Inguinal Hernia

This is the most common hernia (about 70% of all hernias are inguinal hernias). They occur in the groin, the small area of the lower abdomen on each side just above the line separating the abdomen and the legs, and around the pubic bone.

Why do they occur?

They occur through the inguinal canal, a conduit where the testicle comes through on its way to the scrotum during the development of males. Men and women develop from the same basic pattern so there are anatomical similarities between men and women, meaning that women also have the inguinal canal. But in women the inguinal canal is much much smaller, and as a result inguinal hernias are much more uncommon than in men.

How do I know if I have an inguinal hernia?

You may see or feel a lump, bulge or swelling under the skin. It may be a bit uncomfortable. The swelling will often disappear completely when you lie down, as the contents of the hernia sac slip back through the hole into the abdomen. It may also be aggravated by coughing, sneezing, etc.

Sometimes there is hardly any swelling to see, but you may be conscious of a strange feeling in the groin when you are standing or walking for any period of time.

Many hernias cause no pain at all, but that does not mean they are not there or that they are not in need of attention.

What should I do?

See a doctor to confirm the diagnosis. The doctor will examine you (normally very simply) to confirm and will refer you to see a surgeon, ideally one who specialises in hernia.

Making or confirming the diagnosis

If there is an obvious swelling that disappears when you lie down, it is pretty conclusive that you have an inguinal hernia. You shouldn’t need any special tests.

See also Diagnosis & Treatment (Opens in a separate page)

Testicular Involvement

There are many myths and rumours, even jokes, about hernia and testicles. The most common problem that really matters is that in a small number of cases, damage can be caused by the hernia (especially if neglected) or the repair if not performed well. Sometimes it is simply bad luck. We speak here of testicular atrophy – which means death of that tissue. That often requires the removal of the affected testicle.

The blood supply to the testicle runs through the inguinal canal. Careless or inexpert surgery can damage the blood supply or the blood supply could be compromised for several other reasons. Damage to the blood supply is more likely if re-operating for recurrent inguinal hernia because of the scar tissue, difficulty of recognising structures and the blood vessels not being in their ‘correct’ position

We find that using a posterior or pre-peritoneal approach after a failed anterior repair avoids the scar tissue left from the previous operation.   A  posterior or pre-peritoneal approach can be done open (through a new incision) or laparoscopically. The testicular vessels are always at risk in any inguinal hernia repair. To minimise the risks, the surgeon always has to be careful and have the proper expertise.

It has been estimated that the complication of ischaemic (US: ischemic) orchitis and testicular atrophy occur in approximately 2% to 3% of all hernia repairs.

In tens of thousands of cases, however, we have only had one single incidence of such an outcome, in either primary or recurrent repairs.

Rydell WB., Jr Inguinal and femoral hernias. Arch Surg. 1972;87:493–499


See also: Do I Have a Hernia

Next: Femoral Hernia