Groin hernias

What is a groin hernia?

Groin hernias are protrusions of the abdominal contents through abnormal openings in the abdominal wall and can be divided into inguinal and femoral hernias.

There are different types of groin hernias, namely:

• Inguinal hernias usually present with an abnormal swelling in the lower abdomen just above the leg crease. They form in relation to the inguinal canal where a man's testicle must descend before birth. They are much more common in males and can be bilateral. Symptoms of an inguinal hernia include:
  • A bulge on either side of the pubic bone
  • An aching or burning sensation in the area of the bulge
  • A dragging or heavy sensation in your groin
  • Pressure or weakness in your groin
  • Discomfort, pain or swelling around the hernia site
• Femoral hernias usually present with an abnormal swelling in the upper thigh just below the leg crease. They are more common in females than males and are more prone to develop complications than inguinal hernias. Most femoral hernias don’t cause symptoms, but symptoms may be present if the hernia is obstructing your intestines. Symptoms of a femoral hernia may include:
  • Severe pain in the stomach
  • Sudden groin pain
  • Nausea
  • Vomiting

The most feared complications of groin hernias (and most other hernias) are incarceration (inability to reduce the hernia) and strangulation (the blood supply to the hernia contents is cut off possibly leading to necrosis and perforation of the contents). Most hernias will need to be repaired in order to avoid the potential complications; however, if hernias are very small with no symptoms surgery might not be necessary.

How are groin hernias treated?

Procedures to repair groin hernias can be divided into tension repairs or tension-free repairs; tissue-based repairs or mesh-based repairs and open or minimally invasive repairs.

• Tension-free repairs result in appreciably lower recurrence rates.
• Reinforcing the repairs with mesh further reduces the rate of recurrence.
• The most frequently used open technique of groin hernia repair is called the 'Lichtenstein repair' and incorporates both of the above principles.

Minimally invasive ('keyhole') procedures involve Dr Cooper stripping off the inner membrane (the peritoneum) lining the abdominal wall from inside the abdomen. The surgeon will then view the hernia opening from inside the abdomen. A tension-free mesh is placed over each hernia opening, and the peritoneum is again allowed to cover the mesh, thus preventing adhesions to the bowel. Three ports are used, resulting in only 1x10mm and 2x5mm incisions. These hernia repair procedures can be done in a totally extra-peritoneal (TEP) manner or in a trans-abdominal pre-peritoneal (TAPP) manner. The advantages of minimally invasive or 'keyhole' surgery have been discussed extensively elsewhere on this site and are also applicable to groin hernia surgery.

Complications of groin hernia surgery are rare, but can include:

• Hernia recurrence (2-10% lifetime risk depending on the technique used)
• Chronic groin pain (5-10%)
• Transient urinary retention (inability to pass urine)
• Fluid collections (seroma)
• Wound and/or mesh infection (very rare)
• Testicular ischaemia (extremely rare)