There are patients who have pain from small hernias that are undetectable by examination or by any type of x-ray. There are patients who have pain that sounds like hernia pain but who have no hernias. The big question is how to sort these patients out and provide surgery for the patients who need it and not operate on patients who do not need it. The problem is that if you reserve surgery only for patients with obvious hernias then a few patients with hidden hernias will not get the surgery that they need. But if you operate on patients that do not have obvious hernias then a few patients who do not need surgery will get it.
We do as much as we can to help our patients that need help and we do not want to operate on patients that do not need surgery. Sometimes we have to take a chance. In cases of possible occult (hidden or sports) hernias three things are very important. The first is thoroughness. Every effort should be made to rule out other causes of the pain. Secondly, a rational appraisal of the risks should be made. Lastly, solid, experienced clinical judgment should be applied.
Patients who come to see us with a possible occult hernia may be offered surgery if: 1) in our clinical judgment the location and description of the pain is typical for a hernia, 2) After a thorough evaluation including a complete history and physical, x-rays and laboratory testing other possible causes of the pain have been ruled out. 3) The patient, after counseling, understands the risks and benefits and has reasonable expectations and is willing to undergo exploratory surgery. In our clinical experience more than fifty percent of patients that have this surgery based on these criteria are found to have a small hernia, undergo a repair and have resolution of their pain
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"Milan—Chronic groin pain after hernia surgery is now considered the most important issue facing inguinal hernia surgeons and their patients. Yet, there is still much uncertainty surrounding what causes the pain and how to prevent it." - Victoria Stern, General Surgery News