What are the risks of not receiving surgical repair for an inguinal scrotal hernia?

Risks of Not Repairing an Inguinal Scrotal Hernia

Not repairing an inguinal scrotal hernia carries significant risks including incarceration, strangulation, bowel obstruction, and potential life-threatening complications that require emergency surgery with higher mortality rates. 1

Primary Risks of Untreated Inguinal Scrotal Hernias

Incarceration and Strangulation

• Incarceration occurs when hernia contents become trapped and cannot be reduced
• Strangulation is a surgical emergency where blood supply to trapped tissues is compromised
• Signs of strangulation include:
  • Severe pain
  • Tenderness
  • Erythema
  • Systemic inflammatory response syndrome (SIRS)
• Delayed treatment beyond 24 hours significantly increases mortality 1

Bowel Obstruction

• Trapped intestinal contents can lead to mechanical bowel obstruction
• Can progress to:
  • Ischemia
  • Necrosis
  • Perforation
  • Peritonitis
  • Sepsis

Progressive Enlargement

• Untreated hernias typically enlarge over time
• Can reach giant proportions extending below the knee 2
• May develop skin complications including:
  • Ulceration
  • Necrosis
  • Infection 1, 2

Risk Factors for Complications

The risk of complications varies based on several factors:

Patient-Related Factors

• Age (older patients may have higher complication rates)
• Comorbidities (especially cirrhotic patients with Child-Pugh-Turcotte class C, ASA score ≥3, and MELD score ≥20) 1
• BMI (higher BMI increases complication risk) 3

Hernia-Related Factors

• Size of hernia (larger hernias have higher complication rates)
• Duration of hernia presence
• Scrotal involvement (scrotal hernias have higher complication rates) 3
• Recurrent hernias (higher risk of complications) 3

Diagnostic Considerations

Laboratory and imaging findings that may indicate complications:

• Elevated arterial lactate levels
• CT findings showing signs of bowel compromise (56% sensitivity, 94% specificity for strangulation) 1

Benefits of Timely Surgical Repair

Elective surgical repair offers significant advantages over emergency repair:

• Lower complication rates
• Reduced mortality
• Better long-term outcomes
• Choice of surgical approach (laparoscopic vs. open)
• Opportunity for preoperative optimization 1, 4

Surgical Approaches and Outcomes

The International Guidelines of the Hernia-Surge Group recommend:

• Totally extraperitoneal patch plasty (TEP)
• Transabdominal preperitoneal patch plasty (TAPP)
• Lichtenstein technique 4

Each approach has specific advantages:

• Laparoscopic repair: shorter hospital stays, fewer wound infections
• Open repair: potentially lower recurrence rates, better long-term quality of life 1

Common Complications of Surgical Repair

While surgery carries its own risks, these are generally lower than the risks of non-repair:

• Recurrence (11% of patients) 4
• Chronic pain (10-12% of patients) 4
• Wound complications and scrotal/testicular swelling (7-12% in open repair) 5
• Massive penoscrotal hematoma (rare but serious) 6

Conclusion

The risks of not repairing an inguinal scrotal hernia significantly outweigh the risks of surgical repair. While elective repair carries some surgical risks, these are generally lower than the potentially life-threatening complications of an untreated hernia that becomes incarcerated or strangulated.