medially and inferiorly through the inferior part of the abdominal wall. Structures pass from the abdominal wall to the external genitalia through this canal. In men, the spermatic cord passes to the testis through the inguinal canal. In women, the ligament that supports the uterus is present in the inguinal canal.

Inguinal hernia is a condition that occurs when abdominal tissues, such as part of the intestine, protrudes through a weak spot of the inguinal canal. Inguinal hernia can occur in both men and women. The resultant bulge caused by the inguinal hernia can lead to pain and discomfort during movement especially when you cough, bend, or lift a heavy object.

The inguinal hernia can be classified into following:

  • Indirect inguinal hernia: commonly found hernia in new born babies. The hernia will be formed lateral to the blood vessels when the inguinal canal is not fully developed.
  • Direct inguinal hernia: Direct inguinal hernia is found in adults in the middle from the blood vessels.
  • Incarcenated hernia: When the abdominal get stuck in the groin, then the hernia is known as incarcerated hernia.
  • Strangulated hernia: Strangulated hernia is more severe and stops the blood flow to the small intestine and has to be treated immediately.

Inguinal hernia symptoms include:

  • Bulge : A bulge in the groin area on either side of the pubic bone. This can be more obvious couging or straining.
  • Burning Sensation : Burning or aching sensation at the bulge
  • Groin Pain and Discomfort : Pain or discomfort in the groin especially when bending over, straining, coughing or lifting
  • Dragging Sensation : Heavy, dragging sensation at the groin
  • Groin Weakness : Groin weakness or pressure
  • Pain and swelling : Protruding intestine that descends into the scrotum causes occasional pain and swelling around the testicles.

A hernia can become incarcerated. This happens if the hernia becomes trapped in the abdominal wall. This can lead to bowel obstruction that leads to severe pain, inability to have bowel movement, nausea, vomiting.

Strangulated hernia occurs when the incarcerated hernia becomes strangulated and blood flow to the tissue that is trapped is cut. Unless treated, a strangulated hernia can be life threatening and is a surgical emergency.

Symptoms of an incarcerated or strangulated hernia include:

  • Nausea and vomiting.
  • Fever
  • Sudden Pain and tenderness that quickly intensifies
  • Bulge that turns red, purple or dark
  • Inability to move the bowels or pass gas

Some of the factors that lead to inguinal hernia are discussed below:

  • Increased pressure within the abdomen
  • Weak tissues and muscles in the abdominal wall
  • Straining during bowel movements
  • Strenuous activity
  • Pregnancy
  • Chronic coughing or sneezing

Laparoscopic inguinal hernia surgery can be performed that is minimally invasive with less pain and discomfort. The surgeon initiates the surgery by administering a dose of general anesthetic to relax the muscles and to put the patient in sleep like state. The surgeon makes a small incision in the abdomen and is inflated with air to get a clear view of the internal abdominal cavity. A laparoscope (a thin long tube with a camera attached to its end) is inserted through the incision that allows the surgeon to view enlarged images of the organs and abdominal cavity that is connected through the monitor. After inspection, more incisions are made and other surgical repairing tools are inserted through the incisions into the abdominal cavity. A mesh is positioned in the weak spot of the inguinal canal to reinforce the abdominal wall. Later the incision are stitched and closed.

Laparoscopic inguinal hernia surgery can be categorized into two techniques:

  • Transabdominal preperitoneal (TAPP) – In TAPP hernia surgery, a small flap of the lining is peeled back from the hernia and a mesh is placed that acts as a support to the abdominal wall. This mesh acts as a barrier and prevents further thrusting of the abdominal tissues into the inguinal canal.
  • Totally extraperitoneal (TEP) – TEP technique involves refurbishing the hernia without inward bounding of the peritoneal cavity.

Contact Details

Dr. R. Padmakumar
Senior Consultant Laparoscopic and Metabolic Surgeon &
Director - Verwandeln Institute (Transforming Lives)
(Specialist in Laparoscopy, Hernia, Cancer, Obesity, Diabetes Surgery, Endoscopic Thyroid Surgery, Thoracoscopy, Intragastric Balloon)
Keyhole Clinic, Thammanam Road, Plarivattom, Kochi, Kerala, India
VPS Lakeshore Hospital, Maradu, Kochi, Kerala, India
Chairman - Association of Surgeons of India, Kerala Chapter

Mobile: +919447230370, +919846320370


Chairman, Association of Surgeons of India - Kerala Chapter
National President - Indian Hernia Society (2016)
GC Member, Association of Surgeons of India (2013 - 2018)
Vice President- Society of Endoscopic and Laparoscopic Surgeons of India
Jt. Secretary - Indian Association of Endocrine Surgeons (2016)
Founder Member, Obesity and Metabolic Surgery Society Of India
Founder Member, Association of Minimal Access Surgeons of India
International Faculty of IASGO on Hernia and Diabetic Surgery
International Faculty of IFSO on Diabetic Surgery
Associate Editor : Diabetes and Obesity International Journal