Clinical Review

Inguinal hernias

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39450.428275.AD (Published 31 January 2008) Cite this as: BMJ 2008;336:269
  1. John T Jenkins, specialist registrar in surgery 1,
  2. Patrick J O’Dwyer, professor of gastrointestinal surgery1
  1. 1University Department of Surgery, Western Infirmary, Glasgow G11 6NT
  1. Correspondence to: J T Jenkins mrianjenkins{at}hotmail.com

    Summary points

    • If patients with asymptomatic inguinal hernia are medically fit, they should be offered repair

    • Mesh repair is associated with the lowest recurrence rates of hernia

    • Laparoscopic repair is suggested for recurrent and bilateral inguinal hernias, though it may also be offered for primary inguinal hernia repair

    • The median absence from work after hernia repair is seven days and may be 14 days for those doing strenuous work

    • Early complications include bruising, numbness, and wound infection

    • Chronic pain is the predominant late complication

    Abdominal wall hernias are common, with a prevalence of 1.7% for all ages and 4% for those aged over 45 years. Inguinal hernias account for 75% of abdominal wall hernias, with a lifetime risk of 27% in men and 3% in women.1 Repair of inguinal hernia is one of the most common operations in general surgery, with rates ranging from 10 per 100 000 of the population in the United Kingdom to 28 per 100 000 in the United States.2 In 2001-2 about 70 000 inguinal hernia repairs (62 969 primary, 4939 recurrent) were done in England, requiring more than 100 000 hospital bed days. Ninety five per cent of patients presenting to primary care are male, and in men the incidence rises from 11 per 10 000 person years aged 16-24 years to 200 per 10 000 person years aged 75 years or above.3

    How do inguinal hernias present?

    Inguinal hernias present with a lump in the groin that goes away with minimal pressure or when the patient is lying down. Most cause mild to moderate discomfort that increases with activity. A third of patients scheduled for surgery have no pain, and severe pain is uncommon (1.5% at rest and 10.2% on movement).4

    Inguinal hernias are at risk of irreducibility or incarceration, which may result in strangulation and obstruction; however, unlike with femoral hernias, strangulation …

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