I have what appears to be an indirect inguinal hernia. When I apply
pressure to the bulging mass (about as big as a globe grape) it
doesn't pouch-out after I bear down. My urologist told me that he
could make a 4" incision and instead of suturing he would put some
webbing into place(presumably to plug the opening in the inguinal
foramen where the mesentary is protruding.  My question is has anyone
ever heard of a less invasive way of correcting this problem? The
bulge just appeared about 2 weeks ago. Has anyone had experience with
this type of repair? Side affects? I'm a
runner/golfer/surfer/Chiropractor and don't want to be
'out-of-action'for 4-6 weeks. Any reason this procedure can't be done
arthroscopically? Would it be advisable to get an MRI first. I
understand it could also be my bladder protruding (from some anatomy
reading). Thanks for your feedback. 
 

Please Note: Information ur help. Should I avoid my activities? I feel
it
only mildly, at this point.

Hi irwinito,

I'm sorry you're feeling under the weather!  Thankfully, you seem to
have caught things early.  I'm sure you're well aware that hernias
don't go away on their own - they get larger over time and can
eventually cause much more serious problems if they aren't repaired as
soon as possible.

Let me address the very last part of your query first:  If your hernia
is bothering you and you don't want to give up your activities while
waiting for your surgery date, get a truss.  (My grandfather had one
years ago, he called it his "Bulletproof Britches"!)  A truss is a
supportive garment designed to "tuck" a hernia back in and keep it
from bulging.  It's my understanding that they're a little more
flexible these days and a bit more comfortable, so have a chat with
your pharmacist to find out which one would work best for you. 
Alternatively, you can look at and purchase them online:

Hernia Support
http://www.herniasupport.com/herniabelt.asp

Of course, if your doctor tells you to slow down for a little while,
it's best to heed his advice and not overdo things.

There is indeed a hernia repair procedure that is less invasive than
the traditional 3 to 5 inch incision method.  It's lapaparoscopic
inguinal hernia repair, a procedure in which three very teensy
incisions are made in the abdominal wall.  The surgeon is guided by a
microscopic camera to make the necessary repair:

"What is laparoscopic hernia surgery like?

A patient is asleep under general anesthesia during laparoscopic
inguinal hernia repair. The surgeon inserts a thin, telescope-like
instrument called a laparoscope through a tiny tube (called a trocar)
in a small incision at the umbilicus (belly button). The laparoscope
is connected to a camera, giving your surgeon a magnified view of your
internal organs on a video monitor.

The abdomen is inflated with carbon dioxide, a gas, to allow your
surgeon a better view of the operative area. Two or three additional
trocars are inserted to accommodate special instrumentation. The
surgeon pulls the hernial sac back into the abdominal cavity and opens
it to see the defect in the abdominal wall. The defect is covered with
a polypropolene mesh patch that is anchored securely to the abdominal
wall with a tacking device.

Following the repair, the small incisions are closed with a stitch or
two and covered with Band-Aids. Within a few months, the incisions are
barely visible."

University of Michigan Health Services Division of Minimally Invasive
Surgery -
Laparoscopic Inguinal Hernia Surgery 
http://www.michiganminisurg.com/inguinal.html

Sounds pretty nifty, doesn't it?  Aside from the minimal scarring
associated with the procedure, patients who undergo laparascopic
surgery enjoy less post-surgical pain and a faster recovery time.

[ Though I've not had a hernia repair, I have had laparoscopic surgery
- to remove an ovarian cyst.  Had I undergone traditional surgery, I
would have been off my feet for at least 4 weeks.  As a very busy
mother of two young sons, I don't have time for that nonsense.  The
laparascopic method left me with the tiniest of scars, and I was able
to keep up with my boys in just a few days.  Pain was easily
controlled by OTC meds (Motrin!), and I suffered no ill effects from
the surgery. ]

Do keep in mind that, though this procedure is available, it might not
be the best treatment option for your situation.  To determine if this
is correct for you, you'll need to consult with a surgeon.

Garth H. Ballantyne, the director of Minimally Invasive Surgery at
Hackensack University Medical Center (New Jersey) offers a terrific
explanation of the repair procedure, including pictures of the
equipment used and a diagram of how they are inserted:

LAPAROSCOPIC INGUINAL HERNIA REPAIR
http://www.lapsurgery.com/hernia.htm

There is also an in-depth discussion of Laparoscopic Repair of
Inguinal Hernia at the Laparoscopic Hernia Center web page.  Of some
interest is this, which might explain why your urologist didn't
immediately suggest this option:

"Rationale for Laparoscopic Repair

Inguinal hernias may be repaired by either the classical open methods,
or the modern laparoscopic techniques. If the patient is young or the
hernia small , it does not matter how the hernia is repaired. For all
other patients, the choice of the method is as important as the
performance of the repair itself. Usually the patient is not offered a
choice, and the surgeon uses a method he is familiar with, according
to his training and experience. Laparoscopic repair in expert hands is
now quite safe and effective , and is an excellent alternative for
about 95% of patients with inguinal hernias. It is more complex and is
not widely available."

Laparoscopic Hernia Center
http://www.lap-hernia.com/public_sept99.htm

In addition to the noted article, the left sidebar has links to
pictures, decriptions of the procedure, what to expect afterwards, and
FAQs.

