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General Reference ⬇

Jama 1997;277:663

Pathophys and Cause ⬆ ⬇

Cause:Indirect is usually due to congenital failure to close processus vaginalis combined w increased intra-abdominal pressure, eg, from coughing or something else; direct from a defect in transversalis fascia

Pathophys:

Direct inguinal protrudes anteriorly, often bilateral

Indirect goes down inguinal canal, can go to scrotum

Femoral (3%)

Epidemiology ⬆ ⬇

M/F = 25/1

Signs and Symptoms ⬆ ⬇

Sx:Fullness, bulge, pain

Si:Hernia present, at least w straining when standing

Complications ⬆ ⬇

Strangulation, most often in 1st 3 mo; most often w femoral type (>50%)

Treatment ⬆

Rx:

Trusses for direct and indirect types help some. Watchful waiting for asx or mildly symptomatic hernias as good as surgery (Jama 2010;304:1001; 2006;295:285, 328)

Various surgical repairs; mesh repair have a 3-yr 23% recurrence rate, compared to 42% recurrence w suture repair!? (Dutch—Nejm 2000;343:392); open vs. laparoscopic repairs equally good outcomes and latter allow quicker recovery (Jama 2010;304:1001)