Inguinal hernia

This is the most common type of hernia. It occurs in the groin area on either the left or right hand side. As with any hernia, it can cause a range of symptoms. In some people, it may be a painless lump that does not limit a person's activities. In others, it can cause pain or discomfort, and occasionally it can become an emergency problem with severe pain and blockage to the bowel.

When to repair an inguinal hernia

In 2018, an international group of hernia societies from around the world produced guidelines for the management of inguinal hernias (The HerniaSurge Group, 2018; available here). The experts in this group advised that watchful waiting (that is, not operating but keeping an eye on a hernia), is safe for inguinal hernias with no or minimal symptoms. They did also say that most men with no or minimal symptoms from a hernia will go on to develop symptoms at some point, and then require surgery. Therefore, the decision of whether or not to have an operation to repair a hernia that is causing no or only minimal symptoms is something that individuals need to decide for themselves, with the advice and input of their surgeon. The same group of experts advised that men with symptoms from an inguinal hernia should have it repaired, providing they are fit for the operation.

Whether to use a mesh

In the above guidelines, the experts involved agreed that a mesh-based repair was recommended for patients with inguinal hernias. While it is possible to repair inguinal hernias without mesh, research studies have shown that the risk of the hernia coming back (or recurring) is lower if a mesh is used. In addition, there was no evidence of increased problems with using a mesh (the rates of lasting (or chronic) pain and wound infections were similar with or without a mesh).

Repair techniques

Inguinal hernias can be repaired either using an open technique, or using key-hole surgery. For a person with an inguinal hernia on one side only, the international expert group advised that either an open operation, or a key-hole operation by someone who is suitably trained and experienced in this approach, are both good treatments. Key-hole repair usually results in less pain immediately after the operation, and may also result in less long-lasting pain. However, individual patients and hernias may have characteristics that may affect the choice between an open or key-hole operation.

Risks

General risks of any operation include bleeding, infection, clots on the legs or lungs, and damage to nearby structures such as blood vessels. Specific risks include damage to the nerves that supply different patches of skin around the groin. If this happens, some people experience numbness or tingling in the area, and some have pain that continues after the operation itself has healed up. How common this is after the operation can be difficult to measure, in part because the symptoms can be very variable. However, some big research studies have estimated that after an open inguinal hernia repair, approximately 15% of people report having persistent pain in the groin one year later (Lundström et al, 2017). This ranges from mild to more severe pain that can interfere with daily activities. Other complications include damage to the blood supply or sperm tube that pass through the groin to the testicle in men. The risk of this is low, but it could have implications for fertility if there is also a problem with the function of the testicle on the other side. Your doctor can tell you more about benefits and risks specific to your circumstances.

References:

The HerniaSurge Group. International guidelines for groin hernia management. Hernia (2018);22:1-165.

Lundström et al. Patient-reported rates of chronic pain and recurrence after groin hernia repair. British Journal of Surgery (2018);105(1):106-112.