What is the treatment for a hernia?

From the Guidelines

Surgical repair is the definitive treatment for most hernias, and the choice of repair technique depends on the size, symptoms, and location of the hernia, as well as the presence of complications such as intestinal strangulation or bowel necrosis. The treatment approach should prioritize minimizing morbidity, mortality, and improving quality of life. According to the 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias 1, patients with intestinal strangulation should undergo emergency hernia repair immediately.

For patients with clean surgical fields (CDC wound class I), the use of mesh is associated with a lower recurrence rate without an increase in wound infection rate 1. In cases of intestinal incarceration without signs of intestinal strangulation or concurrent bowel resection, prosthetic repair with a synthetic mesh is recommended 1. However, for patients with complicated hernias and intestinal strangulation or concomitant need of bowel resection, the choice of mesh and repair technique should be individualized based on the degree of contamination and the patient's overall condition 1.

The following key points should be considered in the treatment of hernias:

• Emergency hernia repair is recommended for patients with intestinal strangulation 1
• The use of mesh in clean surgical fields is associated with a lower recurrence rate 1
• Prosthetic repair with a synthetic mesh is recommended for patients with intestinal incarceration and no signs of intestinal strangulation or concurrent bowel resection 1
• Biological mesh may be used for repair in contaminated or dirty surgical fields 1
• Open management is recommended for unstable patients to prevent abdominal compartment syndrome 1
• Early, definitive closure of the abdomen should be attempted after patient stabilization 1

In terms of specific management strategies, patients can manage discomfort with over-the-counter pain relievers like acetaminophen or ibuprofen, and wearing a hernia truss or binder may temporarily keep the hernia in place. However, these are not long-term solutions, and surgical intervention is usually necessary for permanent resolution. Patients should also avoid heavy lifting, maintain a healthy weight, prevent constipation, and stop smoking to reduce strain and improve healing.

Some key considerations for surgical repair include:

• Laparoscopic repair may be a useful tool for assessing bowel viability after spontaneous reduction of strangulated groin hernias 1
• The choice between a cross-linked and a non-cross-linked biological mesh should be evaluated depending on the defect size and degree of contamination 1
• Antimicrobial prophylaxis should be used in patients with intestinal strangulation and/or concurrent bowel resection 1
• The component separation technique may be a useful and low-cost option for the repair of large midline abdominal wall hernias 1

From the Research

Treatment Options for Hernia

• Surgical treatment is the primary option for hernia repair, with mesh repair being the recommended first choice 2
• The choice of surgical procedure depends on the surgeon's expertise, patient- and hernia-related characteristics, and local/national resources 2
• Laparo-endoscopic repair techniques have faster recovery times, lower chronic pain risk, and are cost-effective, but require specialized expertise 2, 3

Prevention of Surgical Site Infections

• Routine use of preoperative antibiotics in prosthetic groin hernia repair is not supported by available literature 4
• High-quality data on antibiotic prophylaxis in ventral hernia repair is lacking, but it may reduce surgical site infections 4
• Extended postoperative prophylactic antibiotics can reduce the incidence of postoperative surgical-site infections in ventral hernia repair with placement of surgical drains 5
• Antibiotic prophylaxis can reduce the risk of surgical site infection in open hernia repair patients, particularly in mesh repair patients 6

Postoperative Care

• Patients should resume normal activities without restrictions as soon as they feel comfortable 2
• Perioperative field blocks and/or subfascial/subcutaneous infiltrations are recommended in all cases of open repair 2
• Day surgery is recommended for the majority of groin hernia repair, provided aftercare is organized 2

Special Considerations

• Asymptomatic or minimally symptomatic male inguinal hernia patients may be managed with "watchful waiting" 2
• Symptomatic groin hernias should be treated surgically 2
• Women with groin hernias should undergo laparo-endoscopic repair to decrease the risk of chronic pain and avoid missing a femoral hernia 2
• Watchful waiting is suggested in pregnant women with groin swelling, as it often consists of self-limited round ligament varicosities 2