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Adel El-Ghazzawy, MD

 Experienced, Board-Certified Surgeon in Bellevue, WA

Do you have a hernia? Explore minimally invasive, robotic, and advanced laparoscopic surgery options. Wellness awaits you!

adel el-ghazzawy md

Adel El-Ghazzawy, MD, FACS

To schedule an appointment fill out the form below or call us at (425) 386-7468.

Get Your Hernia Questions Answered By Our Experienced Surgeons

A hernia is a hole in a muscle through which intestines can herniate.  

An inguinal hernia (groin hernia) is where the intestines can herniate through a hole in the muscle of the inguinal region (groin). 

An incarcerated hernia is when the intestine herniates through the hole in the muscle and is unable to be reduced.  This can be caused by edema (swelling) of the intestine due to irritation such that the intestine is too large to retract back through the hole in the muscle. 

Edema from an incarcerated hernia can get so severe that the blood supply to the intestine is cut off as it swells inside the fixed ring of the hole in the muscle.  This acts like a tourniquet and leads to intestinal necrosis (the intestine tissue dies) which can perforate.  This can be life-threatening.  Avoiding strangulation is the main reason to repair inguinal hernias. 

Direct, indirect and femoral.  These are the three potential spaces that can herniate in the groin.   

Indirect inguinal hernias are present at birth. When children have an inguinal hernia repair at a young age, this is for an indirect inguinal hernia.  The indirect inguinal hernia sac is a remnant of a process called testicular migration.  As a male fetus develops before birth, the testicles migrate from just beneath the kidneys to the scrotal sac.  The purpose of this migration is that sperm cannot survive at body temperature.  The testicles drag the abdominal cavity lining with them (processus vaginalis) and this defect is supposed to close once migration is complete.  An inguinal hernia sac results from incomplete closure of the inguinal canal after migration.  The embryologic medical term for this is called "patent processus vaginalis".  Even though indirect inguinal hernias are present at birth, if the hernia defect is small, the intestines won't herniate and it could take many years to cause symptoms.  Over time, as we increase intra-abdominal pressure with lifting, coughing and straining, the small hernia gradually dilates until the intestines enter the inguinal canal through the hernia sac and the patient will notice a bulge and/or discomfort in the groin.  Indirect inguinal hernias are the most common hernia type in men and women.     

Direct inguinal hernias are acquired from tearing of the abdominal wall fascial and muscle due to heavy lifting or repetitive straining.  Chronic coughing can contribute to direct inguinal hernia formation due to the repetitive strain on the inguinal muscles. 

Femoral hernias occur when the intestines try to follow the blood vessels (femoral artery and vein) from the groin into the leg.  Whereas femoral hernias are more common in women than men, indirect inguinal hernias are still the most common inguinal hernia in women.   

  Indirect inguinal hernias are present at birth but the hole in the muscle grows larger over time so lifting can cause them to have symptoms at a younger age.  Direct inguinal hernias are due to heavy lifting or chronic straining and wear and tear of the abdominal wall.  Femoral hernias are a weakness in the femoral canal that can develop over time. 

Yes, but they are much less common than in men.  Femoral hernias are more common in women but the most common inguinal hernia in women is indirect.  

The main reason to surgically repair inguinal hernias is to avoid complications from herniation of the intestine such as incarceration and strangulation, as well as manage the pain and discomfort that hernias can cause.

Mesh is used commonly in inguinal hernia repairs to reduce the chance for recurrence.  The invention of mesh has drastically reduced the risk for recurrence. It has been used to reinforce hernia repairs for over 40 years. As the mesh heals, scar tissue embeds in the weave of the mesh which results in a repair that is stronger than our native tissue.  With proper technique, mesh can be used without causing chronic pain.  Non-mesh repairs can be done but they have a higher recurrence rate.  There are improper techniques that can cause chronic pain after mesh repairs but this is mostly avoidable with proper techniques.     

Open inguinal hernia repairs will heal to about 80% of maximum strength at 4 weeks.  This is the reason to avoid lifting over 15 pounds for 4 to 6 weeks.  Many people return to light duty work such as desk work after one week or less. For laparoscopic repairs, recreational lifting can start at 2 weeks post operatively, awkward heavy lifting can start after 4-6 weeks, with no restrictions on walking or lifting up to 15 pounds immediately after surgery.

It takes about six weeks for an inguinal hernia repair to reach maximum strength.  Heavy lifting or overdoing it can cause the hernia repair to rip apart and cause a sudden recurrence or heal weaker and then recur later. 

Laparoscopic surgery is done through several small incisions instead of one larger incision.  The benefits of laparoscopic repair include, small scars, less pain, quicker recovery and the mesh is placed on the inside of the muscle which is a stronger repair and covers all 3 potential hernia spaces (direct, indirect and femoral).  Bilateral repair (fixing both left and right sides) can be done through the same 3 small incisions.  An open repair would require two larger groin incisions to fix both sides at the same operation and has a higher chance of causing chronic groin pain, though this is a rare event. Open repairs can be safer in a patient that needs to avoid general anesthesia or a patient is on certain blood thinners or blood thinners that cannot be stopped safely before and after surgery.

The two main ways to reduce recurrence after inguinal hernia repair is to avoid lifting over 15 pounds for 4- 6 weeks and to use mesh in the repair. Once the mesh scars in, the repair is stronger than our own tissue. 

Many things can mimic an inguinal hernia. An experienced surgeon is invaluable to determine if a patient's symptoms are due to a hernia that needs repair. Surgeons evaluate many patients with groin pain or bulge and find there is no hernia that needs surgical repair. Muscle, fascia and tendon inflammation or tears from overuse can mimic the symptoms of a hernia. Enlarged lymph nodes, skin cysts or benign fatty tumors can cause a bulge in the groin that mimics an inguinal hernia. An evaluation from an experienced hernia surgeon can determine if your symptoms are due to a hernia that needs surgical repair or something else that may need additional evaluation.

The biggest thing to worry about is strangulation where the herniated intestines swell to the point of cutting off the blood supply. This causes the intestines to die and rupture which can be life threatening.  Several studies have been done where men with proven inguinal hernias are randomized to surgical repair versus no surgery. Typically, within two years most of the men in the non-surgical group crossover and have the hernia repaired due to increasing symptoms. It is also better to repair hernias when they are small instead of waiting for the muscle defect to be so large and chronically inflamed that you increase potential complications from surgery.

The bottom line is, if you are healthy and an inguinal hernia is impacting your lifestyle, you should get it repaired.   


Hear What Patients Are Saying


"Top notch surgical experience; professional, friendly, and up-to-date procedures. Dr. El-Ghazzawy makes the patient feels confidence and comfortable to have him perform the operation. Even at my age, 79, my recovery was so well that I was discharged ahead of schedule."

"I have received excellent care from Dr. El-Ghazzawy. He took the time to explain my surgery and treatment with clarity and precision. He has answered all my questions. It is obvious his staff as well as surgical staff like him and are pleased to work with him. My surgery and recovery have gone well. I strongly recommend him."

"Excellent surgeon. He takes the time to provide all details and educates the patient regarding their condition and what to expect before, during and after surgery. Extremely professional and on-time. The staff is friendly Thank you Dr. El-Ghazzawy!"

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