Key Questions to Ask During Surgical Evaluation of Right Inguinal Hernia
When evaluating a right inguinal hernia, focus on asking questions that help determine the optimal surgical approach, potential complications, and expected outcomes to make the best decision for mortality, morbidity, and quality of life.
Pain and Symptom Assessment
What specific symptoms are you experiencing? (Ask about):
- Groin pain (location, severity, and triggers)
- Genital pain
- Urinary symptoms
- Abdominal pain
- Changes in bowel movements (increased peristalsis or tenesmus) 1
How long have you had the hernia?
Is the pain constant or intermittent?
What activities make the symptoms worse or better?
Does the hernia reduce (go back in) when you lie down?
Hernia Characteristics
- Is the hernia always visible or does it come and go?
- Have you noticed any changes in size or symptoms recently?
- Has the hernia ever become stuck (incarcerated) or extremely painful?
- Have you had any nausea, vomiting, or inability to pass gas when the hernia is more painful? (Signs of possible strangulation)
Medical History Questions
Do you have any chronic medical conditions? (Particularly important):
- Diabetes
- COPD
- Hypertension
- Heart disease
- History of smoking 2
Are you on any blood thinners or anticoagulants? (This increases risk of open procedures by 38 times) 2
Do you have any history of previous abdominal or pelvic surgeries?
Have you had a hernia before? Was it repaired? What type of repair was done?
Surgical Approach Questions
- What surgical approaches are available for my specific hernia? (Open vs. laparoscopic)
- What type of hernia do I have? (Direct vs. indirect - this affects surgical complexity) 3
- What type of mesh will be used? What are the pros and cons of different mesh options?
- What are the success rates and recurrence rates for each approach?
- What is the expected recovery time for each approach?
Risk Assessment Questions
- What are my specific risks for complications based on my age and medical history?
- How does my age factor into the surgical approach? (Patients over 65 are 4 times more likely to have open procedures) 2
- What complications should I watch for after surgery?
- What is the risk of hernia recurrence with each approach?
Recovery Questions
- What restrictions will I have after surgery?
- How long before I can return to:
- Work
- Exercise
- Heavy lifting
- Sexual activity
- What pain management options will be available after surgery?
- Will I need someone to help me at home after the procedure?
Follow-up Care Questions
- What follow-up appointments will I need?
- What signs or symptoms should prompt me to seek immediate medical attention?
- How will we know if the repair was successful?
- What is the long-term outlook after repair?
Important Considerations
- For patients over 65: Ask specifically about the benefits and risks of laparoscopic versus open repair, as age significantly impacts surgical approach selection 2
- For patients on anticoagulants: Discuss medication management before and after surgery, as this significantly affects surgical approach 2
- For athletic patients: Discuss timing of return to sports and activity restrictions 4
Remember that proper surgical evaluation and selection of the appropriate surgical technique are critical for reducing recurrence rates and improving quality of life outcomes 5, 6. The World Journal of Emergency Surgery recommends prosthetic repair with synthetic mesh for patients with intestinal incarceration but no signs of strangulation, as this is associated with lower recurrence rates 5.