Inguinal hernia

Inguinal hernias account for 75% of abdominal wall hernias. Around 95% of patients are male; men have around a 25% lifetime risk of developing an inguinal hernia.

Features

• groin lump
  • superior and medial to the pubic tubercle
  • disappears on pressure or when the patient lies down
• discomfort and ache: often worse with activity, severe pain is uncommon
• strangulation is rare

Whilst traditional textbooks describe the anatomical differences between indirect (hernia through the inguinal canal) and direct hernias (through the posterior wall of the inguinal canal) this is of no relevance to the clinical management.

Hernia in children

Inguinal hernias are a common disorder in children. They are commoner in males as the testis migrates from its location on the posterior abdominal wall, down through the inguinal canal. A patent processus vaginalis may persist and be the site of subsequent hernia development.

Children presenting in the first few months of life are at the highest risk of strangulation and the hernia should be repaired urgently. Children over 1 year of age are at lower risk and surgery may be performed electively. For paediatric hernias a herniotomy without implantation of mesh is sufficient. Most cases are performed as day cases, neonates and premature infants are kept in hospital overnight as there is a recognised increased risk of post operative apnoea.

Management

Surgical options

• the clinical consensus is currently to treat medically fit patients even if they are asymptomatic
• a hernia truss may be an option for patients not fit for surgery but probably has little role in other patients
• mesh repair is associated with the lowest recurrence rate
  • unilateral inguinal hernias are generally repaired with an open approach
  • bilateral and recurrent inguinal hernias are generally repaired laparoscopically

The Department for Work and Pensions recommend that following an open repair patients return to non-manual work after 2-3 weeks and following laparoscopic repair after 1-2 weeks

Complications of hernia repair

Immediate (Intra-op to 24 hours)