Inguinal hernia is a hernia formed by the protrusion of intra-abdominal organs through a defect in the inguinal region to the body surface, commonly known as “hernia”. The inguinal region is a triangle located at the junction of the lower abdominal wall and the thigh. According to the relationship between the hernia ring and the inferior abdominal wall artery, inguinal hernias are divided into two types: inguinal hernia and inguinal hernia. I. Etiology There are many causes of inguinal hernia, mainly reduced abdominal strength, and increased intra-abdominal pressure. Muscle atrophy and weakness of the abdominal wall in the elderly, and even more weakness in the inguinal region, together with the passage of blood vessels, spermatic cords or round ligaments of the uterus, provide a channel for the formation of hernias. In addition, elderly people tend to have coughing and asthma, constipation, and difficulty in urination due to prostate enlargement, resulting in elevated abdominal pressure, which provides the impetus for hernia formation. If a reversible mass appears in the inguinal region, i.e., it appears when standing, walking, coughing or laboring and disappears when lying down at rest, the possibility of inguinal hernia should be considered. Clinical manifestations 1. Inguinal hernia (1) Repeatable hernia: It may vary depending on the size of the hernia sac or the presence or absence of complications. The basic manifestation is the appearance of a reversible mass in the inguinal region, which is small at first and appears only when the patient is standing, working, walking, running, coughing or when the child cries. There is generally no special discomfort, only occasional local swelling and involvement pain. With the development of the disease, the mass may gradually increase in size and descend from the groin to the scrotum or labia majora, making walking difficult and affecting labor. The mass is pear-shaped with a stalk, narrow at the upper end and wide at the lower end. The mass may disappear on its own when lying down or it may disappear by gently pushing the mass outward and upward with the hand and retracting into the abdominal cavity, often with a grunting sound because the contents of the hernia are small intestine. After the hernia mass is retracted, the examiner can use the tip of the index finger to gently reach upward through the scrotal skin along the spermatic cord into the enlarged external ring and ask the patient to cough, then the fingertip will feel impact. In some cases of occult inguinal hernia, the presence of the hernia can be determined by this test. The examiner presses the finger against the internal ring of the inguinal canal and then asks the patient to cough hard, the hiatal hernia mass does not appear, but if the finger is removed, the mass is seen to bulge out from the midpoint of the groin from the external superior to the internal inferior. This compression test can be used to distinguish a hiatal hernia from a straight hernia, which can still appear after the hernia mass is retracted and the patient is asked to cough with the finger pressing firmly on the internal ring. (2) Sliding hiatal hernia: It often appears as a large and difficult-to-recover hernia that cannot be completely retracted. The appendix that slides out of the abdominal cavity often adheres to the anterior wall of the hernia sac. In addition to the incomplete retraction of the mass, there are clinical symptoms such as dyspepsia and constipation. This particular type of hernia should be recognized in clinical work, otherwise the slipped cecum or sigmoid colon may be mistaken as part of the hernia sac and cut open during surgical repair. (3) Incarcerated hernia: It often occurs when there is a sudden increase in intra-abdominal pressure such as strong labor or defecation, and is usually a hiatal hernia. Clinically, it often presents as a sudden increase in size of the hernia mass with significant pain. The mass cannot be retracted by lying down or pushing it by hand. The mass is tense and hard with marked tenderness. If the embedded content is the greater omentum, the local pain is often mild; if it is intestinal collaterals, not only the local pain is obvious, but also the signs of mechanical intestinal obstruction such as paroxysmal abdominal cramps, nausea, vomiting, constipation, and abdominal distension. Once the hernia is embedded, there is less chance of self-retraction; most patients’ symptoms gradually worsen, and if left untreated, it will eventually become a strangulated hernia. In the case of intestinal wall hernia, it is easy to be ignored because the local mass is not obvious and there is not necessarily a manifestation of intestinal obstruction. Strangulated hernia: the clinical symptoms are more serious. Patients have severe and persistent abdominal pain; frequent vomiting, vomit containing coffee-like blood or bloody stool; asymmetric abdominal distension, signs of peritoneal irritation, diminished or absent bowel sounds; hemorrhagic fluid on abdominal puncture or lavage; isolated distended intestinal mix or tumor-like shadow on X-ray; gradual rise in body temperature, pulse rate, white blood cell count, and even signs of shock. 2.Direct inguinal hernia is mainly a reversible mass in the inguinal region, located above the pubic symphysis, hemispherical in shape, mostly without pain and other discomfort. When standing, the hernia mass appears immediately and disappears when lying down. The mass does not enter the scrotum, and because of the wide neck of the hernia, it rarely becomes entrapped. The abdominal wall defect can be directly felt in the inguinal triangle after retraction, and there is a swelling sensation of impact on the fingertips when coughing. The hernia mass can be distinguished from a hiatal hernia by pressing the inner ring with the finger outside the abdominal wall and allowing the patient to rise and cough, still with the hernia mass present. Bilateral straight hernias and hernia masses are often close to each other on both sides of the midline. Most inguinal hernias can be diagnosed based on the clinical symptoms of the patient and the physician’s examination. If the hernia is small and the performance is atypical, the diagnosis can be basically confirmed by ultrasound examination. There is a misconception about the treatment of inguinal hernia that it is not life-threatening, so it can be treated or not. However, once inguinal hernia cannot be retracted to form an incarcerated hernia, it can lead to intestinal obstruction, even intestinal necrosis and perforation, and even death, with a morbidity and mortality rate of about 15%. Treatment of inguinal hernia includes conservative treatment and surgical treatment. 1. Conservative treatment. Conservative treatment includes hernia belt, hernia brace, Chinese medicine and herbal medicine, etc. These methods can relieve the symptoms or slow down the development of the disease, but cannot cure it, and even some improper conservative treatments can aggravate the disease. 2.Surgical treatment. Adult inguinal hernia is not self-healing, and surgery is the only reliable method to treat adult inguinal hernia, which is less likely to recur. Easily recurring hernias should be selected for surgery at an appropriate period of time, while surgery for refractory hernias should be limited to a short period of time, and emergency surgical treatment must be taken for incarcerated and strangulated hernias to avoid more serious consequences. Surgical treatment is subdivided into traditional tissue-to-tissue tension suture repair and tension-free hernia repair techniques, which are currently internationally recognized as tension-free hernia repair techniques, including open and laparoscopic procedures.