•           Hernia is an area of weakness or disruption of the fibro muscular tissues of the body wall

•           It occurs due to raised intro-abdominal pressure due to various causes or weakness of wall due to any disease.

•           A hernia consists of the sac, the coverings and the contents of the sac that could be o intestine, ovary or Meckel's diverticulum.

•           Most common type of the external hernia is the inguinal and incisional hernia, less being femoral and umbilical.

Clinical Features

•           Patient presents with swelling in the groin region.

•           There will be history of decrease in size of swelling on lying down.

•           Cough impulse and reducibility is present in uncomplicated hernia. But hernia can co and present with irreducibility, obstruction or strangulation.

Differential Diagnosis

•           In the male include vaginal hydrocele, encysted hydrocele of the cord, spermatocele, hernia, incompletely descended testis in the inguinal canal, lipoma of the cord.

•           In the female include hydrocele of the canal of Nuck, femoral hernia.

Management

A.  Surgical

•           The treatment of choice for hernia is surgical repair.

•           Any predisposing factors need to be treated first before hernia repair else recurrence is possible.

•           The hernia with complications needs to be operated in emergency.

•           Treatment in children entails herniotomy while in adult’s repair of the

posterior wall of the inguinal canal without (herniorrhaphy) or with prosthesis (hernioplasty) after high ligation and the sac is done. This can be done by open repair or laparoscopic repair by the experts. Day care surgery under local anaesthesia is practiced at many centres.

•           Complications of herniorrhaphy include infection, haematoma formation, injury to viscera like urinary bladder, injury to vas and recurrence.

B.  Nonsurgical treatment

This is not advocated for the treatment of hernia except in the extremely frail patients unfit for surgery or where surgery is refused by the patient. Application of external pressure causes skin and may cause injury to the contents.

C.  Patient education

•           Reduce weight and quit smoking before surgery.

•           Treatment   of    any   predisposing   factors   like chronic cough, prostatic enlargement and constipation is necessary.

•           The surgery should not be delayed since complications of hernia are frequent and can be serious.

•           After surgery, avoid lifting heavyweights, cycling etc. for three months.