Skip to main content

Safer Care Victoria’s Best Care resources support patients and healthcare providers to have conversations and make decisions together about the most appropriate pathways for care.

This resource, developed for clinicians, details a specific elective surgery procedure that should now only be done for specific indications. Evidence-based recommendations that detail ‘best care’ pathways should be discussed with your patient to determine the most appropriate pathway of care.

Advice

Hernia repair is not recommended for patients with minimal symptoms or for asymptomatic inguinal hernias that are small or only detectable by ultrasound.

Pain with an inguinal hernia detected on ultrasound does not necessarily indicate the need for repair, particularly if the patient has significant comorbidities, because there is a risk of ongoing, debilitating post-operative pain.

When the diagnosis is not apparent, imaging can help identify an occult hernia, differentiate inguinal from femoral hernia, and distinguish a hernia from other clinical entities. In the absence of suspected hernia complications, ultrasound is the usual means of initial diagnosis. Other imaging options, including CT and MRI, may be useful under specific clinical circumstances.

When is the procedure indicated?

Femoral hernias have a high risk of complications, so early elective surgical repair is indicated, however they are diagnosed.

Patients who develop strangulation or bowel obstruction from an inguinal or femoral hernia should have urgent surgical repair. 

Patients with an acutely incarcerated inguinal hernia but without signs of strangulation or obstruction also require surgery, with the urgency determined by the treating surgeon. 

In patients with an uncomplicated inguinal or femoral hernia, surgical repair aims to relieve symptoms and prevent future complications. The indications for surgical repair of uncomplicated hernias depends on the type of hernia (inguinal versus femoral), the severity of symptoms, and patient preference. In select patients, waiting while monitoring the patient’s condition is an alternative to surgery.

Best care recommendations

A ‘watch and wait’ approach should be adopted given this does not heighten the risk of the patient developing more severe symptoms.

In cases of minimally symptomatic and asymptomatic inguinal hernias, the patient’s prognosis and long-term health may be improved by non-surgical intervention. Ongoing surgical review is required to ensure the patient’s condition is monitored and that a re-evaluation of their surgical need can be made should their symptoms increase in severity. 

Evidence

HerniaSurge Group. International guidelines for groin hernia management. Hernia: The Journal of Hernias and Abdominal Wall Surgery. 2018; 22(1):1-165.

NPS MedicineWise. Recommendations – Royal Australian College of Surgeons. Sydney (NSW): Choosing Wisely Australia. 2016 Mar [cited 2020 Jun 23]. 

O’Rourke MGE, O’Rourke TR. Inguinal hernia: aetiology, diagnosis, post-repair pain and compensation. ANZ Journal of Surgery. 2012;82(4):201-6.

Page last updated: 23 Dec 2020

Was this content helpful to you?