08 Apr 2023 Groin Hernia in Woman

What is a groin hernia in women and why is it important? What is the preferred repair method?

Groin hernias are typically associated with men, but they can also occur in women. Groin hernias in women are important due to the difficulty in diagnosis and the frequent occurrence of strangulation. Repair using laparoscopic methods is recommended. In this blog post, I will take a closer look at groin hernias in women, including their symptoms, diagnoses, and repair methods.

Groin hernias are seen in women, although their risk accounts for only 2-3%. Femoral hernias, which account for 2-4% of groin hernias, are more common in women. However, hernias in the groin area are 3 times more common in women than in men, and approximately 20% of groin hernias in women are femoral hernias. The female-to-male ratio for femoral hernias is approximately 2.5:1; however, this varies with age. The incidence of femoral hernias in women aged < 35 years is low. They are more common in women who have had multiple pregnancies, and, surprisingly, the ratio is equal to that of men in this group. Almost one-third of femoral hernias present with strangulation and obstruction.

Women with groin hernias may experience a range of symptoms, including;

• A visible bulge in the groin area may be more noticeable during coughing, sneezing, or straining.

• Feeling of heaviness or pressure in the groin.

• Pain or discomfort in the groin, particularly when bending, lifting, or coughing.

• Burning or aching sensation in the groin or lower abdomen.

• Swelling or tenderness in the groin or scrotum (rare).

Groin hernias in women usually cause pain and sometimes a fluctuating swelling. The diagnosis is generally difficult, and the patient is usually referred to a specialist. As femoral hernias are more prone to strangulation, strangulated hernias should be considered in women presenting with bowel obstruction and lower abdominal pain. Ultrasound and, if necessary, computed tomography (CT) or magnetic resonance imaging (MRI) should be used for diagnosis. MRI is the most accurate imaging method for diagnosis under normal conditions. During MRI, particularly during the Valsalva maneuver, the patient should be asked to strain. This can make the hidden hernias visible.

According to extensive studies and guidelines based on their analysis, groin hernia repair in women should be performed laparoscopically. This approach offers several advantages. First, with open repair, femoral hernias may be missed because of the nature of the techniques used. In addition, during open approaches, the nerves are exposed, increasing the risk of chronic pain after surgery. Although this risk is lower in expert hands, it is significantly higher when compared to the laparoscopic approach. In laparoscopic repair, the mesh is placed behind the inguinal wall anatomically, and nerves are located more laterally, reducing the risk of chronic pain.

When repairing groin hernias in women using laparoscopic methods, it is recommended to use a lightweight or medium-weight mesh, not to fix the mesh with staples unless necessary, and to use tissue adhesive materials if necessary. By considering these factors, the risk of chronic pain can be minimized. With laparoscopic repair, the four potential hernia regions (direct, indirect, femoral, and obturator areas) are covered with a mesh. In open repairs, the femoral and obturator canals may be overlooked if the posterior wall of the groin is not opened, and laparoscopy provides a clear advantage in terms of recurrence.

Finally, the laparoscopic approach provides significant advantages, especially in femoral hernias, which are more common in women when the patient arrives in a strangulated state. With this method, it is possible to determine the type and condition of strangulated organs, including the presence of gangrene and tissue death. This approach includes both diagnostic and therapeutic approaches. In addition to freeing the trapped organ from its constricted position, it also allows for possible intervention in the affected organ after evaluating its condition. Following this, a decision is made on whether the hernia should be repaired, depending on the circumstances. If there is organ perforation and bacterial contamination in the field, repair should be delayed because the probability of infection in the mesh used for repair is high. This infection can become chronic, leading to unwanted situations such as abscess surgery in the future or removal of the mesh.

I always say that early hernia surgery is more comfortable for both patients and surgeons. Do not delay hernia surgery.