24 Healthcare Innovations Specialist clinics


Promotional Content • Saturday 28th March 2020


PHOTOGRAPH: MAX LEVERIDGE ON UNSPLASH


Hernias? They can be a pain in the groin M


What do a Stradivarius violin and the blue-stained glass at Chartres Cathedral have to do with hernias and groin pain? Surgical director, Mr Simon Marsh, has the answer


ore than 80,000 inguinal hernia repairs are performed in the UK every year, so,


what is it, who gets one and why, and how are they treated? I’ll also touch on ‘Gilmore’s Groin’, a cause of groin pain athletes, then I’ll come back to Stradivarius and Chartres. A hernia is ‘the protrusion of part, or


the whole, of a viscus through the wall of the cavity that normally contains that viscus’. A ‘viscus’ is just a general term for an organ or any discrete part of the body. What we’re interested in is the common or garden ‘inguinal hernia’ that causes a lump in the groin. About 25% of men will eventually


get one whereas only 2% of women do. Te difference is due the different anatomy in the groin. Men have a


larger gap in the muscles to allow the spermatic cord to reach the testi- cles. Tis causes a weakness which means that a ‘viscus’ (fat or bowel) can protrude through more easily. In women the gap is smaller and so hernias are less common. Most hernias (eventually) need an


operation and are fixed using some kind of artificial mesh patch tech- nique. Tis can either be done from the front (‘open’), or from the inside using a laparoscopic technique which leaves several, smaller, scars. Until the mid-1990s, all hernias


were repaired using stitches and the repair required a thorough under- standing of the anatomy of the groin to prevent complications and the hernia coming back. Ten the mesh patch technique


was developed as a relatively simple technique that would reduce the complication rate and particularly the risk of recurrence. Initially, the operation was ‘open’, but then the laparoscopic surgeons took it up with a larger mesh patch placed inside the abdomen. Tis is often described as


‘minimally Mr Simon Marsh, surgical director invasive’, because


of the small scars, but the amount of surgery ‘inside’ can be greater.


About 25% of men will eventually get one whereas only 2% of women do. Te difference is due the different anatomy in the groin


Interestingly, the recurrence rate probably hasn’t really changed at all and, although most people who have a mesh hernia repair have no trouble, some may develop pain related to the mesh. One solution might be to go back to a completely non-mesh tech- nique, where anatomical knowledge is fundamental. Tis is of relevance in athletes with


Gilmore’s Groin, a syndrome with a specific set of symptoms and signs that occurs when the muscles in the groin are torn. Tere’s no hernia, and the operation relies on the muscles and tendons being repaired with sutures, in an anatomical fashion, at the correct tension, to restore normal function. No mesh is used.


So, what about the blue glass of


Chartres, or the Stradivarius violin? Te expertise and understanding to reproduce them has been lost. In a similar way, the expertise required for non-mesh hernia repair, and particu- larly for Gilmore’s Groin surgery, may have been lost. If you have a hernia that needs an operation, the important thing is to make sure you’re aware of the options (including the potential complications) so you can chose which type of procedure is right for you.


108 Harley Street, London W1G 7ET T: 020 7563 1234 E: info@108harleystreet.co.uk 108harleystreet.co.uk


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