What is an inguinal hernia?
An inguinal hernia is a bulging of intestines or fatty tissue from the abdominal cavity through an opening in the groin region, creating a bulge in the groin. There are two main types: classic inguinal hernia and femoral hernia. The classic inguinal hernia is further divided into medial and lateral hernias, depending on which side of certain blood vessels the bulge appears. A femoral hernia protrudes at the top of the thigh and is more common in women than in men.
This is a very common condition in the population. It is estimated that around 28% of all men and 4% of all women will undergo surgery for an inguinal hernia at some point in their lives.
Why do people develop inguinal hernias?
Recent research has found a genetic component in the development of inguinal hernias. The inheritance patterns and genes involved are complex, so it cannot be said that having a specific gene will guarantee an inguinal hernia. It results from a combination of many factors and multiple genes, which ultimately lead to the development of an inguinal hernia. Interestingly, the strongest predictor is from mother to daughter. Although men are much more likely to have inguinal hernias than women, genetic predisposition is more pronounced in women. Therefore, if a mother has had an inguinal hernia, the risk that her daughter will also develop one is quite high.
If someone has a specific connective tissue composition, their risk of developing a hernia—especially a medial inguinal hernia—is significantly increased.
Certain types of work can also raise the risk. Heavy physical labor and standing for many hours a day increase the likelihood of developing a lateral inguinal hernia.
Femoral hernia as a special risk
A femoral hernia has a higher risk of becoming incarcerated or strangulated compared to other types of hernias. Since it is not possible to determine with certainty the type of hernia before surgery, and because women are more likely to have femoral hernias than men, it is recommended that all women with a groin hernia undergo surgery, regardless of whether they have symptoms.
The patient's journey from general practitioner to specialist
The process usually begins when a patient notices a bulge in the groin and consults their general practitioner. Some patients may have an ultrasound, but this is usually unnecessary, as the hernia can typically be felt during a standard clinical examination. Patients are referred to a surgical department if they wish to pursue treatment. The surgeon, in consultation with the patient, will determine whether surgery is necessary and what type of surgery should be performed.
Historical development of surgical techniques
In the past, hernias were repaired without using mesh, resulting in a recurrence rate of around 20% after surgery. In the 1990s, a mesh-based method was introduced by Dr. Lichtenstein from the USA, which reduced both postoperative pain and the risk of recurrence. Today, the laparoscopic (keyhole) technique is the most commonly used in Denmark, where a mesh is placed inside the abdominal wall through three small incisions in the abdomen, without damaging the intestines. Currently, the recurrence risk after laparoscopic surgery is around 2-3%.
Risk of recurrence and chronic pain
Although the recurrence risk is lower with modern surgical techniques, some patients may still experience chronic pain after surgery. Earlier reports indicated high rates of chronic pain, but recent studies suggest that the incidence may have decreased with current surgical practices. Current research is focused on understanding the long-term outcomes for patients post-surgery, including in the "AfterHernia" project.
Current and future research areas
Chronic pain and genetic research are major areas of study in hernia treatment. The future also holds potential for developing new meshes with growth factors and more personalized treatment options. The goal is to reduce complications such as long-term pain and disease recurrence. Ideally, a medical solution, such as a "hernia pill," could replace the need for surgery, which would be a significant advancement for patients, though this remains far off in the future.