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Posted on Sat, Jul 27, 2013 : 5 a.m.

Enlarged hernia should be surgically repaired

By Ask Dr. K

DEAR DOCTOR K:

I have an inguinal hernia. Do I need to have it repaired? If so, what will the procedure involve?

DEAR READER:

An inguinal hernia occurs when part of the intestine bulges through a weak spot in the abdominal wall, near the groin. The bulge can be small or large. There is a wall of tissue between our intestines and other abdominal organs and the skin of our belly. That wall is composed of muscles and a tough layer called fascia. You see the muscles when a person has trained his abdominal muscles so intensively that he has "washboard abs."

That wall of tissue is supposed to keep the intestines and other abdominal organs inside the abdomen. But holes can develop in that wall. When a part of the intestines pushes out through the hole, it's called a hernia. When the hernia occurs in a particular area in the groin, it's called an inguinal hernia. (I've put an illustration of an inguinal hernia on my website, AskDoctorK.com.) Men are more likely than women to develop this kind of hernia.

At first, an inguinal hernia may not cause symptoms, or it may cause only heaviness or pressure in the groin. As the hernia grows, it produces an abnormal bulge under the skin near the groin. It is likely to become larger and more uncomfortable until it is repaired.

As the hernia enlarges, there's a small chance that a portion of herniated intestine may become trapped and unable to slide back into the abdomen. If this happens, the trapped intestine can twist and die because its blood supply is cut off.

An inguinal hernia will not heal on its own. If your hernia is causing any symptoms, or has become even a little larger, you should talk to your doctor about having it surgically repaired.

Hernia repair may be done through open or laparoscopic surgery. Both usually are done on an outpatient basis.

Most inguinal hernias are repaired by open surgery. The surgeon makes an incision in your groin, then pushes the herniated tissue back into place. He or she repairs the hernia -- the hole in the wall of tissue -- by stitching together the edges of the hole. It's no different from stitching together a hole in a shirt. A small piece of synthetic mesh material reinforces the area to prevent another hernia.

In laparoscopic hernia repair, a surgeon makes small incisions in the abdominal wall. He or she then inflates the abdomen with a harmless gas and inserts a laparoscope, a tube-like instrument with a small video camera and surgical instruments, through the incisions. Viewing the internal scene on a monitor, the surgeon pushes the herniated intestine back into place. The hernia opening is repaired with surgical staples. Laparoscopic surgery usually has a faster recovery time than open surgery.

There are advantages and disadvantages to both types of surgery. Talk to your surgeon about which option is best for you.

(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)

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