Inguinal hernia: aetiology, diagnosis, post‐repair pain and compensation

BACKGROUND: Inguinal hernia compensation depends on aetiology, diagnosis and complications, particularly post-hernia pain. New studies in these three areas bring confusion to claims. METHODS: A comprehensive research of the literature using Medline: in aetiology, in diagnoses, the use of ultrasound and/or other investigations, in chronic post-hernia pain and the understanding of the pathogenesis of hernia and post-hernia pain. Using the above data, a creation of a protocol for acceptance of compensation claim. RESULTS: Although intra-abdominal pressure has been accepted for 200 years as a significant aetiological factor in inguinal hernia, tissue studies and prospective studies suggest an inevitability. In diagnosis, the clinical detection of a lump is the gold standard; investigations are not required. An ultrasonic detection of a hernia without clinical correlation does not require surgery. Post-hernia chronic pain is not singular to hernia, is now considered neuropathic pain and treatment is conservative. CONCLUSIONS: The work scene is possibly an aggravating factor but not a prime aetiological factor. The diagnosis does not require ultrasound. Chronic pain is neuropathic. A protocol for claim acceptance is presented.