Why you should have your hernia repaired

Do you have a groin bulge that seems to come and go, often absent upon waking in the morning? Or perhaps you already know you have a hernia? Hernias are very common and occur in approximately 1 in 4 males (less common in women), so chances are you or someone you know has or has had an inguinal hernia. The main question I always get asked is "should it be fixed?"  

As a general surgeon, I see 4-5 patients every week with a newly diagnosed inguinal hernia. Many are self-referred after discovering a lump in the groin, while many others are referred from their primary care provider after the hernia is discovered during the physical exam. After verifying that a hernia is the correct diagnosis (other possibilities are a groin strain, swollen lymph node, etc.), I have a discussion which addresses the aforementioned question. As an aside, these are very common and also found in the pediatric population (see a similar discussion by one of our pediatric surgeons)

To understand hernias, it's important to first understand some basic anatomy. A hernia is essentially a hole in the musculofascial layer of the abdominal wall. Hernias can occur in a variety of places in the body, though the inguinal region, due to embryologic reasons, is the most common location. Tissue protrudes through the defect when enough pressure develops in the abdominal cavity, often by simple straining.

More commonly, this tissue will recoil back into the abdominal cavity after the straining ceases. This is called a reducible hernia. If the tissue protruding through the hole gets "stuck", we use the term incarcerated hernia. If the blood flow to the protruding tissue is pinched off, then we use the term strangulated hernia. It's important to understand that a strangulated hernia is essentially the only potential emergent scenario. Fortunately, this rate is under 0.5% per year for an inguinal hernia.

So back to the main question: should I get it repaired? In short, yes. Most people are going to develop symptoms or will have enough years remaining in life such that the very small annual risk of developing a strangulated hernia will accumulate to become a more significant number. Is it urgent? No (unless you've had episodes of incarceration which had to be reduced by a professional). I tell people to put it on their medical "to do" list and figure out a convenient time to get it fixed. So, as the year ends, perhaps it's a good time to make that New Year's resolution to get that hernia fixed.