•  There are 1 million abdominal wall hernia’s repaired per year – Inguinal hernia repairs equate to 770,000
•  25% of males & 2% of females have inguinal hernias in their lifetimes, which is the most common type of hernia
•  75% of all hernias are groin related with 2/3rd indirect & 1/3rd direct
•  Indirect inguinal hernias are the most common hernias in M & F
•  Incisional and ventral hernias account for 10% of all hernias
•  Only 3% of hernias are femoral hernias
•  The incidence of inguinal hernias in children ranges up to 4.4%, while umbilical hernias occur in approx 1 in every 6 children
•  90% of inguinal hernia repair occur in males
•  Femoral hernias occur almost exclusively in women
•  Indirect hernias usually occur in 1st year of life
•  Indirect hernias occur more frequently in premature vs term infants
•  Direct hernias occur in older patients
•  Umbilical hernias are 8 x common in black vs white infants
•  Most umbilical hernias close spontaneously within the 1st year of life
•  Epigastric hernia – 0.5-10%, M:F=3:1, 30-50 yr
•  Spigelian hernia –M:F=4:3, 40-70 yr

• Increased pressure within the abdomen
• A pre-existing weak spot in the abdominal wall
• A combination of increased pressure within the abdomen and a pre-existing weak spot in the abdominal wall
• Straining during bowel movements or urination
• Heavy lifting
• Fluid in the abdomen (ascites)
• Pregnancy
• Excess weight
• Chronic coughing or sneezing

Men are more likely to have an inherent weakness along the inguinal canal because of the way males develop before birth. In male babies, the testicles form within the abdomen and then move down the inguinal canal into the scrotum. Shortly after birth, the inguinal canal closes almost completely — leaving just enough room for the spermatic cord to pass through but not enough to allow the testicles to move back into the abdomen. Sometimes, the canal doesn’t close properly, leaving a weakened area.

In female babies, there’s less chance that the inguinal canal won’t close after birth. Weaknesses can also occur in the abdominal wall later in life, especially after an injury or a surgical operation in the abdominal cavity. Whether or not you have a pre-existing weakness, extra pressure in your abdomen from straining, heavy lifting, pregnancy or excess weight can cause a hernia.

Asymptomatic Hernia

• Swelling or fullness at the hernia site
• Aching sensation (radiates into the area of the hernia)
• No true pain or tenderness upon examination
• Enlarges with increasing intra-abdominal pressure and/or standing

Symptomatic Hernia

• A burning, gurgling or aching sensation at the bulge
• Pain or discomfort in your groin, especially when bending over, coughing or lifting
• A heavy or dragging sensation in your groin
• Occasionally, pain and swelling around the testicles when the protruding intestine descends into the scrotum

Incarcerated Hernia

• Painful enlargement of a previous hernia or defect
• Cannot be manipulated (either spontaneously or manually) through the fascial defect
• Nausea, vomiting, and symptoms of bowel obstruction (possible)

Strangulated Hernia

• Patients have symptoms of an incarcerated hernia
• Systemic toxicity secondary to ischemic bowel is possible
• Strangulation is probable if pain and tenderness of an incarcerated hernia persist after reduction
• Suspect an alternative diagnosis in patients who have a substantial amount of pain without evidence of incarceration or strangulation

Site-specific findings

With femoral hernia, medial thigh pain and groin pain are possible. Incisional hernias at sites of prior abdominal surgery are usually asymptomatic. Patients present with a bulge at the site. The bulge may become larger upon standing or with increasing intra-abdominal pressure.

Risk factors for an inguinal hernia include:

• • Being male: You’re far more likely to develop an inguinal hernia if you’re male. Also, the vast majority of newborns and children who develop inguinal hernias are boys.
  • Family history: Your risk of inguinal hernia increases if you have a close relative, such as a parent or sibling, who has the condition.
  • Certain medical conditions: People who have cystic fibrosis, a life-threatening condition that causes severe lung damage and often a chronic cough, are more likely to develop an inguinal hernia.
  • Chronic cough: A chronic cough, such as from smoking, increases your risk of inguinal hernia.
  • Chronic constipation: Straining during bowel movements is a common cause of inguinal hernias.
  • Excess weight: Being moderately to severely overweight puts extra pressure on your abdomen.
  • Pregnancy: This can both weaken the abdominal muscles and cause increased pressure inside your abdomen.
  • Certain occupations: Having a job that requires standing for long periods or doing heavy physical labor increases your risk of developing an inguinal hernia.
  • Premature birth: Infants who are born early are more likely to have inguinal hernias.
  • History of hernias: If you’ve had one inguinal hernia, it’s much more likely that you’ll eventually develop another — usually on the opposite side.