inguinal hernia
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Introduction
A hernia in the inguinal region.
Etiology
- risk factors
- advanced age is a risk factor[9]
- higher body mass index may be protective[9]
Epidemiology
- more common in men than women, ratio 9:1
Pathology
- direct inguinal hernia:
- involves the abdominal wall between the deep epigastric artery & the edge of the rectus muscle
- indirect inguinal hernia:
- involves the internal inguinal ring & the inguinal canal
Clinical manifestations
- pain suggests incarceration or strangulation of bowel
- hernias generally easier to demonstrate with patient standing
Diagnostic procedures
- avoid routine ultrasound for clinically apparent inguinal hernia[12]
Complications
- incarceration, strangulation, bowel obstruction (rare)[1]
- long-term pain may be associated with surgery (6-30%)[5]
Differential diagnosis
- males:
- testicular torsion
- epididymitis
- hydrocele, varicocele, spermatocele
- epididymal cyst
- testicular tumor
- femoral hernia
Management
- asymptomatic hernias may be observed[1][11]
- symptomatic hernias require surgical inguinal hernia repair[2]
- laparoscopic mesh repair[2][3][6] under general anesthesia
- less postoperative pain than with open mesh repair[3][6]
- severe complications (0.05% vs 0.55%) & recurrent hernia within 2 years (0.25% vs 0.5%) more likely than with open mesh repair
- open mesh repair under local anesthesia
- lower initial costs[8]
- suture repair is associated with a higher risk of recurrence within 5 years compared with laparoscopic mesh repair & open mesh repair
- with long-term follow-up, benefits of mesh repair are partially offset in part by mesh-related complications[10]
- laparoscopic mesh repair[2][3][6] under general anesthesia
More general terms
Additional terms
References
- ↑ Jump up to: 1.0 1.1 1.2 1.3 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 18. American College of Physicians, Philadelphia 2009, 2012, 2018.
- ↑ Jump up to: 2.0 2.1 2.2 Journal Watch 23(13):104, 2003 Douek M, Smith G, Oshowo A, Stoker DL, Wellwood JM. Prospective randomised controlled trial of laparoscopic versus open inguinal hernia mesh repair: five year follow up. BMJ 326:1012, 2003 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/12742923 <Internet> http://bmj.com/cgi/content/full/326/7397/1012
- ↑ Jump up to: 3.0 3.1 3.2 Journal Watch 24(11):85, 2004 Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R Jr, Dunlop D, Gibbs J, Reda D, Henderson W; Veterans Affairs Cooperative Studies Program 456 Investigators. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med. 2004 Apr 29;350(18):1819-27. Epub 2004 Apr 25. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15107485
- ↑ Jump up to: 4.0 4.1 Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, Dunlop DD, Reda DJ, McCarthy M Jr, Neumayer LA, Barkun JS, Hoehn JL, Murphy JT, Sarosi GA Jr, Syme WC, Thompson JS, Wang J, Jonasson O. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA. 2006 Jan 18;295(3):285-92. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16418463
- ↑ Jump up to: 5.0 5.1 O'Dwyer PJ et al, Observation or operation for patients with an asymptomatic inguinal herna: a randomized trial. Ann Surg 2006, 244:167 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16858177
Franneby U et al, Risk factors for long-term pain after hernia surgery. Ann Surg 2006, 244:212 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16858183 - ↑ Jump up to: 6.0 6.1 6.2 O'Reilly EA et al. A meta-analysis of surgical morbidity and recurrence after laparoscopic and open repair of primary unilateral inguinal hernia. Ann Surg 2012 May; 255:846. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22470068
- ↑ Shah NR, Mikami DJ, Cook C, Manilchuk A et al A comparison of outcomes between open and laparoscopic surgical repair of recurrent inguinal hernias. Surg Endosc. 2011 Jul;25(7):2330-7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21298523
- ↑ Jump up to: 8.0 8.1 8.2 Fitzgibbons RJ, Forse RA Groin Hernias in Adults. N Engl J Med 2015; 372:756-763. February 19, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25693015 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcp1404068
- ↑ Jump up to: 9.0 9.1 9.2 de Goede B et al. Risk factors for inguinal hernia in middle-aged and elderly men: Results from the Rotterdam Study. Surgery 2015 Mar; 157:540 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25596770
- ↑ Jump up to: 10.0 10.1 Kokotovic D, Bisgaard T, Helgstrand F. Long-term Recurrence and Complications Associated With Elective Incisional Hernia Repair. JAMA. Published online October 17, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27750295 <Internet> http://jamanetwork.com/journals/jama/article-abstract/2565771
Itani KM New Findings in Ventral Incisional Hernia Repair. JAMA. Published online October 17, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27750293 <Internet> http://jamanetwork.com/journals/jama/fullarticle/2569750 - ↑ Jump up to: 11.0 11.1 11.2 de Goede B, Wijsmuller AR, van Ramshorst GH et al. Watchful waiting versus surgery of mildly symptomatic or asymptomatic inguinal hernia in men aged 50 years and older: A randomized controlled trial. Ann Surg 2018 Jan; 267:42. https://insights.ovid.com/crossref?an=00000658-201801000-00010
- ↑ Jump up to: 12.0 12.1 Society of American Gastrointestinal and Endoscopic Surgeons Five Things Physicians and Patients Should Question. Choosing Wisely, January 9, 2019 http://www.choosingwisely.org/societies/society-of-american-gastrointestinal-and-endoscopic-surgeons/
- ↑ Inguinal Hernia https://www.niddk.nih.gov/health-information/digestive-diseases/inguinal-hernia