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 near the hernia to push the protruding tissue back into place and strengthen the weakened area with stitches or synthetic mesh 1. Laparoscopic repair is less invasive, using small incisions and a camera to guide the procedure. Recovery typically takes 1-2 weeks for laparoscopic repair and 3-6 weeks for open surgery, with restrictions on heavy lifting (nothing over 10-15 pounds) during this period.
Some key points to consider in the management of inguinal hernias include:
- The use of local anesthesia can be effective in emergency inguinal hernia repair in the absence of bowel gangrene, with less postoperative complications 1.
- Prosthetic repair with synthetic mesh is recommended for patients with intestinal incarceration and no signs of intestinal strangulation or concurrent bowel resection (clean surgical field) 1.
- In cases of suspected bowel strangulation, immediate surgical intervention is recommended, as the benefits outweigh the risks of surgery 1.
- The use of nonopioid medications, such as ketorolac, can be effective in reducing postoperative pain and opioid requirements in children undergoing inguinal hernia repair 1.
Overall, surgical repair is the most effective treatment option for inguinal hernias, and the choice of approach and technique should be individualized based on the patient's specific needs and circumstances. The most recent and highest quality study 1 supports the use of surgical repair with a focus on minimizing postoperative pain and complications.
From the Research
Treatment Options for Inguinal Hernia
The recommended treatment for an inguinal hernia depends on various factors, including the size and type of hernia, as well as the patient's overall health.
- Laparoscopic surgery is a minimally invasive procedure that has been shown to have better results than open surgery in several studies 2, 3.
- Open surgery, also known as conventional anterior repair, is a more traditional approach that involves making a larger incision in the abdomen.
- Laparoscopic transabdominal preperitoneal inguinal hernia repair is a type of laparoscopic surgery that has been shown to have fewer complications and faster recovery times compared to open surgery 3.
- The use of mesh in hernia repair has been shown to be effective in reducing recurrence rates and improving outcomes 4, 5.
Comparison of Laparoscopic and Open Surgery
Studies have compared the outcomes of laparoscopic and open surgery for inguinal hernia repair, with results showing that:
- Laparoscopic surgery has a faster recovery time and fewer complications compared to open surgery 2, 3.
- Laparoscopic surgery has a lower recurrence rate compared to open surgery 2.
- However, the cost of laparoscopic surgery is higher due to the cost of equipment and technology 3.
Special Considerations
In pediatric patients, laparoscopic hernia repair has been shown to be a safe and effective option, with fewer complications and faster recovery times compared to open surgery 6.
- In cases of recurrent inguinal hernia, open repair using a Lichtenstein open mesh technique or totally extraperitoneal (TEP) method may be effective, with similar outcomes for both approaches 5.