When is surgery needed for an inguinal hernia?

If an inguinal hernia causes pain, grows larger or limits everyday movement, planned surgery is usually discussed. Some men with no symptoms or very little discomfort can wait under medical supervision. This option does not automatically apply to every patient, particularly women with a hernia in the groin.

If the bulge suddenly becomes hard and severely painful and no longer goes back in as before, the situation is no longer a question of planned surgery. Emergency medical help is needed because tissue may be trapped and its blood supply may be affected.

How is a swelling in the groin assessed?

In an inguinal hernia, fatty tissue or part of the bowel can bulge through a weak area in the lower abdominal wall. A swelling that appears when standing, coughing or straining may become smaller when lying down. In men, it sometimes extends into the scrotum. A pulling sensation, a feeling of heaviness and discomfort that increases towards the end of the day are also possible.

The diagnosis is often made through examination by a surgeon. The doctor may examine the area while you are standing and lying down and ask you to cough. If the swelling is not visible during the appointment, describing when it appears is helpful. Not all groin pain is caused by a hernia; muscles, joints and other tissues in the area can also cause pain.

If examination alone is not enough, ultrasound, which uses sound waves to produce images, may be used. Other imaging is chosen in some cases. Not every patient needs every test. The doctor assesses whether the imaging findings match the patient's symptoms, as an incidental finding does not always explain the pain.

When is observation a suitable option?

If the hernia goes back in and a man has no pain or very little discomfort, the benefits and risks of observation and surgery can be discussed. For observation to be suitable, the patient must be able to recognise new symptoms and access medical help when needed. Follow-up appointments are planned individually.

Surgery may become necessary as pain and discomfort increase over time. An initial decision to wait does not prevent a later change of plan. The doctor should be told how pain affects work, walking and exercise. A hernia does not close on its own, so observation is not intended to make the opening disappear.

In women, a hernia visible in the groin may be a femoral hernia or occur alongside one. A femoral hernia lies slightly below the groin and has a higher risk of becoming trapped. Timely planned surgery is therefore usually considered for women who are not pregnant. During pregnancy, groin swelling can have other causes, so the approach is decided separately.

Heart and lung conditions, current medicines and previous abdominal operations are considered when planning surgery. Individual instructions should be given on how to manage blood-thinning medication. Stopping medication on your own is not an appropriate way to prepare for surgery.

How do TEP, TAPP and open surgery differ?

All three approaches aim to return the hernia contents to their normal position and repair the weak area. In many adults, this involves placing a mesh implant, a medical material that supports the abdominal wall. The layer in which the mesh is placed and the route used to reach it vary between techniques.

In TEP, the surgeon works between the layers of the abdominal wall without entering the abdominal cavity. The mesh is placed in front of the peritoneum, the membrane lining the abdominal cavity. This approach can be seen in the video of Laparoscopic inguinal hernia repair using TEP. This surgical footage is intended for adults.

In TAPP, the abdominal cavity is entered first. The peritoneum is then opened, the mesh is placed in the appropriate space behind it, and the membrane is closed to separate the mesh from the bowel. The stages are shown in the Laparoscopic herniorrhaphy (TAPP) video; this is also surgical footage intended for adults. Both techniques are laparoscopic, using a camera and instruments through small incisions, and usually require general anaesthesia.

In open surgery, an incision is made over the groin and the repair is performed through it. In suitable cases, the operation can be performed under local anaesthesia. An open approach remains a suitable option for some patients; previous operations, the features of the hernia and the risks of general anaesthesia may influence the decision.

When performed by an experienced team, laparoscopic repair may be associated with less persistent pain and a faster return to everyday activities. This approach is particularly considered for hernias on both sides and for a hernia that has recurred after previous open surgery. Neither TEP nor TAPP is preferable for every patient. When choosing Laparoscopic Hernia Surgery, the location of the hernia and the surgeon's training in that technique are considered together.

What should you do if a hernia becomes trapped?

A bulge that used to disappear when lying down but now stays stuck suggests an incarcerated hernia. If the blood supply to the trapped tissue is also cut off, this is a strangulated hernia, and the tissue can be damaged. These two conditions cannot be reliably distinguished at home.

A bulge that has newly become impossible to reduce requires immediate emergency care, especially if accompanied by severe pain, vomiting, abdominal swelling, redness or inability to pass wind. Do not wait for a fever to develop. Trying to force the bulge back in or relieve the pain with home remedies can waste valuable time.

Activity and pain after surgery

Pain, bruising and swelling in the groin may occur in the first few days. Possible complications include bleeding, infection, difficulty passing urine, recurrence of the hernia and long-term pain. Discussing these before surgery helps with the decision and with knowing which symptoms should prompt you to seek help afterwards.

Walking usually begins early, and activity increases gradually as comfort allows. A return to desk work may be possible within one or two weeks; heavy physical work may require a longer break. The pace of recovery and restrictions on lifting are tailored to how the operation went.

If pain increases rather than improves, or if you develop fever, wound discharge, repeated vomiting or inability to pass urine, contact a doctor that day. Pain that continues after the wound has healed also needs assessment, as further treatment may be possible depending on the cause.