View Full Chapter Figures Only Tables Only Videos Only Print Share Email Send Email Your Name (required) ! Example: John Doe Email Address (required) ! Please enter a valid sender email address. Example: firstname.lastname@example.org CC Me Recipient Email Address (required) ! Separate multiple email address with semi-colons (up to 5). Subject Subject for your email. Message (Maximum characters: 1,000) Submit Cancel Thank you! Your email has been sent to: Return to: Send Another Email An error has occurred sending your email(s). Please try again later or contact an administrator at OnlineCustomer_Service@mheducation.com. Return to: Twitter Facebook Linkedin Reddit Get Citation Citation AMA Citation Inguinal Hernia. In: Doherty GM. Doherty G.M. Ed. Gerard M. Doherty.eds. Quick Answers Surgery New York, NY: McGraw-Hill; 2010. http://accesssurgery.mhmedical.com/content.aspx?bookid=853§ionid=49662158. Accessed March 25, 2017. MLA Citation . "Inguinal Hernia." Quick Answers Surgery Doherty GM. Doherty G.M. Ed. Gerard M. Doherty. New York, NY: McGraw-Hill, 2010, http://accesssurgery.mhmedical.com/content.aspx?bookid=853§ionid=49662158. Download citation file: RIS (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager © Copyright Tools Search Book Top Return Clip Inguinal Hernia + Essential Features Print Section + • Groin bulge elicited with the Valsalva maneuver• Types of inguinal hernias-Indirect: Patent processus vaginalis extension lateral to the inferior epigastrics in the anterior-medial position of the spermatic cord-Direct: Developed weakness in the abdominal wall located at Hesselbach triangle (inguinal ligament inferiorly, lateral edge of the rectus medially, and the inferior epigastric vessels superior-laterally)-Pantaloon hernia is a combined direct and indirect inguinal hernia• Classification of hernias-Reducible: Visceral contents of the hernia sac able to retract into the abdominal cavity-Incarcerated: Visceral contents cannot be returned to the abdominal cavity-Strangulated: Incarcerated inguinal hernia where the blood flow to the entrapped viscera is compromised-Sliding: Abdominal viscera present in hernia sac; on the left, most commonly the sigmoid colon and bladder, and on the right, most commonly the cecum and bladder ++ Epidemiology + • 5-10% of the world population develops an inguinal hernia in their lifetime• Premature infants most likely to develop inguinal hernia (> 10%)• Nearly all hernias in infants, children, and young adults are indirect• Indirect inguinal hernias develop more commonly on the right• Acute complications from inguinal hernias are more likely to develop in infants and children• Most common etiology of small bowel obstruction in children is incarcerated inguinal hernia• Second most common cause of small bowel obstruction in adults is incarcerated inguinal hernia + Clinical Findings Print Section ++ Symptoms and Signs + • Asymptomatic inguinal bulge most common symptom• Exam of the groin reveals a bulge adjacent to the ipsilateral pubic tubercle that may extend into the scrotum• The hernia bulge may or may not be reducible• Patients may complain of a fullness or dragging sensation• As a hernia enlarges, it is likely to produce a sense of discomfort that may radiate into the ipsilateral groin• Sharp ilio-inguinal groin pain without a detectable groin bulge is most commonly a strained groin muscle• Incarcerated/strangulated inguinal hernia is exquisitely painful• Coughing or straining will help demonstrate small hernias• Small bowel obstruction symptoms (nausea, vomiting, abdominal distention) may be present with incarcerated inguinal hernias ++ Imaging Findings + • US, although rarely needed, can verify the presence of a hernia sac and reliably differentiate between a hernia, solid cord mass, hydrocele, or lymphadenopathy + Diagnostic Considerations Print Section + • Femoral hernia• Hydrocele• Cord mass• Strained groin muscle• Epididymitis• Inguinal lymphadenopathy• Varicocele• Undescended testes ++ Rule Out + • Strained groin muscle (chronic groin pain commonly develops in these patients following operative intervention) + Work-up Print Section + • Physical exam usually all that is required to accurately diagnose inguinal hernia• In equivocal cases, US may be helpful ++ When to Admit + • Uncomplicated inguinal hernia management can be performed as an outpatient• Indications for admission include:-Acute hernia incarceration-Clinical evidence of strangulation-Associated small bowel obstruction ++ When to Refer + • Neonatal and young pediatric hernia repairs performed with less morbidity by experienced pediatric surgeons + Treatment and Management Print Section + • Inguinal hernias should be surgically repaired unless there are specific contraindications ++ Surgery + • Several successful approaches available including native tissue or prosthetic repair• Both open and laparoscopic approaches are commonly used ++ Indications + • Incarcerated or strangulated hernias warrant immediate repair• Uncomplicated inguinal hernias can be repaired electively as an outpatient ++ Contraindications + • Cirrhosis with uncontrolled ascites and indirect hernia is relative contraindication ++ Treatment Monitoring + • Physical exam to detect wound/prosthetic infection or hernia recurrence ++ Complications + • Strangulated inguinal hernia with visceral necrosis• Progressive enlargement of the hernia defect with loss of abdominal domain in the case of giant inguinal-scrotal hernias• Recurrence• Damage to vas deferens• Ischemic orchitis ++ Prognosis + • Recurrence rates < 5% in most series + Resources Print Section ++ References ++Arvidsson D et al: Randomized clinical trial comparing 5-year recurrence rate after laparoscopic versus Shouldice repair of primary inguinal hernia. Br J Surg 2005;92: 1085. [PubMed: 16106480] ++Eklund A et al: Recurrent inguinal hernia: randomized multicenter trial comparing laparoscopic and Lichtenstein repair. Surg Endosc 2007;21:634. [PubMed: 17364153] ++The EU Hernia Trialists Collaboration: Repair of groin hernia with synthetic mesh: Meta-analysis of randomized controlled trials. Ann Surg 2002;235:322. ++Fitzgibbons R et al: Watchful waiting versus repair of inguinal hernia in minimally symptomatic men. JAMA 2006;295:285. [PubMed: 16418463] ++Grunwaldt L et al: Is laparoscopic inguinal hernia repair an operation of the past? JACS 2005;200:616. [PubMed: 15804477] ++Matthews R: Factors associated with postoperative complications and hernia recurrence for patients undergoing inguinal hernia repair: a report from the VA Cooperative Hernia Study Group. Am J Surg 2007;194:611. [PubMed: 17936422] ++McCormack K et al: Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev 2004;4:CD001785. ++Mellinger J et al: Primary inguinal hernia repair: open or laparoscopic, that is the question. Surg Endosc 2004;18:144. ++Neumayer L et al: Open mesh versus laparoscopic mesh repair of inguinal hernia. New Engl J Med 2004;350:1819. [PubMed: 15107485] ++Scott NW et al: Open mesh versus non-mesh for groin hernia repair. Cochrane Database Syst Rev 2004;4:CD002197.