Groin hernia, scrotal hernia, sportsman's groin or incipient hernia – what does this mean?

The “wall” of the groin or “inguinal” region is built by very thin but normally strong layers of connective tissue and fascias. Behind this wall is the intra-abdominal space.
Holes in this wall are called hernias.
All organs, that lie in the intra-abdominal space may move through these holes outwards under the skin and the subcutaneous tissue of the groin.

If, for example an intestinal loop moves through a hernia and cannot go back into the abdomen, a very severe and sometimes deadly complication occurs: the intestinal obstruction, caused by the strangulation of the intestinal loop, often combined with necrosis of this part of the intestine.

How do I recognize a groin hernia?
Many patients have some pain in the groin region, especially when they cough, shoot a ball or lift a heavy load.
Often this pain is misinterpreted (even by physicians) as caused by tendons or muscles.
Especially in soccer players we can find in theses cases often an incipient hernia that is called a “typical sportsman's groin” In many other patients there is no pain at all, but only some little swelling – in most cases not constantly – but only sometimes: again, dependent from physical action.

Which treatment for which kind of hernia?
There are generally two different ways of hernia repair:

• “open” surgery, where a short cut in the groin-region is needed to repair the hernia with or without implanting a polypropylene-mesh: often carried out under local anaesthesia or superficial total anaesthesia
• endoscopic surgery, where a polypropylene-mesh is implanted endoscopically, through the inner abdomen (TAPP- technique) or through the muscles of the abdomen (TEP-technique) in a deep anaesthesia with complete relaxation of the muscles

It is recommended to choose the “open” way in most cases because it is very safe, has much fewer severe complications and can be carried out both as a day patient and under local or superficial anaesthesia.

The endoscopic operations should be left for special cases:
e.g. older patients who have undergone some open hernia-repairs before.

The different “ open ” operations
There are many different methods, but only three are really important today:

• the SHOULDICE –repair without mesh-implantation
• the LICHTENSTEIN-repair with mesh- (but without plug) implantation
• the RUTKOW-repair with implantation of mesh and plug

There is no “best way” for any hernia:
The decision whether to choose the one or the other way of repair is individually made in each case and depends on many factors, such as:

• age
• sex
• the individual patient's history
• physical activity

We have designed a special form that will help us to decide upon the choice of the right method:
Please fill in the answers and send it to us via e-mail.

An experienced surgeon will work out a suggestion for the individually best suited method and send an answer within 24 hours. This hernia-repair-evaluation-form is very useful and in most cases we do not have to change our ideas following further examination of the patient.

It is without saying that the final decision upon the applied method in each individual case is made after an examination by a well-trained and highly experienced surgeon the day before surgery.

In all our cases our aim is:

• to enable the patients to do sports and work (even heavy) after only three days
• to have the lowest possible rate of relapse.

This is due to our specialisation and the enormous experience that we have with built up with hernia-patients.