groin hernia

Introduction

A hernia in the groin region.

Classification

• inguinal hernia
  • indirect inguinal hernia
  • direct inguinal hernia
• femoral hernia

Epidemiology

• inguinal hernias are more common in men than women, ratio 9:1
• femoral hernias are more common in women than men, ratio 4:1, especially in elderly women

Clinical manifestations

• pain suggests incarceration or strangulation of bowel
• hernias generally easier to demonstrate with patient standing

Radiology

• herniography
• ultrasound
• magnetic resonance imaging
• imaging if clinical diagnosis in doubt
• best imaging modality unclear

Complications

• incarceration, strangultion, bowel obstruction

Management

• surgical repair
  • definitive treatment
  • symptoms of acute incarceration & strangulation require emergency surgery
  • operative repair is similar for different types of groin hernia
  • four approaches with similar 30-day or 1 year occurrence
    • open repair
    • laparoscopic repair
    • robotic transabdominal preperitoneal repair
    • laparoscopic total extraperitoneal repair
  • 30-day surgical site infection, or hospital readmission similar with different approaches
• use of truss
• watchful waiting for minimally symptomatic hernias
  • majority of men will ultimately be referred for surgery, primarily because of pain, within 10 years
• watchful waiting is not recommended in women

More general terms

• hernia

More specific terms

• femoral hernia
• inguinal hernia