From the Guidelines
Hernia treatment should typically involve surgical repair, prioritizing a laparoscopic approach when possible, to minimize morbidity, mortality, and improve quality of life. The choice of surgical approach depends on various factors, including the type of hernia, the presence of strangulation, and the patient's overall health status 1.
Key Considerations
- For patients with intestinal incarceration and no signs of intestinal strangulation or concurrent bowel resection, 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 suspected bowel strangulation, immediate surgical intervention is recommended, as the benefits outweigh the risks of surgery 1.
- Diagnostic laparoscopy may be a useful tool for assessing bowel viability after spontaneous reduction of strangulated groin hernias, and laparoscopic repair can be performed in the absence of strangulation and suspicion of the need for bowel resection 1.
Surgical Approach
- Open repair and laparoscopic/robotic repair are both viable options, with the choice depending on the specific circumstances of the patient and the hernia 1.
- The use of synthetic mesh is recommended for patients with intestinal incarceration and no signs of intestinal strangulation or concurrent bowel resection, as it is associated with a lower recurrence rate 1.
Preoperative and Postoperative Care
- Patients can manage discomfort before surgery with over-the-counter pain relievers like acetaminophen or ibuprofen, and by avoiding heavy lifting or straining 1.
- Recovery from hernia repair typically takes 1-2 weeks for light activities and 4-6 weeks before returning to strenuous activities, with specific timelines varying by surgical approach and individual healing 1.
Timing of Intervention
- Patients should undergo emergency hernia repair immediately when intestinal strangulation is suspected, as early detection and treatment can significantly improve outcomes 1.
- Systemic inflammatory response syndrome (SIRS), contrast-enhanced CT findings, as well as lactate, CPK, and D-dimer levels are predictive of bowel strangulation, and can guide the decision for immediate surgical intervention 1.
From the Research
Hernia Treatment Options
- Inguinal hernia repair is a common surgical procedure, with over 600,000 cases performed annually in the United States 2
- The choice of treatment depends on various factors, including the type of hernia, patient-related factors, and the surgeon's experience 2, 3
- Open-mesh repair and laparoscopic procedures are two common treatment options, each with its advantages and disadvantages 2, 4
Advantages and Disadvantages of Treatment Options
- Open-mesh repair:
- Laparoscopic procedures:
Patient-Related Factors Influencing Treatment Outcome
- Patient-related factors, such as constipation, ASA classification, diabetes, and smoking, can influence the outcome of hernia repair 2
- A classification system that takes into account patient-related factors and the complexity of the hernia can be helpful in evaluating treatment outcomes 2
Diagnosis and Management
- Diagnosis of inguinal hernias is typically made through physical examination, with imaging studies such as ultrasonography and magnetic resonance imaging used in certain cases 4, 5
- Watchful waiting is a reasonable option for asymptomatic or minimally symptomatic inguinal hernias in men, but not recommended for symptomatic hernias or nonpregnant women 4
- Surgical intervention is not always necessary, and the decision to operate should be made on a case-by-case basis 5