Inguinal (Upper Groin) Hernia

An inguinal hernia occurs when part of the bowel or fatty tissue from inside the abdomen pushes through a weakness in the muscle wall of the lower abdomen, in the region of the groin crease where the abdomen meets the thigh. It is the most common hernia in adults and is much more frequent in men because of the natural passage in this area through which the testicle descends before birth.

Typical symptoms include a lump or bulge in the groin that is more obvious when standing, coughing, lifting or straining, and often disappears when lying down. Many people notice a dragging or aching sensation, particularly towards the end of the day or after physical activity. In men the bulge can sometimes extend into the scrotum. Some hernias cause no symptoms and are found during a routine examination.

Hernias do not heal on their own and usually enlarge gradually over time. Surgery is the only way to repair the weakness. Repair is generally recommended when a hernia is causing pain or discomfort, is limiting work or activity, or is increasing in size. Small hernias that cause no symptoms can sometimes be watched, but many people eventually develop symptoms and choose to have the hernia repaired.

The other reason for repair is to prevent complications. Occasionally bowel or fat becomes trapped in the hernia (incarceration) and, less commonly, its blood supply is cut off (strangulation), which is an emergency. Repairing a hernia in a planned way is safer and simpler than emergency surgery. Your surgeon will discuss the timing of surgery with you based on your symptoms, the size of the hernia and your general health.

Inguinal hernia repair is performed under general anaesthesia and takes around an hour. The contents of the hernia are returned to the abdomen and the weak area is reinforced, usually with a synthetic mesh that reduces the chance of the hernia coming back.

There are two main approaches:

• Open repair - a single incision is made in the groin over the hernia and the mesh is placed over the weakness
• Laparoscopic (keyhole) repair - three small incisions are made in the abdomen and the mesh is placed behind the muscle wall using a camera and fine instruments

Keyhole repair is often preferred for hernias on both sides or for hernias that have come back after a previous open repair. Your surgeon will recommend the approach best suited to your hernia, your previous surgery and your general health.

Most inguinal hernia repairs are performed as day surgery, with patients going home the same day or after one night. Some pain, bruising and swelling in the groin are expected for the first week or two and are managed with regular simple pain relief. You will be encouraged to walk from the day of surgery.

Most people return to desk-based work and driving within one to two weeks, and to heavy lifting, manual work and vigorous sport within four to six weeks, depending on the type of repair and the nature of the work.

We regularly care for patients whose hernia is a workers compensation matter and are pleased to see them. Please bring your claim number, insurer details and any relevant paperwork to your first appointment so that approvals can be arranged without delay.

Most hernias cause only mild, intermittent symptoms, but occasionally the contents of a hernia become stuck (incarcerated) or lose their blood supply (strangulated). This is a medical emergency that requires urgent surgery.

Seek emergency care immediately, by going to your nearest emergency department or calling 000, if you notice any of the following:

• The hernia becomes suddenly painful, hard or tender and cannot be pushed back in
• The skin over the hernia becomes red or discoloured
• You develop nausea, vomiting or severe abdominal pain
• You are unable to pass wind or open your bowels

If you have been booked for surgery and your symptoms change or worsen while you are waiting, please contact the practice so that your operation can be brought forward if needed.