Many patients with inguinal hernias are advised to “wait and see” if symptoms aren’t bothersome.
But according to general surgeon Zachary Parshall, MD, early surgical consultation – even for asymptomatic hernias – can prevent complications and optimize outcomes.
Clinical presentation
Inguinal hernias result from a weakness in the groin musculature, affecting up to 25% of men during their lifetime.
“For most people, it’s just an unlucky weakness in the musculature of the groin,” Dr. Parshall says.
The hallmark symptom is a visible bulge or swelling in the groin that patients can feel moving in and out. While some patients experience isolated pain, particularly after a remembered incident, many seek evaluation due to a concern about the bulge itself.
Why size matters
“I always tell people that a smaller hernia is an easier hernia to fix,” Dr. Parshall says. “Easier hernias to fix are typically easier to recover from.”
Small hernia repairs typically require only two to three weeks of lifting restrictions. In contrast, large hernia repairs can require six to eight weeks of recovery and may necessitate overnight hospitalization.
Large hernias also affect the surgical approach. Nebraska Medicine has a first-line treatment that uses robotic surgery with three small incisions. This treatment is performed as an outpatient procedure.
However, as hernias enlarge, the likelihood of requiring open repair with a larger groin incision increases, along with higher rates of hospital admission.
Potential complications
While watchful waiting is generally safe, allowing hernias to enlarge increases the risk of several complications, including:
- Bowel obstruction.
- Incarceration with a compromised blood supply.
- Seromas.
- Hematomas.
- Infection.
- Testicular injury (rarer).
When to refer
Dr. Parshall, who practices at Bellevue Medical Center, recommends referring patients at the time of diagnosis, regardless of symptom severity.
While studies show that observation is safe and not significantly different from immediate surgery in terms of major complications, most patients in these studies eventually progressed to surgery.
The key issue is quality of life: Patients with large hernias face more invasive procedures and longer recoveries than those treated earlier.
“Sometimes the patient never has that conversation with us until it’s already a big thing, and we’ve missed the opportunity to do it while it’s small,” Dr. Parshall says.
Sooner is better
Early consultation allows for shared decision-making. Patients who choose observation remain informed participants in their care rather than facing emergency surgery when complications arise.
“We’re happy to see any patient, regardless of whether they’re ready for surgery right away or not,” Dr. Parshall says. “We just want to talk to these patients sooner.”
For referrals or additional information, email mailto:physicianoutreach@nebraskamed.com or call 402.559.2500.