How to reduce an inguinal (groin area) hernia?

From the Guidelines

To reduce an inguinal hernia, manual reduction should be attempted first, but if this is not possible or if there are signs of strangulation, immediate medical attention is necessary, and laparoscopic repair may be considered as a viable option, as it has been shown to be feasible and safe in emergency settings, with lower wound infection rates and no higher recurrence rates compared to open repair 1.

When attempting manual reduction, it is essential to follow proper techniques to avoid causing further injury. This can be done by lying on your back with knees bent, applying gentle pressure to the hernia bulge, and guiding it back into the abdomen. Before attempting reduction, relax in this position for 10-15 minutes to decrease abdominal pressure. If successful, immediately apply ice (15 minutes on, 15 minutes off) to reduce swelling and wear a supportive garment like compression shorts until you can see a doctor.

Some key points to consider when reducing an inguinal hernia include:

• Manual reduction is only a temporary measure, and medical attention should be sought even after successful reduction, as the hernia will likely recur without proper treatment.
• If you cannot reduce the hernia yourself, experience severe pain, nausea, vomiting, or the area appears dark or red, go to the emergency room immediately as this may indicate a strangulated hernia requiring urgent surgical intervention.
• Laparoscopic repair has been shown to be a viable option in emergency settings, with studies demonstrating its feasibility and safety, including a retrospective 4-year analysis of 188 patients who underwent emergency surgical repair of strangulated groin hernias, which revealed a significant lower wound infection rate in the laparoscopic group, without a higher recurrence rate 1.
• Hernioscopy, a mixed laparoscopic–open surgical technique, can also be effective in evaluating the viability of the herniated loop, thus avoiding unnecessary laparotomy 1.

It is crucial to prioritize medical attention and proper treatment to prevent complications and ensure the best possible outcome in terms of morbidity, mortality, and quality of life.

From the Research

Reducing an Inguinal Hernia

To reduce an inguinal hernia, the following options are available:

• Surgical repair is the current approach, whereas asymptomatic or minimally symptomatic hernias may be good candidates for watchful waiting 2
• Mesh repairs are superior to "nonmesh" tissue-suture repairs, with Lichtenstein repair and endoscopic/laparoscopic techniques having similar efficacy 2
• Local anesthesia is a suitable and economic option for open repairs, and should be popularized in day-case setting 2

Surgical Techniques

Different surgical techniques can be used to reduce an inguinal hernia, including:

• Open repair with mesh, which is recommended as the first choice 3
• Laparo-endoscopic repair, which has faster recovery times, lower chronic pain risk, and is cost-effective 3
• Single-incision laparoscopic surgery (SILS), which has been introduced to further improve surgical outcome and cosmetic results 4
• Robotic surgery, which is associated with low rate of postoperative and chronic pain without a significant increase in operative time 5

Non-Surgical Management

For asymptomatic or minimally symptomatic inguinal hernias, non-surgical management options are available:

• Watchful waiting, which is an acceptable management strategy because it is safe and the rate of hernia accident is very low 6
• Observation, which can be used for patients who do not have significant symptoms or complications 6