When does hernia surgery become an emergency?

May 3, 2016

Updated March 2025 

Many inguinal hernia repairs are considered elective procedures, because patients often have the option of when to schedule surgery. The same usually applies for umbilical and ventral hernia repairs as well. However, just because a surgery is elective does not mean that it is unnecessary, or cosmetic. 

There is always a chance that a hernia could become strangulated, leading to emergency hernia surgery. Most of the time, people have warning signs before their hernia becomes an emergency. Patients who have worsening pain, intestinal or urinary symptoms should have their hernia repaired more urgently to avoid emergency hernia surgery.

An inguinal hernia occurs when there is a weakness or defect in the abdominal wall that allows the contents of the abdominal cavity to protrude outside. The majority of these hernias can be described as reducible – meaning that can be pushed back in, or returned to the abdominal cavity. Reducible hernias are not life threatening. Only a small percentage of hernias cause a situation where emergency hernia surgery is necessary every year.

We evaluate about 2,000 new patients every year for a suspected hernia. We feel that most patients fall into one of 4 categories:

  • Groin strains – About 15% of the patients we see have pain and no bulge. While hernias sometimes present this way, a groin strain or other core muscle injury is often the culprit. Rather than surgery, treatment involves physical therapy and/or strength training.
  • Asymptomatic hernias – Some patients have a reducible, painless bulge. These patients are able to do all activities with no discomfort at all. For asymptomatic inguinal hernias, the risk for becoming strangulated is around 0.2% per year(1-6). We typically give patients the option of continuing with their everyday life and follow up when they become symptomatic. Some patients prefer to address their hernia, even if it does not cause pain, given that about 80% of inguinal hernias will require surgery within 10 years of diagnosis. 
  • Symptomatic reducible hernias – Many patients present to us with mild-moderate pain at the site of hernia, pain in the abdomen, intestinal or urinary issues. Some patients are still able to perform daily activities or even exercise. However, symptoms can become severe enough to restrict most activities, including going to work, doing chores around the house, or standing or sitting for long periods of time. Patients in this category need surgery to resume their daily lives, improve their quality of life and avoid emergency hernia surgery(6). A hernia specialist can help determine when a hernia requires more urgent surgery to avoid an emergency. Waiting too long to have a symptomatic hernia fixed can lead to longer and more complicated surgery(5,9). 
  • Incarcerated hernias – “Incarcerated” refers to when bulging hernia contents cannot be pushed back in. This commonly is NOT an emergency. However, for some patients, who have severe pain and have signs to suggest that what is incarcerated is the intestine, this can be a surgical emergency. If a hernia cannot be pushed back in, and there is new significant pain in that area, this requires evaluation in an emergency room. When an inguinal hernia is no longer reducible, the abdominal contents – specifically if this includes intestine – are permanently stuck outside of the abdominal cavity. When an incarcerated hernia becomes strangulated, the piece of intestine stuck outside of the abdominal cavity no longer receives adequate blood supply. As the tissues spend longer periods of time with little or no blood supply, they begin to die. This strangulated hernia is a surgical emergency, and requires surgery to save the dying tissues.

 

It’s important to follow up with a specialized hernia surgeon any time there is an increase in the pain or change in symptoms related to your hernia. If this pain is not relieved by the usual methods, then you should be evaluated to see if more urgent surgery is required. Waiting too long can lead to more problems down the road. Emergency surgery for inguinal or umbilical hernia can be serious and sometimes life threatening(5,9).  

 

Interested in learning more? Check out some of our other resources:

 

References

  1. Twelve-year outcomes of watchful waiting versus surgery of mildly symptomatic or asymptomatic inguinal hernia in men aged 50 years and older: a randomised controlled trial. Van den Dop, L. Matthijsvan den Dop, Matthijs et al.
    eClinicalMedicine, Volume 64, 102207
  2. Reistrup H, Fonnes S, Rosenberg J. Watchful waiting vs repair for asymptomatic or minimally symptomatic inguinal hernia in men: a systematic review. Hernia. 2021 Oct;25(5):1121-1128. doi: 10.1007/s10029-020-02295-3. Epub 2020 Sep 10. PMID: 32910297.
  3. Collaboration IT Operation compared with watchful waiting in elderly male inguinal hernia patients: a review and data analysis. J Am Coll Surg. 2011;212:251–259.e1-4. – PubMed
  4. de Goede B., Wijsmuller A.R., van Ramshorst G.H., et al. Watchful waiting versus surgery of mildly symptomatic or asymptomatic inguinal hernia in men aged 50 Years and older: a randomized controlled trial. Ann Surg. 2018;267:42–49. – PubMed
  5. O’Dwyer P.J., Chung L. Watchful waiting was as safe as surgical repair for minimally symptomatic inguinal hernias. Evid Based Med. 2006;11:73. – PubMed
  6. Fitzgibbons R.J., Jr., Giobbie-Hurder A., Gibbs J.O., et al. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA. 2006;295:285–292. – PubMed
  7. Fitzgibbons RJ, Ramanan B, Arya S et al (2013) Long-term results of a randomized controlled trial of a nonoperative strategy (watchful waiting) for men with minimally symptomatic inguinal hernias. Ann Surg 258(3):508–515. https://doi.org/10.1097/SLA.0b013e3182a19725
  8. Schroeder A.D., Tubre D.J., Fitzgibbons R.J., Jr. Watchful waiting for inguinal hernia. Adv Surg. 2019;53:293–303. – PubMed
  9. Stroupe KT, Manheim LM, Luo P et al (2006) Tension-free repair versus watchful waiting for men with asymptomatic or minimally symptomatic inguinal hernias: a cost-effectiveness analysis. J Am Coll Surg 203:458–468. https://doi.org/10.1016/j.jamcollsurg.2006.06.010