What is happening
An indirect inguinal hernia follows the path the testis took during development. If the defect is large enough and the hernia long-standing, its contents pass the whole way down the canal and sit within the scrotum. The result is a swelling that appears continuous from the groin crease downwards, rather than a discrete lump in one place or the other.
It is more likely to become uncomfortable, harder to reduce, and more disruptive to daily life than a small groin hernia. It also indicates a substantial defect, which is relevant to how it should be repaired.
Telling it from a testicular swelling
Swellings arising from the testis or its coverings — a hydrocele, an epididymal cyst, a varicocele — sit entirely within the scrotum. The key distinguishing sign is whether the examiner can get above the swelling: with a hydrocele they can; with an inguinoscrotal hernia they cannot, because it is continuous with the groin. A hydrocele will usually transilluminate; a hernia containing bowel will not.
This distinction is made at examination, not by guesswork, and it changes who should be treating you — a hernia is a general surgical problem, a primary testicular swelling is usually urological.
Attend A&E immediately if
- The swelling becomes suddenly painful and tense
- It cannot be reduced when it previously could
- The overlying skin becomes red, dusky or shiny
- You develop vomiting, abdominal pain or distension
Any new testicular swelling needs assessing
Separately from hernia, any firm, painless lump arising from the testis itself must be examined promptly, because testicular cancer presents this way and is highly treatable when caught early. If assessment shows the problem is testicular rather than a hernia, you will be directed to urology without delay rather than being kept in the wrong clinic.
Repair considerations
Large inguinoscrotal hernias are technically more demanding than standard groin hernias. The sac is longer and often adherent, and there is a higher chance of postoperative fluid collection — seroma — in the space the hernia leaves behind. Discussing this honestly beforehand matters, because a temporary scrotal swelling after surgery is common and is not a sign the repair has failed.
Keyhole and robotic approaches work well in experienced hands for most of these hernias, with an open approach reserved for the largest or most adherent. Whichever is used, it is a planned day-case or single-night stay operation in most patients.
Local pathway
Consultation and surgery at Nuffield Health Warwickshire Hospital, Leamington Spa, drawing patients from Warwick, Coventry, Rugby, Solihull and across Warwickshire. Repair from £4,500, with dates usually available within 7 days of the clinic appointment.
Common questions
Is a scrotal hernia more serious than a groin hernia?
It is not automatically dangerous, but it reflects a larger defect, tends to be more symptomatic, and is less likely to be manageable by waiting. It also has a higher chance of becoming difficult to reduce.
Will repair affect my fertility or testicle?
The vas deferens and testicular vessels run through the operative field, and injury to them is a recognised but uncommon risk that is discussed with you. In experienced hands the risk is low, and it is lower with a properly planned operation than with an emergency one.
Why is my scrotum swollen after the operation?
Fluid frequently collects in the space the hernia previously occupied. It is called a seroma, it is expected after repair of a large inguinoscrotal hernia, and it settles over several weeks without intervention in the great majority of cases.
Can it be repaired keyhole?
Most can, including many large ones. The decision is made after examining you, and the reasoning is explained rather than presented as a fixed policy.
How urgent is it?
It is not usually an emergency, but it is one of the presentations where waiting months rarely improves anything and often makes the operation larger.