A hernia is any structure passing through another which in doing so ends up in the wrong place. Formally, it is defined as the protrusion of a loop or knuckle of an organ or tissue through an abnormal opening.
An inguinal hernia is most common – these occur in the area where the skin crease at the top of the thigh joins the torso (the inguinal crease) and appear as a bulge.
Groin hernias occur in approximately 2% of the adult population and 4% of infants.
Their relative frequencies are as follows:
Inguinal are approximately 10 times more common in males, while femoral and paraumbilical are more common in women.
Predisposing factors include
The natural history of most hernia is that they will slowly increase in size although may remain the same size for an extended period. They do not spontaneously heal and are at risk of the complications described and thus need to be repaired surgically.
Hernia especially Inguinal hernia are a clinical diagnosis. However, occasionally an ultrasound is used for confirmation.
This depends on whether the patient develops complications (e.g. bowel obstruction, strangulation). Herniae are treatable surgically, although they may recur.
The recurrence of a inguinal herniae after surgical repair may occur but should be less than 2% (10-20% in the case of incisional herniae). Other complications include infection, ilioinguinal nerve entrapment and testicular ischaemia. Testicular ischaemia (lack of blood supply) is rare after initial repair but occurs with a higher incidence after the repair of recurrent herniae.
Often a supportive hernia belt is prescribed to be worn to control the pain.
Elective surgical repair is recommended. They are not an emergency, unless they cause a bowel obstruction, or strangulation of the trapped bowel.
There are two accepted methods in adults: