When Does an Inguinal Hernia Require Surgery?

Inguinal hernia surgery is primarily indicated when the hernia causes symptoms or presents complications. Men with asymptomatic or minimally symptomatic hernias may, in selected situations, be managed with watchful waiting without immediate surgery.

When is Inguinal Hernia Surgery Indicated?

Inguinal hernias that cause symptoms are generally treated surgically. Pain, discomfort, or limitation of daily activities are factors considered in the indication for surgery.

The decision also considers the characteristics of the hernia, the evolution of symptoms, the patient’s clinical conditions, and their activities.

Surgery corrects the area of weakness in the abdominal wall where the hernia occurs. The 2023 international HerniaSurge update recommends mesh repair for most patients undergoing inguinal hernia surgery.

Mesh is a prosthesis used to reinforce the abdominal wall in the repair area. Different surgical techniques exist, and the choice depends on the characteristics of the hernia and the patient.

Is it Possible to Manage an Inguinal Hernia Without Surgery?

Men with asymptomatic or minimally symptomatic inguinal hernias may be managed without immediate surgery in selected situations. This strategy is called clinical observation or watchful waiting.

Watchful waiting can be safe for selected men because the risk of an acute hernia-related complication is low. The decision should consider the possibility of symptoms appearing or increasing over time.

According to the 2023 HerniaSurge update, about one-third of men initially managed with watchful waiting undergo surgery within 1.5 to 3 years. After approximately 7 years, this number reaches almost 70%.

The need for surgery during watchful waiting primarily arises from the evolution of symptoms such as pain and discomfort. Therefore, watchful waiting means observing the hernia’s progression and re-evaluating the surgical indication when necessary.

Can an Inguinal Hernia Increase in Size Over Time?

An inguinal hernia does not disappear spontaneously because there is an area of weakness or a defect in the abdominal wall. Its size and symptoms can change over time.

Hernia growth or the appearance of pain and discomfort may lead to a new evaluation of the surgical indication. The hernia’s impact on professional activities, exercise, and daily tasks should also be considered.

The presence of a hernia does not mean that any physical exertion will cause an emergency. Guidance on exercise and activities should consider the symptoms and characteristics of each patient.

Can Inguinal Hernias in Women Also Be Managed with Watchful Waiting?

Non-pregnant women with a hernia in the groin area are generally advised to undergo surgical correction in a timely manner. The possibility of a femoral hernia is one reason for this approach.

A femoral hernia occurs when abdominal contents pass through the femoral canal, an area located in the groin. Femoral hernias carry a higher risk of complications than inguinal hernias.

Data used by the HerniaSurge guideline show that approximately 36% to 39% of femoral hernias were operated on in an emergency setting. Among inguinal hernias, this percentage was approximately 5%.

For this reason, observation without surgery is not routinely recommended for non-pregnant women with a hernia in the groin area.

When Does an Inguinal Hernia Become an Emergency?

A hernia that becomes trapped and does not return to the abdomen requires urgent medical evaluation, especially when intense pain arises.

An acutely irreducible hernia occurs when the hernia contents become trapped and cannot be pushed back into the abdomen. This situation can progress to compromise the blood supply of the trapped tissue.

Strangulation occurs when the blood supply to the trapped contents is compromised. Intense pain, nausea, vomiting, and signs of intestinal obstruction may accompany this complication.

Suspected strangulation requires emergency surgery. The 2023 HerniaSurge update recommends immediate surgery when strangulation is suspected or when an adequate attempt at reduction is unsuccessful.

When Can Inguinal Hernia Surgery Be Scheduled?

A symptomatic inguinal hernia can be corrected through elective surgery. Elective surgery means the procedure is scheduled, without a complication requiring an emergency operation.

Men with asymptomatic or minimally symptomatic hernias can discuss watchful waiting with their surgeon. The onset or progression of symptoms during watchful waiting may alter the indication.

Non-pregnant women with a hernia in the groin area are generally advised to undergo repair in a timely manner due to the possibility of a femoral hernia.

Surgical evaluation helps determine whether the hernia can be managed with watchful waiting, if surgery should be scheduled, or if there is a situation requiring immediate treatment.