Inguinal Hernia. A Review

Abstract

Background: Inguinal hernia is a common surgical problem, but it can present a surgical dilemma for the skilled surgeon when it exhibits some unusual contents. While watchful waiting is an acceptable strategy for minimally symptomatic hernias, the definitive treatment of inguinal hernias, regardless of their origin or type, is surgical repair. Surgical repair is the only chance a surgeon has to deal with any abnormal content that may arise. This paper is intended to make readers, especially young surgeons, surgical residents and general practitioners aware of current thinking in the management of inguinal hernias. Methods: Publications in English language from 1959 up to 2015 were obtained from both reprint requests and by searching Pubmed database. Data extracted included authors, country, year of publication, age and sex of patients, epidemiology, geographical distribution, pathophysiology, risk factors, clinical features, investigations, types of surgical treatment, and unusual findings in inguinal hernias. Results: The pathophysiology explains the higher incidence of inguinal hernias in males than females, while the aetiology explains the physiological background for the different modern methods for repair of inguinal hernias and the reason for recurrence of hernias using the older sutured repairs. In addition, some other unexpected benign and malignant lesions were found to also present in inguinal hernias. Recommendations: Up to date knowledge of these findings is important for proper repair of inguinal hernias to reduce recurrence rates, and careful handling of these unusual contents of inguinal hernias.