What to do about an inguinal hernia

An inguinal hernia refers to a weakness in the muscle or tissue wall within the groin area (lower abdomen and upper thigh). Since the hernia is an actual hole, soft tissue from inside the abdominal cavity will protrude to the outside, resulting in a bulge. Symptoms of an inguinal hernia are often mild, and include a sharp pain or dull pressure and a sensation that something is sliding or popping in and out of the body.

The soft tissue that protrudes through the hernia is usually the small or large intestine. If the intestine protruding through becomes trapped (incarcerated), it may result in increased pain. If blood is not able to get to the trapped portion of intestine, gangrene may develop, requiring emergency surgery. Patients with an incarcerated inguinal hernia will find the hernia bulge to be firm and will be unable to push the bulge back in.  Worrisome signs and symptoms, which require prompt medical attention, include redness of the skin over the hernia, increasing pain, nausea, vomiting and abdominal swelling.

For years, physicians have been taught that all inguinal hernias require repair due to the high risk of incarceration of the intestine. This remains true to some extent for women, as they carry a higher risk of incarceration compared to men. We now know that men with inguinal hernias causing minimal symptoms can safely choose to delay or not undergo surgery. A large study was performed in the Veterans Administration hospital system where men with minimally symptomatic inguinal hernias were randomly instructed to undergo either inguinal hernia repair or observation without hernia repair. After following the men for over 11 years, only 1% in the observation group ended up requiring emergency surgery. What was most impressive about the study was that almost 70% of the men in the observation group ultimately made the decision to have a hernia repair due to increasing pain. While patients should understand the actual risk of the inguinal hernia becoming incarcerated, the percentage of those requiring emergency surgery is quite low. What is more likely to happen is that a man will eventually desire repair of the hernia due to increasing pain.

In summary, inguinal hernias can cause no symptoms whatsoever, in which case one could safely consider not undergoing surgical repair. On the other hand, if the inguinal hernia causes worry, discomfort or pain, or interferes with daily activities, then it should be repaired.

How is a patient supposed to know if they have a hernia, and if they do, how do they know if it should be repaired?  Patients should schedule an appointment with their surgeon to make the diagnosis and determine whether observation or surgery is most appropriate for them.

At the Prisma Health Hernia Center, our surgeons have over 25 years of combined specialty hernia experience and are trained specifically in open, laparoscopic and robotic surgery for hernia repair. Additionally, our surgeons are all members of the Americas Hernia Society and participate in the Americas Hernia Society Quality Collaborative, a national surgical quality improvement registry of patients undergoing hernia repair (www.ahsqc.org).  For additional information or consultation, please call the Prisma Health Hernia Center at (864) 676-1072.

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