Inguinal Hernia Grows In Size, Prompting A Surgical Repair

DEAR DR. ROACH: I'm an 83-year-old healthy woman. In 2019, I became aware of a little bulge in my groin and suspected an inguinal hernia. It was confirmed by my family doctor. Given its small size and the fact that it gets reduced easily, we decided to wait and watch it.

An ultrasound revealed that the only contents of the hernia were abdominal fat. However, last year, I noticed a change and suspected intestinal intrusion, which was confirmed again by my doctor's examination and an ultrasound.

Since then, the hernia has been increasing in size, from the size of a small walnut to the size of a duck's egg. It doesn't hurt or bother me, and it still is reduced easily. I decided to have the hernia repaired.

One big problem that I came across, and the reason I'm reaching out to you, is that I found scarce information in medical/surgical journals about outcomes in female patients. I realize that most inguinal hernia patients are male; however, there are enough women with this condition that there should be more information than what I was able to find.

The little I found was concerning: pudendal nerve damage, chronic pain in the perineal area and a lack of sensation. One study revealed that 50% of patients have nerve damage. I'm booked at Toronto's Shouldice Hospital for the repair. -- E.H.

ANSWER: I was able to find a large study of almost 8,000 women who were treated for groin hernias. The overall complication rate is definitely higher for women, and the techniques that work well for men don't always work well for women.

However, part of the reason for the high complication rate is that many of these surgeries are done on an emergency basis, and this leads to worse outcomes.

Since you are getting yours done electively before any problems have emerged, this gives you the chance of a much better outcome. However, 50% is much higher than anything I read in the literature; 25% is about the highest that I have seen.

In the large study coming from Sweden, the complication rate in women for elective surgery was about 7%, which is actually lower than the complication rate in men.

As always, finding a surgeon and an institution with expertise in your particular surgery is important, and Shouldice is certainly renowned for expertise in hernia surgery. Their methodology is used by many surgeons across the world. You are fortunate to have this option available to you.

Based on the very strong data, you can be reassured that you have a high likelihood of success. Still, there isn't a surgery that doesn't have risks, so a patient always needs to weigh the risks and benefits.

Since an increase in the size of the hernia is concerning, I understand why you chose to get the surgery and agree with your choice to find the highest expertise available to you.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.