The current approach to inguinal hernia: Why endoscopic surgery makes the difference
By Dr. Ignacio Hevia Lorenzo
Inguinal hernia is one of the most common surgical conditions we encounter in daily clinical practice. To understand the true extent of this ailment, one need only look at the global statistics: more than 20 million patients undergo surgery for this condition worldwide each year.
Recently, I had the opportunity to discuss this topic as a specialist in General and Digestive Surgery and Endoscopic Surgery on the La Nueva España podcast. Although radio is a space Excellent for dissemination; I also believe it's necessary to use the press. To delve deeper, from a purely medical perspective, into what exactly this diagnosis entails and how surgical techniques have evolved to minimize the impact on the patient.
The origin of the problem: Why does an inguinal hernia appear? A hernia occurs when there is a weakness or tear in the muscular wall of the abdomen, allowing a portion of tissue, fat, or intestine to protrude through it.
As I explained in the podcast, this condition can be congenital (present from birth), or acquired throughout life: Aging of tissues, continuous physical exertion, or conditions that increase intra-abdominal pressure are key factors in its appearance.
The paradigm shift: From traditional surgery to endoscopy
For decades, open surgery has been the standard method. Fortunately, medicine is advancing toward minimally invasive procedures. Currently, one of the most effective techniques for treating this condition is endoscopic surgery. This procedure offers significant advantages over traditional treatment.
Through tiny incisions, we insert a camera and the necessary instruments to access the preperitoneal space (the layer just behind the abdominal wall muscles). By repairing the defect and placing the mesh from the inside, we keep the superficial muscle structure intact, respecting the patient's natural anatomy and drastically reducing surgical trauma.
Furthermore, this technique minimizes postoperative pain and complications arising from the surgical wound and, on the other hand, allows the placement of larger meshes and their fixation using surgical glue, avoiding two of the main drawbacks of open surgery in the medium to long term, such as the recurrence of the hernia and the existence of chronic groin pain.
Back in 2018, the International Guide for the Management of Inguinal Hernias published the recommendation for endoscopic inguinal hernia repair as the technique of choice in patients with bilateral inguinal hernias, women, young patients, patients who exercise, and all those who have undergone open surgery in whom the hernia has recurred, Therefore, since its inception in the 1990s, the spectrum of patients eligible for endoscopic inguinal hernia repair has been progressively increasing, to the point that the traditional or open technique has been relegated to a secondary role, given the evident benefits of endoscopic treatment, as I have been able to confirm with my patients in the clinic, after 20 years of experience.
The biological impact of minimally invasive surgery: Recovery in 5-7 days
The major clinical difference that this technique provides lies not only in the aesthetic aspect of having smaller scars and all the benefits mentioned above, but also in the significant benefit of a reduced inflammatory response in the body.
It is precisely the reduction of tissue damage that allows for much more effective postoperative pain management. As a direct clinical result, endoscopic surgery It allows the patient to return to their normal life in 5-7 days.
Frequently Asked Questions in Consultation
To clarify the most common doubts about this procedure, below I answer the questions most frequently asked by patients who come for evaluation at my consultations in Gijón and Oviedo .
- What are the risks if a hernia is not operated on?
We must start from a clear anatomical basis: an inguinal hernia does not disappear on its own. Since it is a physical defect, the main risk of not operating is that the hernia will increase in size over time, becoming more symptomatic. However, the most serious risk is acute complications, such as incarceration or strangulation. This occurs when the trapped tissue loses its blood supply, which constitutes a life-threatening surgical emergency.
- What type of anesthesia is used in endoscopic surgery?
To perform endoscopic surgery with maximum safety, precision, and comfort, we use general anesthesia. Unlike open surgical techniques, endoscopy requires the abdominal muscles to be completely relaxed. This allows us to create an optimal working space for inserting the camera and instruments through tiny incisions, ensuring the surgeon works under ideal conditions and the procedure is painless for the patient.
- What is the preparation process like before the operation?
Preparation begins with a thorough preoperative evaluation (blood tests, electrocardiogram). During the consultation, we review the patient's current medications, paying particular attention to anticoagulants. On the day of surgery, the patient must arrive fasting completely. Since our goal is for the patient to be able to return to their normal life within a few days, optimal preparation is the first step toward achieving a complication-free recovery.
- What are the differences between unilateral and bilateral hernias?
A unilateral hernia occurs on only one side of the groin, while a bilateral hernia affects both sides simultaneously. Clinically, endoscopic surgery makes a world of difference in the case of bilateral hernias. With traditional open surgery, we would need to make two separate, large incisions (one on each side). However, with the endoscopic technique, we can repair both sides from the inside using the same small incisions, which greatly minimizes trauma.
- Is endoscopic surgery recommended for older people?
Absolutely. Advanced age, in and of itself, is not a contraindication. What we thoroughly assess is the patient's overall health to ensure they tolerate the procedure well. In fact, this minimally invasive technique is especially beneficial for older people: by drastically reducing pain and allowing for rapid mobilization, we minimize the risks associated with prolonged bed rest, such as muscle atrophy or circulatory problems.
- What are the advantages of endoscopic surgery in hernias that recur (recurrent hernias)?
As I mentioned in the text above, endoscopic surgery involves a absolute indication When treating recurrent hernias (those that have been previously operated on and have reappeared), we use an endoscopic approach. When a patient has undergone traditional open surgery, the tissues in the superficial area exhibit fibrosis (scar tissue), and the original anatomy is altered. By using an endoscopic approach, we access the hernia from the inside (preperitoneal space), addressing the problem from a fresh anatomical plane and completely avoiding the previous scar tissue. This greatly facilitates the repair, reduces complications, and allows us to maintain the significant advantages of the procedure.
As a specialist in General and Digestive Surgery, my commitment both in the operating room and in the clinics of Gijón and Oviedo is to always offer the safest and most advanced surgical approach, so that each patient recovers their health and quality of life as soon as possible.
I invite you to continue browsing this website to learn more about me. path, Consult the section on What do I operate on?, delve into my surgical techniques or take a look at the press gallery. If you need a personalized assessment or have any questions, please feel free to go to the section on contact. You can write to me directly at info@drhevialorenzo.com or call 684 61 20 84.