From the Guidelines
Hernia treatment should always prioritize surgical intervention, especially in cases of suspected intestinal strangulation, as it significantly reduces morbidity and mortality rates 1. When it comes to hernia treatment options, the primary goal is to alleviate symptoms, prevent complications, and improve the patient's quality of life. The following are key considerations:
- Surgical approaches, including open repair and laparoscopic repair, are the definitive treatments for most hernias, with laparoscopic repair being a feasible option for patients without suspected bowel resection 1.
- Non-surgical management, such as watchful waiting and wearing a supportive truss or binder, may be suitable for small, asymptomatic hernias or patients with high surgical risks.
- Robotic-assisted surgery offers enhanced precision for complex cases and can be considered as an alternative to traditional open or laparoscopic repair.
- Pain management typically involves over-the-counter medications, and patients should avoid heavy lifting and gradually return to normal activities as advised by their surgeon. Some key points to consider when evaluating hernia treatment options include:
- The risk of complications, such as incarceration or strangulation, which require emergency intervention 1.
- The patient's overall health, age, and surgical risk, which can influence the choice of surgical approach 1.
- The surgeon's familiarity with a particular surgical approach and the availability of necessary expertise and equipment. It is essential to note that hernias do not heal on their own and can lead to severe complications if left untreated. Therefore, surgical intervention is always the recommended course of action, especially in cases of suspected intestinal strangulation, as it significantly reduces morbidity and mortality rates 1.
From the Research
Hernia Treatment Options
- Umbilical hernias can be treated with open, laparoscopic, or robotic repair, each with its advantages and disadvantages 2
- The use of mesh in hernia repair has been shown to decrease recurrence rates, even in small hernias 2
- Laparoscopic inguinal hernia repair can be performed with either oral or intravenous acetaminophen for pain control, with no significant difference in outcomes 3
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ketorolac and ibuprofen can provide adequate pain control for patients undergoing laparoscopic hernia repair, with ibuprofen offering equivalent pain control at a lower cost and reduced potential for adverse events 4
Postoperative Pain Management
- There is no significant difference in opioid use or pain medication requirements between open, laparoscopic, and robotic inguinal hernia repair techniques 5, 6
- Patients undergoing open inguinal hernia repair are just as likely to receive opioids at discharge as those undergoing minimally invasive surgery, and are prescribed similar amounts of opioids 6
- More than one-third of patients use no opioids after discharge, and 75% of prescribed opioids remain unused 6
- Low discharge pain and normal body mass index are independently associated with needing no opioids at discharge 6