The first step in the workup for an inguinal hernia is obviously making an accurate diagnosis. Once that diagnosis is made, then our patients need to make a decision on whether they want treatment at the time of diagnosis. So let’s start with how hernias are diagnosed.
By far the most common diagnostic test for determining the presence of an inguinal hernia is a Clinical Examination (CE). This involves a surgeon like myself examining the groin area for the signs of a hernia. Studies have shows that about 75% of hernias can be diagnosed with this technique. When found on an examination, hernia surgeons are accurate in the diagnosis 96% of the time. For those patients who have a very small hernia, or are obese making the examination difficult, additional modalities can be used. The most common imaging test is an ultrasound of the groin which increases the chances of finding a hernia to about 82%, with it’s accuracy about 95%. Most patients will never need an MRI or a CT scan to diagnose a hernia since the sensitivity is usually not much better than with CE and ultrasound.
When patients are diagnosed with an inguinal hernia, they have to make a decision on what step to take next. Clearly the first decision for patients is whether to just watch their hernia over time or have it surgically repaired. In patients who have no symptoms from their hernia, large studies have examined the risk of watchful waiting and found it to be very low. The biggest risk that patients have is that the hernia becomes ‘strangulated’ or ‘acutely incarcerated’ requiring emergency surgery. The incidence of this happening in these large studies is about 2% at 10 years.
Patients who have symptoms at the time they see me in our office, should have surgery. The incidence of an emergent surgery is higher in these patients with symptoms, and the outcomes show more complications after surgery. Thus, in patients with symptoms, I recommend surgery at that time.
In patients who watch their hernia over time, the chances of developing pain or other symptoms and crossing over to having surgery is about 75%. This depends on age with older patients having a higher chance of crossing over to having surgery and younger patients crossing over to surgery less often. Regardless, about 3 out of every 4 patients who just watches his or her hernia will need surgery at some point.