From the Guidelines
Surgical repair is the recommended treatment for an inguinal hernia, as it is the only definitive treatment option that can prevent serious complications like incarceration and strangulation. The two main surgical approaches are open hernia repair and laparoscopic repair. Open repair involves making an incision over the hernia site and either pushing the protruding tissue back into place and strengthening the abdominal wall with sutures (traditional repair) or reinforcing it with synthetic mesh (tension-free repair) 1. Laparoscopic repair is minimally invasive, using small incisions and a camera to guide the placement of mesh.
Some key points to consider in the management of inguinal hernias include:
- The use of mesh in clean surgical fields is associated with a lower recurrence rate compared to tissue repair, without an increase in wound infection rate 1.
- Local anesthesia can be used for emergency inguinal hernia repair in the absence of bowel gangrene, providing effective anesthesia with less postoperative complications 1.
- The timing of inguinal hernia repair in preterm and term infants represents a balance of the risks of inguinal hernia incarceration and postoperative respiratory complications 1.
- Laparoscopic repair has been used effectively in preterm infants, with reported hernia recurrence rates comparable to those associated with open repair 1.
Recovery typically takes 1-2 weeks for laparoscopic repair and 3-6 weeks for open repair, with restrictions on heavy lifting during this time. Surgery is recommended because hernias don't resolve on their own and can lead to serious complications. For temporary symptom management before surgery, patients can use supportive undergarments or hernia trusses, though these don't treat the underlying condition. The choice of surgical approach should be individualized based on the patient's specific condition and the surgeon's expertise.
From the Research
Inguinal Hernia Treatment
The recommended treatment for an inguinal hernia is surgery, with various methods available, including open repair, laparoscopic repair, and robotic repair 2, 3.
Comparison of Surgical Methods
- Open repair is the most popular method, but it has a higher risk of chronic groin pain compared to laparoscopic repair 2.
- Laparoscopic repair is associated with a lower risk of chronic groin pain, but its recurrence rate is still unclear 2.
- Robotic repair is a newer method that has been shown to be safe and effective, with comparable rates of wound complications, postoperative prolonged discomfort, and recurrence to open and laparoscopic repair 3.
Surgical Anatomy
The anatomy of the inguinal region is complex and has been studied extensively, with various structures involved in hernial repair, including the iliopubic tract, the transversus abdominis aponeurosis, and the inguinal canal 4, 5.
Pediatric Inguinal Hernia Repair
In pediatric patients, laparoscopic herniorrhaphy (LH) has been shown to be a safe and effective method, with advantages including less complications and a significant decrease in contralateral metachronous hernia 6.
Outcomes and Complications
The outcomes and complications of inguinal hernia repair vary depending on the surgical method used, with factors such as operative time, recurrence rate, and postoperative discomfort being important considerations 2, 3, 6.