A hernia is a weakness or disruption of the fibromuscular tissues through which an internal organ (or part of the organ) protrudes or slides through. Collectively, inguinal and femoral hernias are often lumped together into groin hernias. Surgery remains the only effective treatment, but the optimal timing and method of repair remain controversial. Although strangulation rates of 3% at 3 months have been reported by some investigators, the largest prospective randomized trial of (watchful waiting) men with minimally symptomatic inguinal hernias showed that watchful waiting is safe. Frequency of strangulation was only 2.4% in patients followed up for as long as 11.5 years. Long-term follow-up shows that more than two-thirds of men using a strategy of watchful waiting cross over to surgical repair, with pain being the most common reasons. This risk of crossover is higher in patients older than 65 years. Once an inguinal hernia becomes symptomatic, surgical repair is clearly indicated. Femoral hernias are more likely to present with strangulation and require emergency surgery and are thus repaired even when asymptomatic. Because this article focuses on incarcerated hernias, nonoperative options are not discussed.
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