A few days ago, Zhang unintentionally found a bulge in his right small abdomen near the root of his thigh, which was obvious when he stood up, but disappeared when he lay flat, and was not particularly uncomfortable. In fact, Zhang has an inguinal hernia. So what is inguinal hernia? An inguinal hernia is a hernia formed when an organ in the abdominal cavity protrudes to the body surface through a defect in the groin, commonly known as a “hernia” or “small intestine gas”. Inguinal hernias are divided into hiatal and ventral hernias. Hiatal hernias are more common in children and young men, while rectal hernias are more common in older men. Inguinal hernias account for the majority of cases. Inguinal hiatal hernia is mostly right-sided, but it can also develop on both sides. It appears when adults stand, walk or work for a long time, or when children play with increased intra-abdominal pressure; it disappears again when intra-abdominal pressure decreases after rest or lying down. The mass can often fall into the ipsilateral scrotum when the disease is prolonged. In a few patients, a huge hernia can be formed and the contents of the hernia are difficult to be returned into the abdominal cavity, which can be called a “refractory hernia”. When the hernia mass is embedded, strangulated, or stuck and cannot be retracted at all, accompanied by obvious pain, it is called “incarcerated hernia”, which can be life-threatening in severe cases. Direct inguinal hernias are more common in elderly men, where there is no congenital underlying channel and the tissue is weak. The mass is spherical, does not enter the ipsilateral scrotum, and because of the wide base of the hernia mass, inversions rarely occur. Why do inguinal hernias occur? It is generally believed to be related to the decrease in the strength of the abdominal wall muscles and the increase in intra-abdominal pressure. Muscle atrophy in the elderly makes the abdominal wall weak, and the inguinal region is even weaker, with blood vessels, spermatic cord or round ligament of the uterus passing through it, providing a channel for hernia formation. In addition, diseases such as coughing and asthma, constipation and difficulty in urination due to prostatic hyperplasia in the elderly result in increased abdominal pressure, which also provides the impetus for hernia formation. What are the clinical manifestations of inguinal hernia? The clinical manifestations vary according to the type of hernia: 1. Repeatable hernia is characterized by the appearance of a repeatable mass in the inguinal region, which is small at first and appears only when the patient is standing, working, walking, running, coughing or when the child cries. There is generally no special discomfort, only occasional local distension and involvement pain. With the development of the disease, the mass may gradually increase in size and descend from the groin to the scrotum or labia majora, making walking difficult and affecting labor. The mass is pear-shaped with a stalk, narrow at the upper end and wide at the lower end. The mass may disappear on its own when lying down, or it may disappear by gently squeezing and pushing the mass outward and upward by hand, and it may disappear by retraction into the abdominal cavity. The mass is soft, smooth surface, and has a drum sound when tapped. When retracting, there is often resistance first; once retraction starts, the mass disappears more quickly. If the contents of the hernia are large omentum, the mass is tough and inelastic, with a turbid sound on percussion and slow retraction. 2. Sliding hiatal hernia Clinical features are large and difficult to reopen hernias that cannot be completely retracted. The cecum that slides out of the abdominal cavity often adheres to the anterior wall of the hernia sac. In addition to the incomplete retraction of the mass, there are also symptoms such as indigestion and constipation. Sliding hernias are mostly seen on the right side, with an incidence ratio of about 1:6 between the left and right sides. 3. incarcerated hernia Often occurs when there is a sudden increase in intra-abdominal pressure such as labor or defecation, and is usually a hiatal hernia. The clinical features are sudden increase in size of the hernia mass with obvious pain. The mass cannot be retracted by lying down or pushing it by hand. The mass is tense and hard with marked tenderness. If the embedded content is the greater omentum, the local pain is often mild. Once the hernia is embedded, the above symptoms will gradually worsen, and will eventually become strangulated hernia if not treated in time. In the case of intestinal wall hernia, it is easy to be ignored because the local mass is not obvious and there is not necessarily a manifestation of intestinal obstruction. The clinical symptoms of strangulated hernia are more serious. Patients have persistent severe abdominal pain, frequent vomiting, vomit containing coffee-like blood or bloody stool; abdominal signs show asymmetric abdominal distension, signs of peritoneal irritation, diminished or absent bowel sounds; abdominal puncture or lavage is bloody fluid; X-ray examination shows isolated distended intestinal mix or tumor-like shadow; body temperature, pulse rate, white blood cell count gradually increases, and even signs of shock. How is an inguinal hernia diagnosed? The vast majority of inguinal hernias can be diagnosed based on the patient’s clinical symptoms and physical examination. If the hernia is relatively small and the presentation is atypical, the diagnosis can be basically confirmed by ultrasound examination. In some complicated cases, a CT scan of the lower abdomen can also be performed to help the doctor understand the condition. Do inguinal hernias need to be treated or not? Some patients think that small intestinal gas is a minor problem and can go back when they lie flat anyway, so they keep putting off going to the hospital for treatment. In fact, it is not. As patients get older, the hernia mass in the inguinal region will get bigger and bigger, and they will feel the discomfort of cramping and swelling after walking for a long time, and the risk of surgery will also get bigger as they get older. Especially critical is that if the inguinal hernia fails to retract and form an intussusception can lead to intestinal obstruction, even intestinal necrosis and perforation, and even death. Therefore, it is important not to think that inguinal hernia is a minor problem, and delaying it without treatment may lead to great danger. How can inguinal hernia be treated? Inguinal hernia is usually treated in two ways, conservative treatment and surgical treatment: 1. Conservative treatment Conservative treatment includes hernia belt, hernia brace, Chinese herbal medicine, etc. These methods can relieve the symptoms or delay the development of the disease, but cannot cure it, and some improper conservative treatments can aggravate the disease. This method is only suitable for infants under 2 years old, the elderly and frail or those with serious diseases. Special hernia belts are often used to press the hernia ring and relieve the symptoms. Surgery Surgery is the only reliable treatment for inguinal hernia in adults and is less likely to recur. Easily recurring hernias can be treated with elective surgery, while refractory hernias should be limited to short-term surgery, and incarcerated and strangulated hernias must be treated with emergency surgery to avoid serious consequences. Surgical treatment is subdivided into traditional tissue-to-tissue tension suture repair and tension-free hernia repair techniques, which are currently internationally recognized and include open and laparoscopic procedures. The preperitoneal patch repair, which has emerged in recent years, places the patch in the preperitoneal position in the inguinal region, thus strengthening the weak area of the abdominal wall where the hernia occurs at the source, repairing the inguinal hernia while eliminating the potential for further femoral hernia formation in the future. There are usually open preperitoneal patch repairs (Kugel procedure) and laparoscopic preperitoneal patch repairs (TAPP and TEP). Generally, unilateral, primary inguinal hernias are repaired with an open preperitoneal patch repair, which is less expensive and can be done under spinal or local anesthesia. Laparoscopic repair requires general anesthesia, is relatively expensive, and is indicated for bilateral inguinal hernias or recurrent inguinal hernias.