An inguinal hernia is a hernia formed when an intra-abdominal organ protrudes through a defect in the inguinal cavity to the surface of the body, commonly known as a “small bowel hernia”. Professionally, inguinal hernias are divided into hiatal and ventral hernias. High prevalence: elderly and children. Most of the hernias are oblique, mostly on the right side, but can also develop on both sides. There are congenital and acquired inguinal hernias. Congenital hernia is more common in infants and young adults and appears after birth, more often on the right side. Acquired, due to weakness or defect of the abdominal wall, is more common in the elderly. Symptoms: early onset without obvious symptoms; only a pear-shaped or oval-shaped mass appears in the inguinal region, which may be felt as a cramping sensation. Subsequently, the mass often recurs. 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. In longer cases, the mass can often fall into the ipsilateral scrotum. When the patient suddenly exerts force, such as coughing or lifting heavy objects, too much abdominal contents 9c (intestinal tube) enters the hernia sac and becomes stuck and cannot be returned, accompanied by obvious pain, it is called “incarcerated hernia”, which can lead to life-threatening intestinal necrosis in severe cases. Treatment: A hernia belt can be used to compress the hernia for 6 months in infants aged 1 year, and it may be cured with muscle strengthening. Older and frailer people who have difficulty in tolerating surgery can wear a hernia belt. During the day, the soft pressure pad at one end of the medical hernia belt can be filled against the hernia ring after retrieving the hernia contents to stop the hernia mass from protruding. Long-term use of the hernia belt may increase the incidence of hernia intussusception by making the neck of the hernia bursa thick and tough with frequent friction, and may promote adhesion of the hernia bursa to the hernia contents. The most effective treatment for inguinal hernia is surgical repair. Traditional hernia repair The basic principles of surgery are high ligation of the hernia sac and strengthening or repair of the wall of the inguinal canal. Bassini’s method, as shown in the lower left. The Shouldice method. The disadvantages are obvious: the anatomical layers of different structures, forcibly sutured together, high tension, high postoperative recurrence rate, and high incidence of chronic postoperative pain. It is rarely used at present. Tension-free hernia repair. Modern hernia surgery emphasizes suture repair under tension-free conditions. The commonly used repair material is synthetic fiber mesh. Clinically applied synthetic fiber mesh includes polyester mesh, polytetrafluoroethylene mesh, nylon mesh, Memilene mesh, and Marlex mesh. Currently, polypropylene mesh is commonly used. There are various forms of patches, which are mainly divided into two categories: 1. anterior muscular layer: lichtenstein procedure, as shown on the right, which was finalized in 1989 and is a milestone in hernia repair surgery, and it has solved the problem of postoperative recurrence and is the “gold standard” of hernia repair; 2. anterior peritoneum: including mesh plug repair, kugel patch, double patch method, etc. Trans-laparoscopic hernia repair: a true minimally invasive hernia repair surgery, which can be completed by opening three small eyes (5mm) in the abdominal wall and placing the patch in front of the peritoneum. The lumpectomy hernia repair ensures that the patch is placed at the most proximal end. In addition, lumpectomy hernia repair is a truly tension-free repair with deep mesh placement, no incision, minimal postoperative pain, rapid recovery, and no activity restriction. The results of the procedure can be seen in foreign athletes who participated in the Tour de France 3 weeks after surgery. There are two main methods: ① transperitoneal anterior method, i.e. TAPP, which is rarely used in China because of the need to enter the abdominal cavity and the chance of postoperative complications; ② completely extraperitoneal method; i.e. TEP, which has obvious advantages because it does not need to enter the abdominal cavity. However, it is more difficult to master, has a long learning curve, and requires some surgical experience.