From the Guidelines
Surgical repair is the recommended treatment for inguinal hernia, with laparoscopic repair being a viable option for patients without strangulation or suspicion of bowel resection. The treatment of inguinal hernia depends on various factors, including the size and type of hernia, as well as the patient's overall health.
- Two main surgical approaches are available: open hernia repair and laparoscopic repair, with the choice of approach depending on the individual patient's needs and medical history 1.
- Open repair typically involves making an incision in the groin, pushing the hernia contents back into the abdomen, and reinforcing the weakened area with mesh or by suturing the tissue.
- Laparoscopic repair is less invasive, using small incisions and a camera to guide the placement of mesh from inside the abdomen, and may be preferred for patients with smaller hernias or those who want a quicker recovery time 1.
- The use of mesh in clean surgical fields is associated with a lower recurrence rate, and prosthetic repair with a synthetic mesh is recommended for patients with intestinal incarceration and no signs of intestinal strangulation or concurrent bowel resection 1.
- Patients should undergo emergency hernia repair immediately when intestinal strangulation is suspected, and systemic inflammatory response syndrome (SIRS), contrast-enhanced CT findings, as well as lactate, CPK, and D-dimer levels are predictive of bowel strangulation 1.
- Postoperative pain management typically involves over-the-counter medications like acetaminophen or ibuprofen, with prescription pain medications sometimes needed for the first few days, and guidelines for opioid prescribing should be followed to minimize the risk of overprescribing 1.
- The recovery time varies from 1-2 weeks for laparoscopic repair to 3-6 weeks for open repair before returning to normal activities.
- Surgery is recommended because inguinal hernias don't heal on their own and can lead to serious complications like incarceration (trapped tissue) or strangulation (cut-off blood supply), which constitute medical emergencies requiring immediate surgical intervention.
From the Research
Treatment Options for Inguinal Hernia
The treatment for inguinal hernia typically involves surgical repair, with the goal of improving patient outcomes by decreasing recurrence rates and reducing chronic pain 2.
Surgical Techniques
There are several surgical techniques used for inguinal hernia repair, including:
- Open repair: This is the most traditional method, where an incision is made in the groin to push the hernia back into place 3, 4.
- Laparoscopic repair: This is a minimally invasive technique, where small incisions are made and a laparoscope is used to repair the hernia 3, 4, 5.
- Transabdominal preperitoneal (TAPP) repair: This is a type of laparoscopic repair where the hernia is repaired from inside the abdomen 3.
- Totally extraperitoneal (TEP) repair: This is another type of laparoscopic repair where the hernia is repaired from outside the abdomen 2.
Recommendations
The recommended treatment for inguinal hernia is surgical repair, with mesh repair being the preferred method for elective operations 2. The Lichtenstein technique is the standard for open inguinal hernia repair, while TAPP and TEP have comparable outcomes and are considered minimally invasive alternatives 2. Laparoscopic repair is also recommended for strangulated hernias, but only in clean and clean-contaminated operations 2.
Benefits and Risks
Laparoscopic repair has been shown to have several benefits, including:
- Less postoperative pain and numbness 3, 4, 5
- Faster return to usual activities 3, 4
- Lower risk of chronic groin pain 5 However, laparoscopic repair also has some risks, including:
- Longer operation times 3
- Higher risk of serious complications, such as visceral and vascular injuries 3
Special Considerations
In children, the risk of incarceration and strangulation is substantial, and surgical repair is recommended to avoid these complications 6. In adults, the choice of surgical technique depends on individual factors, such as the type and size of the hernia, as well as the patient's overall health and preferences.