How do inguinal hernias present?
Inguinal hernias are at risk of irreducibility or incarceration, which may result in strangulation and obstruction; however, unlike with femoral hernias, strangulation is rare. National statistics from England identified that 5% of repairs of primary inguinal hernia were emergency operations in 1998-9. Older age and longer duration of hernia and of irreducibility are risk factors for acute complications. Gallegos and colleagues studied the presentation of inguinal hernias with a “working diagnosis of strangulation.” Only 14 of their 22 patients with an acute hernia had compromised tissue at operation, with one of 439 patients requiring bowel resection.5 Though the study numbers are small, these findings emphasise the rarity of strangulation. A recent larger study estimated the lifetime risk of strangulation at 0.27% for an 18 year old man and 0.03% for a 72 year old man.
Surgical options for inguinal hernias
Surgery is the treatment of choice varying from a nylon darn, Shouldice layered, Lichtenstein mesh (fig 2) to a laparoscopic repair.
recovery period
Convalescence is of socioeconomic importance. Single centre studies suggest that for most repairs five to eight days should be adequate, although studies are difficult to integrate owing to different definitions of convalescence. Recently Bay-Nielsen and colleagues examined convalescence after Lichtenstein repair in a case-control study using data from the Danish hernia database.21 The median length of absence from work was seven days (sedentary work 4.5 days, strenuous work 14 days). The study found that a single day of convalescence was feasible without increasing recurrences. Pain was the most common cause of a delay in returning to work (60%), followed by wound problems (20%).
