Inguinal hernia symptoms:
Many people find that they notice a bulge in their groin while they are in the shower. Sometimes this bulge is painless, and just worrisome. As long as it is soft, and can be easily pushed back into the abdomen, it’s likely to be an asymptomatic inguinal hernia. An evaluation by a primary care provider, or hernia specialist is important to make sure there is nothing else going on. Groin hernias that are not uncomfortable, can be safely watched for years in most patients.
About 80% of people with an inguinal hernia develop symptoms in the first 10 years. These symptoms can range from mild discomfort or aching at the end of the day, to more significant pain that interferes with daily activities. Rarely an inguinal hernia can become incarcerated (stuck) and necessitate an emergency operation. Surgery is the best treatment option for a symptomatic inguinal hernia.
Inguinal hernia treatment options:
Most surgeons divide hernia surgery into two types of approaches – Anterior and Posterior
The anterior approach is used to repair the abdominal wall from the outside. This can be done with or without mesh.
- We have written extensively on non-mesh inguinal hernia surgery
- Traditional open mesh repair is something we have written about and rarely ever perform since recent literature suggest that posterior mesh placement is superior for inguinal hernia surgery
The posterior approach is used to repair the hole in the abdominal wall with a patch on the inside.
Mesh is placed underneath all of the abdominal muscles, relying on the abdominal pressure to keep the mesh in place. Most high volume hernia surgeons and medical research now agree that the posterior approach is the best way to fix an inguinal hernia when using mesh. Boston Hernia has used these methods for the last 15 years when using mesh to repair an inguinal hernia. Both Dr. Reinhorn and Dr. Fullington each performed over 500 laparoscopic inguinal hernia surgeries before learning the advanced open preperitoneal repair.
The posterior repair can be performed in two ways:
- Laparoscopic or robotic – these require general anesthesia and are best suited to certain body types and patients with certain specific medical conditions.
- Advanced open preperitoneal repair – this can typically be done under local anesthesia with sedation and can be performed in the hospital or in an ambulatory surgery center.
In most patients, the advanced open preperitoneal repair offers the best of both worlds. It offers faster recovery without the need for general anesthesia and reduced pain medication requirements than laparoscopic hernia surgery. Our group studied this in conjunction with the Abdominal Core Health Quality Collaborative and published these results in the peer reviewed Hernia Journal. Check out our paper here.
For certain patients looking for a non-mesh hernia repair, the Shouldice technique may be an option.
We look forward to meeting prospective patients and speaking with them about their options as each patient benefits from a consultation with our providers. Call us or fill out the contact us form in order to schedule a consultation.
The Boston Hernia Difference
At Boston Hernia, we specialize in providing the highest quality of hernia repair to each and every one of our patients. While most general surgeons prefer to practice one or two types of hernia repairs, we offer a variety of approaches. Through extensive experience, we have studied which patient characteristics lead to better outcomes with each repair. Because of our focus in this area, we are able to tailor our surgical approach to the individual patient, selecting the repair that is ideal for the patient and ultimately getting better results.
About Dr. Reinhorn & Dr. Fullington
Dr. Michael Reinhorn is a specialist in inguinal hernia and umbilical hernia. He started his practice as a general surgeon in 2001, and in 2012 he transitioned to focus on the care of hernia patients. In 2018, he co-founded Boston Hernia, an ambulatory surgery practice focused exclusively on hernia surgery. In 2020, Dr. Nora Fullington was recruited from her work as a general surgeon, where she performed hundreds of laparoscopic hernia repairs, to Boston Hernia where she was intensively trained by Dr. Reinhorn in the open preperitoneal and Shouldice techniques. Together with their physician assistant team, they perform approximately 1000 hernia surgeries every year. Both surgeons offer a tailored approach for each patient, taking into account individual patient factors to decide if surgery is recommended or not, what type of repair (open, laparoscopic, mesh, non-mesh) is best, and what type of anesthesia is safest. At Boston Hernia, our focus is on each individual patient and continuously improving our own surgical techniques and outcomes. We do this by participating in various hernia societies, studying our own outcomes through a national database, and publishing our data to influence the care of hernia patients nationally and internationally. Boston Hernia is an affiliate practice of the Mass General Brigham system. In addition to operating at Newton-Wellesley Hospital, a Mass General Brigham Hospital, we offer care at ambulatory surgery centers in Waltham, MA and Derry, NH.