Inguinal hernias

Abstract

How do inguinal hernias present?Inguinal hernias present with a lump in the groin that goes away with minimal pressure or when the patient is lying down. Most cause mild to moderate discomfort that increases with activity. A third of patients scheduled for surgery have no pain, and severe pain is uncommon (1.5% at rest and 10.2% on movement).4Inguinal hernias are at risk of irreducibility or incarceration, which may result in strangulation and obstruction; however, unlike with femoral hernias, strangulation is rare. National statistics from England identified that 5% of repairs of primary inguinal hernia were emergency operations in 1998-9. Older age and longer duration of hernia and of irreducibility are risk factors for acute complications. Gallegos and colleagues studied the presentation of inguinal hernias with a “working diagnosis of strangulation.” Only 14 of their 22 patients with an acute hernia had compromised tissue at operation, with one of 439 patients requiring bowel resection.5 Though the study numbers are small, these findings emphasise the rarity of strangulation. A recent larger study estimated the lifetime risk of strangulation at 0.27% for an 18 year old man and 0.03% for a 72 year old man.6