From the Guidelines
For an 86-year-old with an inguinal hernia causing intermittent discomfort, the next step should be a consultation with a surgeon to discuss treatment options, as surgery is the definitive treatment for inguinal hernias, and the decision requires careful consideration in elderly patients. The patient's overall health status, comorbidities, and fitness for surgery will be evaluated by the surgeon. If the hernia is reducible and symptoms are mild, watchful waiting with pain management using acetaminophen (500-1000mg every 6 hours as needed, not exceeding 3000mg daily) may be appropriate, as recommended by general medical guidelines 1. The patient should avoid heavy lifting (nothing over 10 pounds) and straining during bowel movements. A truss may provide temporary relief by keeping the hernia reduced. However, if the hernia becomes irreducible, painful, or shows signs of strangulation (severe pain, redness, nausea, vomiting), immediate medical attention is necessary as this represents a surgical emergency, according to the guidelines for emergency repair of complicated abdominal wall hernias 1.
Some key points to consider in the management of this patient include:
- The use of local anesthesia (LA) can provide effective anesthesia with less postoperative complications for emergency inguinal hernia repair in the absence of bowel gangrene, as stated in the guidelines 1.
- Diagnostic laparoscopy may be a useful tool for assessing bowel viability after spontaneous reduction of strangulated groin hernias, and repair of incarcerated hernias can be performed with a laparoscopic approach in the absence of strangulation and suspicion of the need of bowel resection 1.
- The patient's age alone is not a contraindication to hernia repair, and many elderly patients safely undergo hernia surgery with minimally invasive techniques that allow for faster recovery and less postoperative pain.
Given the patient's age and the presence of intermittent discomfort, a thorough evaluation by a surgeon is necessary to determine the best course of treatment, taking into account the patient's overall health status and fitness for surgery, as well as the potential benefits and risks of watchful waiting versus surgical intervention 1.
From the Research
Next Steps for an 86-Year-Old with an Inguinal Hernia
The next steps for an 86-year-old with an inguinal hernia measuring 14 mm x 7 mm x 15 mm and intermittent discomfort can be considered based on the available evidence.
- The size and symptoms of the hernia are important factors in determining the best course of action 2.
- For patients with symptomatic inguinal hernias, surgical repair is often recommended to alleviate discomfort and prevent potential complications such as incarceration or strangulation.
- Laparoscopic hernia repair has been shown to result in less postoperative pain and faster recovery times compared to open repair 3, 4.
- The European Hernia Society guidelines recommend that the treatment of inguinal hernia should be individualized, taking into account the patient's age, symptoms, and overall health status 5.
- In the case of an 86-year-old patient, the decision to operate should be made after careful consideration of the potential risks and benefits, as well as the patient's ability to tolerate surgery.
- Watchful waiting may be considered for asymptomatic or minimally symptomatic hernias, but this approach requires regular follow-up to monitor for any changes in symptoms or hernia size 3, 2.
Considerations for Surgical Repair
- Laparoscopic repair is a viable option for many patients, offering the benefits of reduced postoperative pain and faster recovery 3, 4, 6.
- The choice of surgical technique, whether open or laparoscopic, should be based on the patient's individual needs and the surgeon's expertise.
- The use of mesh in hernia repair has been shown to reduce the risk of recurrence and is a common practice in both open and laparoscopic repairs 4, 6.