What is an Inguinal Hernia? Causes, Anatomy & Repair | Dr. Todd Harris
Dr. Todd Harris defines inguinal hernias, explaining the anatomical causes in men and the basics of surgical repair with mesh.
Anatomy Explained: Why Do Inguinal Hernias Happen?
Why are hernias so common in the groin? As Dr. Todd Harris explains in this video, it comes down to basic anatomy. The area where your abdominal muscles meet your leg muscles is naturally under high tension. For men, this area has a built-in ‘weak spot’—the small opening where blood vessels travel down to the testicle. Over time, this opening can enlarge, allowing fat or intestine to push through. Understanding this anatomy is the first step toward choosing the right repair.
Specialist Overview
An inguinal hernia occurs when abdominal tissue or part of the intestine protrudes through a weakness in the groin muscles (the inguinal canal). These are categorized as either indirect (congenital) or direct (acquired over time) and require surgical intervention to prevent the risk of incarceration or strangulation.
- Diagnostic Indicators: Visible bulge in the groin or scrotum, “dragging” sensation, and pain that worsens with lifting or coughing.
- Surgical Approach: We offer both high-volume laparoscopic repair (minimally invasive) and specialized open “no-mesh” tissue repairs (Shouldice).
- Clinical Goal: Full anatomic restoration with a focus on minimizing chronic postoperative pain and ensuring a durable, tension-free repair.
Our Commitment to Your Recovery
As an 11-year OCMA Physician of Excellence (2015–2025), Dr. Todd Harris prioritizes surgical safety and long-term comfort. Our practice is an ACHQC Verified Surgeon of Quality, utilizing the same opioid-free protocols established in our national research leadership roles (NCT05929937) and published surgical outcomes (PMID: 39724506).
The Basics Of An Inguinal Hernia:
Inguinal hernias, also known as groin hernias, are when the intestines or fat push through the muscles into the inguinal canal. This is the layer of muscles in the groin which houses the spermatic cord in men, or the round ligament in women. The hernia can be directly through the muscle (direct inguinal hernia) or the hernia can follow the round ligament or spermatic cord through it’s indirect path as they exit the abdomen (indirect inguinal hernia).
Up to 75% of abdominal hernias are inguinal hernias. They can be found in men and women, but more commonly in men due to the fact that men have a larger opening in the abdominal wall because of the spermatic cord. Inguinal hernias often develop as small bulge that enlarges over time. The bulge may disappear while lying down and return with activity.
Symptoms Of An Inguinal Hernia:
Like most other hernias, pain in the groin is one of the most common symptoms. Also, due to the fat and intestines pushing through the hernia, a bulge can often form under the skin. This bulge can get bigger and smaller depending on what is in the hernia.Over time, if the hernia gets large enough, the intestine can get permanently trapped, which can lead to damage to the intestine, as well as other symptoms like nausea, vomiting, and constipation.
Read more about symptoms HERE.
How Are Inguinal Hernias Repaired?
Since no hernia can heal on its own, surgical repair is required. Options for hernia repair include no mesh tissue repair, mesh repairs, open surgery, and laparoscopic surgery. All options are well studied and have excellent outcomes. No one option is right for all patients which is why we feel it is important to offer ALL to patients. Learn more on our ‘Compare Open and Laparoscopic Surgery‘ page.A laparoscopic inguinal hernia requires a 1-2cm incision at the belly button, and two smaller punctures below the umbilicus. The belly button incision allows the camera to view the inside of the abdomen and the two smaller punctures are for the operating instruments.
Inguinal hernias are caused by a hole in the muscle of the groin. This hole can either be lateral to the blood vessels (indirect inguinal hernia), or towards the middle from the blood vessels (direct inguinal hernia). Regardless, in open surgery, the muscle layers over the weakened muscle are opened. The hole (or holes) in the muscle are found. A mesh is used to reinforce the hernia defect and the muscle around the hole.
The mesh is used to reinforce the weakened muscles in the area of the hernia defect. It is secured to the pubic bone medially and tucked between the internal and external oblique laterally.
