Common Conditions

Inguinal Hernia: Overview

You have an inguinal hernia and have been advised to have it repaired. This is an information sheet which advises you of the pros and cons of having your hernia repaired and answers to common worries that patients have. It is not intended to replace a consultation nor is it intended to be a textbook of surgery.

An inguinal hernia is a protrusion of a loop of intestine into the groin or scrotum through a defect in the lower abdominal wall. It is common in baby boys and older men and relatively uncommon in women. It produces a soft lump in the groin or scrotum, which can usually be pushed back into the abdomen. It usually occurs on on one side but can occur on both sides either at the same time or at different times. The lump can vary in size from a 'golf ball' to a 'grapefruit' and sometimes even bigger.

The risks of not repairing the hernia include continuing discomfort, increase in size of the hernia, obstruction and strangulation. The latter two complications are serious and can result in peritonitis and death.

Currently there are two established techniques of repairing inguinal herniae: The most common is the 'open' mesh tension free technique. An incision is made through the skin at the site of the hernia and the hernia repaired. Further reinforcement is obtained by placing a very fine nylon mesh in the tissues. This technique is now well established and used by most surgeons. Depending on facilities available, patients requirements and suitability ( age, social circumstances and general health), the procedure can be undertaken under local anaesthetic and as a Day Case i.e. You are admitted to hospital and discharged within 24 hours. Sometimes it may be necessary for you to spend a couple of nights in hospital. If this is the case you will have been advised of this. This technique is eminently suitable for single herniae.

The less common (in the UK) technique is that of the laparoscopic or 'keyhole' method. CO2 gas is used to insufflate (blow up) the abdominal cavity and the hernia is then repaired from the 'inside'. The procedure is undertaken under general anaesthetic ( i.e. you are asleep) and a mesh is placed in much the same way as in the open technique. The main difference being that the abdominal wall wounds are tiny. This is a relatively new (10 years old) technique which is now established as routine in some European countries. However, extensive studies have not demonstrated a significant, consistent advantage over the 'open' technique for single herniae. The greatest advantage appears to occur when the laparoscopic technique is used to repair bilateral (double) or recurrent herniae.

In this situation the advantages in terms of early mobility, fewer complications and less pain are significantly in favour of the keyhole method.

Therefore, my current policy is to offer laparoscopic repairs only to those patients who have bilateral or recurrent inguinal heniae.

Very occasionally, I advise patients that they should not have their hernia repaired. This is usually because of extreme frailty associated with a very large hernia. Most hernias will require to be repaired surgically.

Despite the Americanisms, you may find this related link useful in understanding more about herniae - MEDLINEplus®

The British National Institute for Clinical Excellance (NICE) has recently issued guidance (to both surgeons and patients) pertaining to the repair of inguinal herniae and you may find the section on Patient Information useful.