A Bulge in the Groin Could be a Hernia

Dear Dr. B: I have bulge in the groin. Is it a hernia?

Answer: A bulge in the groin could be a hernia, an enlarged lymph gland, an enlarged vein, an aneurysm of femoral artery, a lump of fat or a swollen skin gland. Let us presume it is a hernia.

There are two types of hernia in the groin: inguinal and femoral. Inguinal hernia is by far the commonest hernia. Inguinal hernia can appear at any age – from birth (congenital) to old age (weak muscles).

The hernia appears through a potentially weak spot in the abdominal wall. The hernial sac may contain an organ, most often the bowel but sometimes the bladder or an ovary.

The hernia can be a source of discomfort or pain or can be totally asymptomatic.

A groin hernia presents as a bulge during straining, coughing, micturating or doing heavy lifting. The bulge will appear whenever there is increase in the intra-abdominal pressure. The bulge will usually disappear on lying down or after gentle manual reduction.

If the bulge cannot be reduced then it becomes a potentially life-threatening problem. The hernial contents trapped in the hernial sac may lose its blood supply and become gangrenous.

Treatment of hernia is surgery. If the hernia is causing no symptoms then one can elect not to have surgery. Hernia does not go away without surgical treatment. If surgical treatment is not undertaken then the hernia may remain the same, get bigger or there is a small risk of strangulation and gangrene.

If the hernia is symptomatic then surgery is the best answer. There are two surgical approaches to repair of inguinal hernia: open method (a groin incision with tension free mesh repair) and laparoscopic repair (done through small holes in the abdominal wall).

People commonly ask: Which method is superior? Answer to this question is controversial. Commonly four outcome measurements are used to measure the success of each technique: return to work, operative time, postoperative pain, and recurrence rate.

Studies have shown that patients return to work after a minimum of nine days, regardless of the type of repair. Return to work is more a function of employment status; self-employed workers go back to work earlier than patients on workers’ compensation.

Operative time depends on individual surgeons. Overall operative times are not significantly different between the two repairs although some studies have shown that laparoscopic repair takes little longer.

Some reports have suggested that post-operative pain is less for laparoscopic repair, but these studies have not adequately compared the patients who had open tension-free repair. What about the recurrence rate? Laparoscopic repair appears to have lower recurrence rate than open method but there were very few tension-free repairs in that study to make appropriate comparison.

Overall, the two repairs appear to have similar complication rates. The procedure is done as a day surgery under local, spinal or general anaesthetic. The type of anaesthetic used depends on the surgical technique used and the general condition of the patient.

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