Surgical Repair is Indicated for Fat-Containing Inguinal Hernias in Females
All inguinal hernias in females, including those containing only preperitoneal fat (peritoneoceles), should undergo surgical repair. 1
Rationale for Repair
The presence of fat alone does not change the indication for surgery in female patients with groin hernias. Here's why:
High Risk of Femoral Hernia Misdiagnosis
- Approximately 30% of all female groin hernias are actually femoral hernias, though often misdiagnosed preoperatively as inguinal hernias. 2
- Femoral hernias carry an 8-fold higher risk of requiring bowel resection due to their propensity for strangulation. 1
- In one study, 18.3% of female patients had an incorrect preoperative diagnosis, with femoral hernias found in 17.3% of women diagnosed preoperatively with inguinal hernias. 2
Risk of Progression and Complications
- Even hernias containing only fat can progress to contain bowel or other intra-abdominal contents over time. 1
- The goal of elective repair is to prevent complications that would necessitate emergency surgery with significantly higher complication rates. 3
- Delayed treatment beyond 24 hours in complicated cases is associated with significantly higher mortality rates. 1
Recommended Surgical Approach for Females
Laparoscopic repair (TEP or TAPP) is the preferred approach for female groin hernias. 1, 2
Advantages of Laparoscopic Approach in Women
- Permits identification of occult femoral hernias that may be missed on clinical examination and would not be addressed by an anterior open repair. 1, 2
- Allows simultaneous diagnosis and treatment of both inguinal and femoral hernias during the same procedure. 2
- Associated with significantly lower postoperative pain rates (6.4% moderate-to-severe pain with TEP vs 21.7% with open repair, P=0.03). 2
- Lower recurrence rates (1.4% after TEP vs 12.5% after open repair, P=0.02). 2
- Significantly lower wound infection rates compared to open repair. 1
Technical Considerations
- Both TEP and TAPP approaches demonstrate comparable outcomes with low complication rates. 1
- TAPP may be easier in recurrent cases or when TEP proves technically difficult. 1
- General anesthesia is required for laparoscopic approaches. 1
Common Pitfalls to Avoid
- Do not adopt a "watchful waiting" approach for female groin hernias, even if they appear to contain only fat, due to the high risk of femoral hernia and potential for strangulation. 2
- Do not rely solely on preoperative clinical diagnosis to determine hernia type in women—the diagnostic accuracy is poor. 2
- Avoid performing only an anterior Lichtenstein repair in women, as this will miss femoral hernias present in up to 30% of cases. 2
- Failing to examine both groins can result in missing contralateral hernias, which occur in 11-50% of cases. 3