1300 HERNIA (1300 437 642)
Hernias > Indirect and Direct Inguinal Hernia
Inguinal Hernia - In the Groin
Inguinal hernias are the most common type encountered in surgical practice (approx. 80%). They are far more common in men than women. They occur at any age – from the newborn to the elderly. In men the descent of the testes at birth has left the abdominal wall in this region more prone to weakness and herniation.
At birth there is a sac, which if it does not shrivel up, leads to the development of a hernia. With aging as the muscles undergo attrition, this can also cause hernias. Straining and lifting are common factors associated with the development of a hernia.
There are two basic types but they both protrude through the superficial external ring of the inguinal canal in the groin.
The indirect occur at any age, from infancy to the elderly. In children or females the hernia is invariably indirect.
Direct herniae occur with increasing frequency in males as they age.
The persistence of the processus vaginalis sac at birth associated with and following the descent of the testis results in the development of indirect herniae in children. This is the congenital type of the sac.
With incomplete descent of the testis (undescended testis) there is usually
an associated indirect hernial sac.
Persistence of a patent process vaginalis is also responsible for communicating hydroceles of the testis and encysted hydrococeles of the cord.
There is conjecture as to whether this congenital type of sac (persistent patent process vaginalis) is responsible for the development of indirect herniae in adults or whether the herniae developed as a new event, associated with failure of the muscular shutter mechanism at the internal ring. The 'congenital sac' theory assumes there is a congenital sac which only fills with contents in adult life.
It is not always possible to distinguish clinically between a direct and indirect inguinal hernia.
Some guiding points are size:
While these are all practical points in differentiation there is a significant error rate in differentiation. The basic need is to be able to decide which hernia should be operated on and which can be observed and reviewed.
Generally indirect herniae should be surgically repaired because they become larger, cause symptoms and may obstruct and strangulate.
In children this is especially so because strangulation is more prone to occur with little warning.
Direct herniae may not cause marked symptoms or become very large, nor do they obstruct or strangulate as frequently. However there can be no strict rules and direct hernias can complicate.
Many other factors will decide whether surgery is carried out, but generally it is advised for either type. A truss is sometimes used to prevent the hernia protruding and to minimise the discomfort. A truss is often used when the patient declines or is considered unfit for surgery. A truss however, is not always effective and cannot be used for irreducable hernias.
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