Pantaloon Hernia

A pantaloon hernia is a rare type of hernia that affects your groin. It occurs when two hernias form at the same time on the same side. These hernias sit on either side of a group of blood vessels called the inferior epigastric vessels. Together, they can look like a pair of pants. That’s why it’s called a pantaloon hernia. You may also hear the term “saddlebag” hernia.

A hernia happens when part of your body pushes through a weak spot in muscle or tissue that normally holds it in place. Because a pantaloon hernia involves two weak areas, the condition can be more complex than a single hernia. Pantaloon hernias also have a higher risk of coming back after surgery.

Symptoms of a pantaloon hernia

Symptoms can vary and may be mild at first. Common signs include:

• A bulge or lump in your groin, which may be easier to see when you’re standing or coughing
• Discomfort or aching in your groin
• A feeling of pressure or heaviness
• Swelling in the area
• Nausea and vomiting

Pantaloon hernia causes

All pantaloon hernias involve your inguinal canal, a passageway in your groin. They’re all a type of inguinal hernia. What makes a pantaloon hernia unique is that it always involves two different kinds of hernias:

• Indirect hernia: An indirect hernia pushes through an opening in your inguinal canal. Indirect hernias are present at birth. During fetal development, the openings of one or both of your inguinal canals don’t close as they should. Some babies are born with this defect. For others, a hernia might develop later in life because this area can be weak.
• Direct hernia: A direct hernia pushes through a weak spot in the back wall of your inguinal canal. Direct hernias develop as you get older. Weak spots in your muscles or tissue often occur due to straining or heavy lifting, along with other factors.

Risk factors

Pantaloon hernias are more common in males and people over 65. Other risk factors include:

• Frequent heavy lifting
• Having overweight or obesity
• Long-term (chronic) cough
• Chronic constipation
• Pregnancy
• Biological family history of inguinal hernias

Complications of this condition

Without treatment, a pantaloon hernia can become stuck (incarceration). That means your healthcare provider can’t push the contents of the hernia back inside your abdominal wall.

When incarceration occurs, the hernia may become strangulated. Strangulation means blood flow to the hernia is cut off. This can lead to the death of tissue inside the hernia.

A pantaloon hernia can also lead to a bowel blockage if it involves part of your small intestine.

How doctors diagnose this condition

Your healthcare provider will ask you about your symptoms and perform a physical exam. They’ll gently touch and press your groin area to feel for a lump or bulge. They may ask you to stand or cough to watch the hernia move in and out.

Your provider may need imaging tests to confirm the diagnosis. Tests may include an ultrasound or a CT scan.

How is a pantaloon hernia treated?

A pantaloon hernia requires surgical repair. Your surgeon will move the herniated tissue back into place. Then, they’ll repair the weakened area where the hernia occurred. They may reinforce the area with stitches, synthetic mesh or tissue from another part of your body.

The type of hernia repair surgery your provider uses will depend on several factors, including:

• The size of the hernia
• Your medical history
• Your age and overall health

Your surgeon can repair the hernia with:

• Open surgery: Your surgeon makes one large cut to find and repair the hernia. They may use this type if the hernia is larger.
• Minimally invasive surgery: Your surgeon makes several small cuts. Then, they insert a camera and special tools to see and repair the hernia.

They can do minimally invasive surgery laparoscopically or robotically:

• Laparoscopic surgery: Your surgeon controls long instruments directly with their hands.
• Robotic surgery: Your surgeon controls robotic arms at a console in the operating room.

Recovery time

Recovery depends on the type of surgery. You’ll likely:

• Go home the same day
• Resume light activities within days
• Return to normal daily activities within about a week

Pain after surgery is usually mild and should improve quickly.

When should I see my healthcare provider?

See your provider if you:

• Notice a new or growing bulge or lump in your groin
• Have pain or discomfort in your groin
• Develop urinary symptoms
• Have sudden pain, swelling or nausea, which may signal a complication

What can I expect if I have this condition?

With proper surgical repair, most people do well. But pantaloon hernias have a higher risk of coming back than single hernias. To reduce your chances of a recurrence, follow your surgeon’s recovery instructions. Make sure to:

• Avoid heavy lifting while healing
• Attend follow-up visits
• Report any new symptoms early