Why inguinal hernia is more common on right side?

Inguinal hernias are more common on the right side due to delayed descent of the right testicle, which leaves a larger patent process vaginalis. Additionally, asymmetry in abdominal wall development and the protective effect of the sigmoid colon on the left make the right side more prone to herniation.

Why inguinal hernia is more common on right side?

Inguinal hernias are more common on the right side due to several anatomical and developmental factors:

1. Delayed Closure of the Right Processus. Vaginalis During fetal development, the processus vaginalis (a pouch of peritoneum that descends with the testes) usually closes after testicular descent. The closure tends to be delayed or incomplete more frequently on the right side, leaving a potential weak spot in the inguinal canal.
2. Later Testicular Descent on the Right Side. The right testis generally descends later than the left during embryogenesis. This delay increases the likelihood of incomplete closure of the processus vaginalis, predisposing the right side to indirect inguinal hernias.
3. Right-Sided Rotation of the Intestines. During fetal development, the intestines undergo a rotation and fixation process. The cecum and appendix usually settle in the right lower quadrant, which may create additional pressure on the right inguinal canal, making herniation more likely.
4. Increased Venous Pressure on the Right Side. The right gonadal vein drains directly into the inferior vena cava at an oblique angle, whereas the left gonadal vein drains into the left renal vein. This difference in venous drainage patterns may contribute to variations in pressure that predispose the right side to herniation.
5. Handedness and Muscle Strength. Some theories suggest that because most people are right-handed, they tend to have slightly stronger abdominal muscles on the right side. However, this could also mean that the left side is weaker and more prone to herniation in some cases.

1. Indirect inguinal hernia

Cause: Congenital (present from birth) due to failure of the process vaginalis to close properly.

• Pathophysiology: The hernia sac follows the path of the spermatic cord in males or the round ligament in females.
• Location: Lateral to the inferior epigastric vessels, through the deep inguinal ring, and possibly into the scrotum.
• More common in infants, young males, and premature babies.
• Clinical Features: Swelling in the groin that may extend into the scrotum, more prominent with straining or standing.

2. Direct Inguinal Hernia

• Cause: Acquired due to weakness of the abdominal wall, often from aging, chronic strain (e.g., heavy lifting, chronic cough).
• Pathophysiology: Hernia sac pushes directly through the posterior wall of the inguinal canal (Hesselbach’s triangle).
• Location: Medial to the inferior epigastric vessels; does NOT pass through the deep inguinal ring.
• More common in older men (>40 years) due to weakened abdominal muscles.
• Clinical Features: Bulge in the groin that increases with standing or straining but rarely extends into the scrotum.

Inguinal hernia treatment at home

While surgery is the definitive treatment for an inguinal hernia, home care can help manage symptoms. Avoid heavy lifting and strenuous activities to prevent worsening the condition. Wearing a hernia belt or truss may provide temporary support. Over-the-counter pain relievers and applying ice packs can help reduce discomfort. Eat a high-fiber diet and drink plenty of water to prevent constipation and straining. Resting and avoiding activities that increase abdominal pressure can also help. Monitor for signs of complications such as severe pain, nausea, or a hard, immovable bulge, and seek medical attention immediately if these occur.

• Diagnosis: Physical examination, ultrasound, or CT scan if needed.
• Treatment: Small, asymptomatic hernias may be monitored; symptomatic or large hernias require surgical repair (open or laparoscopic).

Ask Questions

Q. Why is inguinal hernia common on the right?

Ans. Inguinal hernias are more common on the right due to delayed descent of the right testicle during fetal development, anatomical asymmetry of the abdominal wall, and the relatively larger right-sided patent processus vaginalis, making it more prone to herniation.

Q. What size of inguinal hernia needs surgery?

Ans. Inguinal hernias larger than 2 cm in adults or persisting beyond 1-2 years in infants typically require surgery. Any hernia causing symptoms, bowel obstruction, strangulation, or rapid enlargement also necessitates surgical intervention to prevent complications like ischemia or incarceration.

Q. At what point should an inguinal hernia be repaired?

Ans. An inguinal hernia should be repaired if it is symptomatic, enlarging, irreducible, incarcerated, or strangulated. In infants, persistent hernias beyond 1-2 years require surgery. Elective repair is recommended for adults with discomfort to prevent complications like bowel obstruction or ischemia.

Q. What is the Mayo technique for hernia repair?

Ans. The Mayo technique for hernia repair, primarily used for ventral or umbilical hernias, involves overlapping fascia layers (vest-over-pants closure) to reinforce the defect. It provides a strong repair without mesh, reducing recurrence, and is commonly used for small hernias.

Q. What is the new technique for hernia repair?

Ans. New hernia repair techniques include robot-assisted and laparoscopic approaches, like eTEP (extended totally extraperitoneal) repair for complex cases. Enhanced mesh fixation, bioabsorbable meshes, and minimally invasive extraperitoneal techniques improve outcomes, reduce pain, and lower recurrence rates compared to traditional open surgery.

Q. What is the main cause of hernia? 

Ans. A hernia mainly occurs due to increased abdominal pressure, which forces an internal organ or tissue through a weakened area in the surrounding muscle or tissue wall. This pressure can result from heavy lifting, chronic coughing, constipation, obesity, or pregnancy, especially when combined with muscle weakness.

Q. What lifestyle causes hernia?

Ans. Lifestyle factors that can cause hernias include heavy lifting, poor posture, lack of exercise, obesity, smoking, and chronic coughing. Straining during bowel movements or urination, often due to constipation, also increases risk. An inactive lifestyle weakens abdominal muscles, making it easier for tissues or organs to push through weak spots.

Q. Is hernia 100% curable?

Ans. Hernia is not always 100% curable without surgery. While lifestyle changes can help manage symptoms, surgery is the only definitive treatment to repair the weakened area. With successful surgical intervention, most hernias are effectively cured, though there’s a small risk of recurrence depending on the type and individual health factors.