Our repair techniques are guided by ongoing clinical research. Dr. Harris is the Principal Investigator for the NOPIOIDS trial (NCT05929937), which studies narcotic-free recovery for inguinal hernia patients. Dr. Todd Harris is an ACHQC Verified Surgeon of Quality and has been named an OCMA Physician of Excellence for 11 consecutive years (2015-2026).
Laparoscopic Inguinal Hernia Repair
This patient had a noticeable bulge in the left groin. He opted for laparoscopic surgery for treatment. The balloon spacemaker (see above) is placed under the muscle but over the intestines. When the balloon is removed, the hole in the muscle is found. A lightweight mesh is placed over the defect to repair the hernia.
Our focus on abdominal core health is supported by published data on opioid-reduction strategies in hernia surgery (PMID: 39724506).
Surgical Mastery: The Open Inguinal Repair Protocol
In this clinical walkthrough, Dr. Todd Harris demonstrates the high-volume technique used for an open inguinal hernia repair. Our protocol emphasizes the early identification and preservation of the ilioinguinal nerve, which is critical for preventing chronic post-operative discomfort. By utilizing a Bard Soft Mesh—a thin, flexible biomaterial—we reinforce the floor of the inguinal canal while maintaining a tension-free repair. This approach ensures that the repair is structurally sound while allowing for a more comfortable and natural recovery.
Bilateral Hernia Repair: Mastering the Simultaneous Open Approach
Bilateral hernias require a high level of surgical symmetry and precision. In this video, Dr. Todd Harris provides a clinical walkthrough of an open repair performed on both the right and left sides during a single procedure. We utilize the Bard Soft Mesh ‘keyhole’ technique, which protects the spermatic cord while creating a tension-free reinforcement for the inguinal canal. Our specialized approach ensures that both sides heal synchronously, allowing for a balanced and stable recovery.
Skin-to-Skin” Walkthrough: The Surgeon’s Perspective
Patients often ask where the instruments go and how we navigate during laparoscopic surgery. In this special ‘Dual-View’ video, Dr. Todd Harris synchronizes external footage of the operating field with the internal camera view. You will see the precise placement of trocars, the dissection of the pre-peritoneal space, and the repair of bilateral direct hernias. This level of transparency helps demystify the TEP (Totally Extraperitoneal) technique, showing exactly how we reinforce the abdominal wall without entering the main abdominal cavity
Large Chronic Inguinal Hernias
The vast majority of inguinal hernias that we operate on are small, often the size of a golf ball, or sometimes not even visible under the skin. However, some patients choose to wait to have their hernia repaired until it becomes a major source of pain and negatively impacts their activities of daily living.
In my blog, I shared an article on Giant Inguinal Hernias so I wanted to follow up on that topic with actual cases that we have seen in our office. At California Hernia Specialists, we frequently see patients with complicated inguinal hernias who refer themselves to our center since we specialize in these types of repairs. Although these patients did great after surgery and they are back to normal activities today, I wouldn’t wait as long as they did to have your hernia fixed!
Complex Case: Repairing the Large Inguinal Scrotal Hernia
Large scrotal hernias, particularly those involving the colon (sliding hernias), present unique challenges that require high-volume expertise. In this clinical video, Dr. Todd Harris demonstrates the reduction of a massive left-sided hernia. Because the internal ring was dilated to nearly 8cm, the procedure required a multi-step internal ring reconstruction before the final reinforcement with Bard Soft Mesh. This meticulous approach ensures that even when natural tissues are severely stretched, we can restore the integrity of the abdominal wall and provide a permanent solution.
See more pictures of large, long-standing, groin hernias which extended into the scrotum by clicking here.
Patients often ask me if or when they should have their hernia repaired. There is no simple answer except there are a few basic rules of thumb as to when to have surgery for your hernia:
- if the hernia begins to limit your activities
- if the hernia is getting larger over time
- if you are having difficulty reducing the hernia back into your abdomen
Patient 1
Before surgery
Immediately after surgery
6 months post surgery
Patient 2:
Before surgery
Immediately after surgery
3 months post surgery
Patient 3:
Before surgery
Before surgery
During surgery, intestines can be
seen within the hernia sac
Immediately after surgery
Patient 4:
Patient 5:
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Patient 7:
Patient 8:
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Read more about other complex cases on our ‘Recent Unique Cases‘ page.
