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. 2024 Dec;38(12):7525-7530.
doi: 10.1007/s00464-024-11253-4. Epub 2024 Sep 16.

Hidden hernias hurt: a plea for early diagnosis and treatment of occult inguinal hernias

Harry J Wong  1 , Cherin Oh  2 , Shirin Towfigh  3
Affiliations

Hidden hernias hurt: a plea for early diagnosis and treatment of occult inguinal hernias

Harry J Wong et al. Surg Endosc. 2024 Dec.

Abstract

Introduction: Hidden or occult inguinal hernias are symptomatic hernias that do not present with a bulge. For some surgeons, if a bulge is not present, then no hernia repair is contemplated. We report preoperative findings of patients with occult inguinal hernias and outcomes after repair to assist in early detection and treatment of this special population.

Methods: All patients who underwent inguinal hernia repairs, 2008-2019, were reviewed. Patients were classified as having occult inguinal hernias if they (a) complained of groin pain, (b) did not have bulging on exam, (c) had supportive imaging showing an inguinal hernia, and (d) were confirmed to have inguinal hernias that were repaired intraoperatively. Presentation and outcomes were compared with the non-occult group treated during the same time period.

Results: Of 485 patients who underwent elective inguinal hernia repairs over 10 years, 212 (44%) had occult inguinal hernias. Patients in the occult group were significantly more likely to be female, younger, and with higher BMI compared to the non-occult group. They also had more preoperative pain for a significantly longer time. This was associated with higher incidence of pain medications usage, including opioids, in the occult group. On physical examination, those with occult hernias were twice as likely to have tenderness over the inguinal canal. Most hernia repairs (66%) were laparoscopic and 94% used mesh. Postoperatively, the occult group had 83% resolution of symptoms after hernia repair.

Conclusion: Some surgeons hesitate recommending hernia repair to patients with occult inguinal hernias, as these patients do not fit the traditional definition of a hernia, i.e., a bulge. Our study challenges this perception by showing that discounting groin pain due to occult hernia prolongs patient's suffering and may risk increased opioid use, especially in females, although 83% cure can be achieved with hernia repair.

Keywords: Gender disparity; Groin pain; Inguinal hernia repair; Inguinodynia; Occult inguinal hernia.

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Conflict of interest statement

Declarations. Disclosures: Dr. Wong, Ms. Oh, and Dr. Towfigh have no conflict of interests or financial ties to disclose.

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