Is surgical repair recommended for a left inguinal hernia in a healthy 86-year-old female?

From the Guidelines

Surgical repair for a left inguinal hernia in a healthy 86-year-old female is recommended if the hernia is symptomatic or at risk for complications, with the choice of anesthesia, such as local anesthesia, being a crucial consideration to minimize postoperative complications. When considering surgical repair, the patient's overall health, functional status, and life expectancy should be taken into account, as well as her personal preferences and goals of care 1. The use of local anesthesia (LA) can provide effective anesthesia with less postoperative complications for emergency inguinal hernia repair, as seen in a study that reported less cardiac complications, respiratory complications, shorter ICU stay, and hospital stay, as well as lower cost and faster recovery time compared to general anesthesia 1.

Some key points to consider in the decision-making process include:

• The patient's symptoms and quality of life issues related to the hernia
• The risk of hernia incarceration or strangulation, which is roughly 3-5% annually
• The patient's medical fitness for surgery and potential anesthesia complications
• The potential benefits of surgical repair, including relief of symptoms and prevention of complications
• The importance of a comprehensive preoperative assessment and shared decision-making with the patient.

In the case of an asymptomatic and reducible hernia, watchful waiting may be an appropriate option, but this should be decided on a case-by-case basis, taking into account the patient's individual circumstances and preferences. Ultimately, the decision to proceed with surgical repair should be based on a thorough evaluation of the potential benefits and risks, as well as the patient's values and goals.

From the Research

Surgical Repair for Left Inguinal Hernia in an 86-Year-Old Female

• The decision to perform surgical repair for a left inguinal hernia in a healthy 86-year-old female should be based on various factors, including the presence of symptoms, the risk of complications, and the patient's overall health status 2.
• Studies have shown that watchful waiting is a reasonable option for asymptomatic groin hernias, especially in older adults, due to the low risk of life-threatening complications 3.
• However, other studies have demonstrated that there is an increased risk of mortality after surgery in older persons (age ≥65 years), which should be taken into consideration when making a decision 2.
• The risk of incarceration is approximately 4 per 1,000 patients with a groin hernia per year, and risk factors for incarceration include age above 60 years, femoral hernia site, and duration of signs less than 3 months 3.
• In terms of treatment options, laparoscopic repair is a viable alternative to open repair, and the choice of approach should be individualized based on the patient's specific needs and circumstances 4, 5, 6.
• A systematic review and meta-analysis found that repairing an asymptomatic contralateral inguinal hernia during a unilateral inguinal hernia repair may be beneficial, as it can prevent the need for another operation in almost a third of patients, with minimal increase in operation time and pain 6.