Should I have surgery for inguinal hernia now, or should I wait?

Introduction

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This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

Many doctors recommend that people with an inguinal hernia (say "IN-gwuh-nul HER-nee-uh") have surgery to repair it. This is because surgery can prevent a rare but serious problem called strangulation. This occurs when a loop of intestine or piece of fatty tissue is trapped in a hernia and the blood supply is cut off, killing the tissue.

If your hernia does not bother you, you may not need to have surgery. Waiting to have surgery does not increase the chance that part of your intestine or abdominal tissue will get stuck in your hernia. Waiting will also not increase your risk for problems if you decide to have surgery later. If the hernia is small and painless and it goes away when you lie down or you can push it back into your belly, you may be able to wait.

Consider the following when making your decision:

• Only surgery can repair a hernia. Hernias do not go away on their own.
• Surgery can prevent strangulation, a serious problem that occurs when tissue gets trapped inside the hernia and gets cut off from its blood supply. But strangulation is rare in adults.
• Many people are able to delay surgery for months or even years and some people may never need surgery for a small hernia. If the hernia is small and you do not have any symptoms, or if the symptoms do not bother you much, you and your doctor may simply continue to watch for symptoms to occur.
• Some people wear supports (trusses or corsets) to hold their hernias in. Talk with your health professional before wearing a corset or truss for a hernia. These devices are not recommended for treating hernias and sometimes can do more harm than good. There may be certain situations when your doctor thinks a truss would work, but these are rare.

Medical Information

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What is an inguinal hernia?

An inguinal hernia occurs when tissue pushes through a weak spot in your groin muscle. This causes a bulge in the groin, scrotum, or labia. The bulge may hurt or burn, or it may not hurt at all.

Why do hernias need to be repaired?

If you have a hernia, it will not heal on its own. Surgery is the only way to fix a hernia. Having surgery for a hernia can prevent a serious complication, like part of your intestine getting trapped in your hernia.

Repairing the hernia can also relieve the symptoms of pain and discomfort and make the bulge go away.

If your hernia does not bother you, you most likely can wait to have surgery. Your hernia may get worse, but it may not. In some cases small, painless hernias may never need to be repaired.

What kinds of surgery are used for inguinal hernia?

There are two types of hernia repair surgeries:

• Open hernia repair surgery. During open surgery, the hernia is repaired through a cut, called an incision, in the groin. Open surgery is safe and effective and has been done for many years.¹
• Laparoscopic hernia repair. This is a newer method for hernia repair in adults. A surgeon inserts a thin, lighted scope through a small incision in the belly. Surgical tools to repair the hernia are inserted through other small incisions in the belly. Laparoscopic hernia surgery may have some advantages over open surgery in certain situations. Studies show that people have less pain after this type of surgery and can return to work and other activities more quickly than after open repair.² But this surgery costs more than open repair. Hernias may also come back more often after this type of surgery.

When is it safe to delay surgery?

Surgery may not be needed for some time. Many people are able to delay surgery for months or even years and some people may never need surgery for a small hernia. If the hernia is small and you do not have any symptoms, or if the symptoms do not bother you much, you and your doctor may simply continue to watch for symptoms to occur.

If a hernia in an adult can be pushed back into the belly (reduced) or it goes away when lying down, the person can wait to have surgery. If it cannot be pushed back, surgery must be done sooner.

What are the risks of surgery?

Surgery for hernia repair includes risks for:

• Bad reaction to anesthesia.
• Infection and bleeding at the site.
• Nerve damage, numb skin, or a loss of blood supply to the scrotum or testicles that could cause the testicles to waste away. None of these are frequent.
• Damage to the cord that carries sperm from the testicles to the penis. This could affect your ability to father children.
• Damage to the artery or vein in the thigh.
• Damage to the intestines or bladder for certain types of hernias or if the surgery is a laparoscopic repair.

With hernia surgery, it usually takes up to 4 weeks before you can begin normal strenuous activities.

What are the risks of waiting to have surgery?

The main risk of waiting to have surgery for an inguinal hernia is a rare but serious problem called a strangulation. This occurs when a loop of intestine is trapped in a hernia and the blood supply is cut off, killing the tissue. Talk with your doctor to decide when you need hernia repair surgery.

If you need more information, see the topic Inguinal Hernia.

Your Information

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Your choices are:

• Have surgery now to repair the inguinal hernia, even if you do not have symptoms.
• Take a "wait and see" approach to surgery because the hernia does not bother you much.

The decision about when to have hernia surgery takes into account your personal feelings and the medical facts.

Deciding about hernia surgery

Reasons to have surgery now

Reasons to wait

Only surgery can repair a hernia. Waiting to have surgery may result in strangulation of the hernia. You have swelling and a feeling of heaviness, tugging, or burning in the area of the hernia. You have sudden pain, nausea, and vomiting caused by the hernia. The hernia keeps you from doing daily activities or from returning to work or starting a new job. You want to get pregnant and do not want problems during pregnancy. You want to have the hernia repaired while your insurance or worker's compensation will help cover the costs. You will be traveling to an area where health care may not be available. Are there other reasons you might want to have surgery now for inguinal hernia?

Your doctor says that watchful waiting is a reasonable choice for you. You do not have any symptoms. You can push the hernia back into your belly or it goes away when you lie down. The hernia does not interfere with your work or other daily activities. You are pregnant and you are concerned about harm to the baby from the anesthesia and surgery. Your doctor has suggested that wearing supports (trusses or corsets) could help. Your insurance does not cover all of the cost of surgery, and you are concerned about the expense. Surgery is not convenient at this time, and you are at low risk for more serious problems. You are taking medicines such as blood thinners that cannot be stopped for surgery. You have other health problems that make surgery dangerous. You have a skin infection that could also infect the material used to repair the hernia. Are there other reasons you might want to wait to have surgery for inguinal hernia?

These personal stories may help you make your decision.

Wise Health Decision

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Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having surgery for inguinal hernia. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I am having discomfort and pain.	Yes	No	NA*
I have talked to my doctor about my hernia.	Yes	No	NA
The hernia is small and painless, and I can push it back into my belly.	Yes	No	Unsure
I understand the risks of waiting to have surgery.	Yes	No	Unsure
I am concerned about the costs.	Yes	No	Unsure
Surgery is convenient for me at this time.	Yes	No	NA

*NA=Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have surgery now or to wait to have surgery for inguinal hernia.

Check the box below that represents your overall impression about your decision.

Leaning toward having surgery for inguinal hernia

Leaning toward waiting to have surgery for inguinal hernia

Return to the topic Inguinal Hernia.

References

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Citations

1. Kingsnorth A, LeBlanc K (2003). Hernias: inguinal and incisional. Lancet, 362(9395): 1561–1571.

2. Deveney KE (2006). Hernias of the groin section of Hernias and other lesions of the abdominal wall. In GM Doherty, LW Way, eds., Current Surgical Diagnosis and Treatment, 12th ed., pp. 765–773. New York: Lange Medical Books/McGraw-Hill.

Credits

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Author	Monica Rhodes
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology
Last Updated	May 16, 2007