From the Guidelines
Surgical repair with mesh placement is the recommended treatment for most patients with inguinal hernias, as it is associated with lower recurrence rates and minimal increase in wound infection rates, as supported by the 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias 1.
Key Considerations for Inguinal Hernia Surgery
- The choice between open repair and laparoscopic repair depends on patient factors and surgeon expertise, with laparoscopic approaches including transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repairs.
- Diagnostic laparoscopy may be useful in assessing bowel viability after spontaneous reduction of strangulated groin hernias, with a grade 2B recommendation 1.
- For patients with intestinal incarceration and no signs of intestinal strangulation or concurrent bowel resection, prosthetic repair with a synthetic mesh is recommended, as it is associated with a lower recurrence rate and no increase in wound infection rate, as stated in the 2017 WSES guidelines 1.
- In cases of intestinal strangulation and/or concomitant need of bowel resection without gross enteric spillage, emergent prosthetic repair with synthetic mesh can be performed, with a significant lower risk of recurrence, as recommended by the 2017 WSES guidelines 1.
Postoperative Care and Management
- A multimodal approach to pain management is recommended, including local anesthetics, scheduled acetaminophen, and NSAIDs, with opioids reserved for breakthrough pain.
- Early mobilization is encouraged to prevent complications like deep vein thrombosis and respiratory issues.
- Most patients can return to light activities within 1-2 weeks and full activities by 4-6 weeks.
Special Considerations
- For stable patients with strangulated hernia with bowel necrosis and/or gross enteric spillage, primary repair is recommended when the size of the defect is small, while biological mesh may be used for larger defects, as stated in the 2017 WSES guidelines 1.
- For unstable patients, open management is recommended to prevent abdominal compartment syndrome, with intra-abdominal pressure measurement and early definitive closure of the abdomen, as recommended by the 2017 WSES guidelines 1.
From the Research
Inguinal Hernia Surgery Recommendations
- The use of antibiotic prophylaxis for elective inguinal hernia repair is a controversial issue, and its administration cannot be universally recommended 2.
- Laparoscopic inguinal hernia surgery leads to rapid recovery and low complication rates, and the use of self-fixated meshes is a viable option 3.
- The diagnosis of inguinal hernias is typically made through history and physical examination, and symptomatic patients often experience groin pain, burning, gurgling, or aching sensations 4.
- Surgical intervention is not always necessary, and the patient should be counseled about the best approach, whether open or laparoscopic, based on their individual needs 4.
Surgical Approaches
- Open, laparoscopic, and robotic inguinal hernia repair are all viable options, and the choice of approach depends on the surgeon's expertise and the patient's specific needs 5.
- Laparoscopic inguinal hernia repair has been shown to be effective in reducing postoperative pain and improving quality of life, with low recurrence rates 3, 5.
- Robotic inguinal hernia repair has been associated with higher rates of recurrence and complications compared to open and laparoscopic approaches 5.
Prevention of Surgical Site Infections
- The use of prophylactic antibiotics, such as amoxicillin-clavulanic acid, can help prevent surgical site infections after open prosthetic inguinal hernia repair 2, 6.
- Oral prophylaxis with amoxicillin-clavulanic acid has been shown to be equally effective as parenteral prophylaxis in preventing surgical site infections 6.