With respect to the possibility of the hernia being your bladder
protruding, I would advise you to discuss this thoroughly with your
physician.  He should be able to determine whether or not this is the
case through a manual examination.  MRIs are costly, and typically
aren't called for unless the physician is well and truly stumped. 
More than likely, this is not a concern for you - traction
diverticulum (hernia of the bladder) occurs in only 1.5% of all hernia
cases.

[ Source:  Dr. Sheraz Memon  http://surgery.4t.com/65.8.htm ]

For more information about laparoscopic inguinal hernia repair, have a
look at the following resources:

Minimal Access Surgery Center @ Columbia Presbyterian Medical Center -
includes Flash Video
http://www.masc.cc/inguinal.htm

Frequently asked questions about laparoscopic hernia
http://www.laparoscopyhospital.com/frequently_asked_questions_about_hernia.htm

Online Laparoscopic Technical Manual - Procedural videos in right
sidebar
http://www.laparoscopy.net/inguinal/ingher17.htm

Hernia Surgery Discussion Board (and Hernia Surgery Experiences Site)
http://members.boardhost.com/hernia1/

Personal Hernia Surgery Pages - "MY PERSONAL EXPERIENCE & 2,413
OTHERS"
http://pages.prodigy.net/replyasap/web/

I hope you find this information helpful!  If you need further
assistance, simply ask for clarification, and I'll be happy to help!

Feel better soon!

--Missy

Search terms: [ "inguinal hernia" repair "less invasive" ]

About two years ago, I had a direct inguinal hernia repaired.  After
doing some research online, I found a nearby hospital with a rather
intriguing reputation... their success rate is over 99% for their
method of repairing hernias of the abdominal wall.  This place is the
Shouldice Clinic in Toronto, Canada.  Their web site is at
http://www.shouldice.com/.

One of the nicest things about this place is that, after I got my
hernia repaired, I was well on the way to recovery after a few days. 
In fact, they encourage that the patient keep moving and participate
in exercises in the morning, even right after the surgery is
performed.  And this was major abdominal surgery!

The method employed is neither laproscopic, nor does it use a mesh,
but is instead a 'pure tissue repair,' a technique developed by the
hospital's founder Dr. Edward Earle Shouldice.  I quote from their web
site:

"This pure tissue technique was introduced in 1945 by Dr. E.E.
Shouldice. Since then, the operation has proved to be the most
reliable, safe and cost-effective technique. The operation is carried
out under local anaesthesia, contributing to the exceptional safety of
the operation. Just as important as the technique is the fact that a
team of 12 surgeons have devoted all their time and resources
exclusively to the practice of hernia surgery. Shouldice Hospital
surgeons will each perform from 400 to 700 operations a year,
providing a sixth valuable sense in the recognition and handling of
all the problems that surround hernia pathology. The Shouldice Team of
Surgeons have performed more than 270,000 operations."
(http://www.shouldice.com/hernia.htm)

I highly recommend their method and believe that it's worth the trip
to Toronto, even if you live a significant distance away.  They have
had patients from throughout the world.  Not only is the procedure
quick and noninvasive (all that's left is a stainless steel suture, no
mesh at all), but the hospital atmosphere is extremely nice.  It will
definitely be an enjoyable two-day stay; you may even forget that
you're at a hospital!

as a surgeon who has repaired thousands of hernias, I'd chime in with
this: first, have it done by a general surgeon, not a urologist.
Second, the placement of mesh is pretty much standard now, and has the
lowest recurrance rate, the least amount of post op pain, and no more
chance of complication (very rare) than with procedures (such as the
Shouldice repair) which don't use it, while having an even better
success rate. It can be done open or laparoscopically. There is less
post op discomfort when done laparoscopically, but maybe a slightly
higher recurrance rate, depending on the size of the mesh placed, and
the experience of the surgeon. With a small hernia as you describe,
there's virtually no chance it involves bladder. And a bulge in the
groin which comes and goes is certainly a hernia; getting an MRI is
not going to add any info unless for some reason the physical exam is
equivocal. As to a truss; they don't really work for most people,
especially if you want to live an active life. They rarely can be made
to fit properly enough to prevent protrusion, and they may weaken the
muscles of the area which can make the surgery less likely to hold up
when done. In my opinion, the choices are live with it as is, or get
it fixed. If it doesn't bother you enough to want surgery, there's no
hurry. The danger is incarceration with strangulation, meaning the
tissue protruding gets stuck and gets its blood supply cut off. It's
relatively unlikely; and it's not subtle. If it happens you'd know it,
and would seek attention right away. Finally, there ought to be no
need to go to far from home. Any competent, busy general surgeon ought
to know how to fix a hernia properly.

PS: you should check with your surgeon as to what he/she says; but
it's highly unlikely you'd need to be out of commission for more than
a very few days.

Just to point a link: 
THE BRITISH HERNIA CENTRE 
http://www.hernia.org/
They specialize in a kind of minimal surgery, performed under LOCAL
anesthesia.
"It is not a 'patch' stuck on the outside, but a total, tension-free
reinforcement inside the abdominal wall".
I think it is worth while having a look to it.
Regards,
Tom136