[Occult hernias, classification of inguinal lipomas and chronic postoperative groin pain]

Inguinal hernias that are asymptomatic and cannot be easily detected clinically are called occult hernias. The question arises whether these hernias, when incidentally detected intraoperatively during the repair of a symptomatic contralateral inguinal hernia, should be repaired simultaneously. Some of these hernias become symptomatic over time and require surgery (metachronous inguinal hernia). Metachronous hernias must be distinguished from overlooked lipomas of the inguinal canal (cord lipomas) missed at the index operation. Until now, no classification of cord lipomas has been available. This article is the first to present such a classification. Lastly, chronic postoperative inguinal pain (CPIP) is a key reason for reluctance in the occasional treatment of occult hernias. The following text provides an overview and decision-making aid for the management of occult inguinal hernias.