Protrusion of abdominal content through inguinal canal; indirect (lateral to inferior epigastric vessels) or direct.
History taking
- • Groin swelling, increases with cough/strain, reduces on lying
- • Pain, dragging sensation, history of obstruction (vomiting, distension)
- • Risk factors: chronic cough, constipation, BPH, heavy lifting
Examination
- • Standing examination; cough impulse, expansile cough impulse
- • Reducibility, deep ring occlusion test
- • Examine for bilateral hernia, scrotum
Red flags
- • Irreducible, tender, tense, with vomiting/distension — obstruction/strangulation
- • Skin discoloration over swelling
Differential diagnosis
- • Femoral hernia, hydrocele, varicocele, lipoma of cord, undescended testis, inguinal lymphadenopathy
Recommended investigations
- • Mostly clinical; USG groin if uncertain
- • Pre-op: CBC, basic metabolic, ECG, CXR per age/comorbidity
Diagnosis
- • Clinical with imaging if needed
Initial treatment / management
- • Elective laparoscopic/open mesh repair (Lichtenstein, TAPP, TEP)
- • Avoid trusses except when surgery contraindicated
- • Emergency surgery for obstruction/strangulation
Prescription examples
- • Pre-op: optimisation of cough/constipation/BPH
- • Post-op analgesia: Tab Paracetamol 1 g QID + Tab Diclofenac SR 100 mg BD x 5 d
- • Stool softeners post-op (Lactulose 15 mL HS)
Follow-up advice
- • Wound review at 7 days, then 6 weeks
- • Return to light work 2 weeks, heavy work 6 weeks
Patient counselling
- • Avoid heavy lifting, manage cough/constipation
- • Recurrence rate low with mesh repair (<2%)
Referral criteria
- • All inguinal hernias to surgery
- • Urgent referral if pain, irreducibility, obstruction
Clinical pearls
- • Watchful waiting acceptable for asymptomatic in elderly comorbid males
- • Femoral hernia has higher risk of strangulation — repair promptly
References
- • European Hernia Society Guidelines 2018
- • HerniaSurge Guidelines: International Groin Hernia 2018
Educational outpatient guide — verify against local guidelines before clinical use.
