From the Guidelines
Surgery is not always necessary for inguinal hernias, but it is recommended for symptomatic or complicated cases to prevent morbidity and mortality. When considering the management of inguinal hernias, it's crucial to assess the risk of complications such as strangulation, which is a medical emergency 1. The decision to operate depends on several factors including symptoms, size, and risk of complications.
- For asymptomatic inguinal hernias, watchful waiting may be appropriate, especially if the hernia is small and reducible.
- However, for symptomatic hernias, surgical repair is the definitive treatment, either through open surgery or laparoscopic techniques, as it reduces the risk of recurrence and complications 1.
- The use of mesh in clean surgical fields is associated with a lower recurrence rate without an increase in wound infection rate 1.
- In cases of intestinal strangulation, emergency hernia repair is immediately recommended 1.
- For patients with intestinal incarceration and no signs of intestinal strangulation, prosthetic repair with synthetic mesh is recommended 1.
- The choice of surgical approach and mesh type depends on the individual case, including the size of the defect, degree of contamination, and patient stability 1. It's essential to consult with a surgeon to discuss the specific situation and determine the best course of treatment, as the management of inguinal hernias can vary significantly depending on the individual case 1.
From the Research
Inguinal Hernia and the Need for Surgery
- Inguinal hernias do not always require immediate surgery, especially in asymptomatic or minimally symptomatic cases 2, 3.
- Watchful waiting is a reasonable and safe option for men with asymptomatic or minimally symptomatic inguinal hernias, with a conversion rate to elective surgery ranging from 35.03% to 57.8% 2.
- However, symptomatic hernias or those in nonpregnant women may require surgical intervention 3.
Risks and Benefits of Surgery
- The risk of incarceration in children with inguinal hernia is substantial, with a crude incarceration rate of 7% for all children and 11% for preterm children 4.
- Delaying surgery unnecessarily may not be recommended, but individual cases may benefit from delayed surgery 4.
- Laparoscopic repair is associated with shorter recovery time, earlier resumption of activities of daily living, less pain, and lower recurrence rates than open repair 3, 5.
- The incidence of chronic pain after repair is high, and physicians must carefully select patients and explain the risks and benefits of surgery 2.
Management of Incarcerated Hernias
- Management of incarcerated hernias requires prompt assessment and decision-making, with options including laparoscopic repair or open surgery 5, 6.
- The laparoscopic approach is a feasible procedure with acceptable results, but its efficacy needs to be studied further in larger multicenter randomized controlled trials 5.