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 decision to operate should be based on the presence of symptoms, the size of the hernia, and the risk of complications. Two main surgical approaches are available: 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.
- Laparoscopic repair is less invasive, using small incisions and a camera to guide the procedure. According to the 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias 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.
- The choice of anesthesia depends on the presence of bowel gangrene, with local anesthesia being a viable option in the absence of gangrene 1.
- Postoperative care should include pain management with over-the-counter medications like acetaminophen or ibuprofen, and prescription pain medications may be provided for short-term use. It is essential to note that early detection of complications is crucial, and patients should undergo emergency hernia repair immediately when intestinal strangulation is suspected 1.
- Systemic inflammatory response syndrome (SIRS), contrast-enhanced CT findings, as well as lactate, CPK, and D-dimer levels are predictive of bowel strangulation 1.
- The grade of recommendation for each treatment option is based on the quality of supporting evidence, with grade 1A being the strongest recommendation and grade 2C being the weakest 1. Overall, surgical repair is the most effective treatment option for inguinal hernias, and the choice of approach and anesthesia should be based on individual patient factors and the presence of 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 involves making small incisions in the abdomen to repair the hernia 2, 3.
- Open surgery, also known as traditional hernia repair, involves making a larger incision in the groin area to repair the hernia 2, 4.
- The choice of treatment depends on the individual patient's needs and the surgeon's expertise.
Comparison of Laparoscopic and Open Surgery
Studies have compared the outcomes of laparoscopic and open surgery for inguinal hernia repair.
- Laparoscopic surgery has been shown to result in less postoperative pain, shorter hospital stays, and faster recovery times compared to open surgery 2, 3.
- However, laparoscopic surgery may be more expensive due to the cost of equipment and technology 3.
- The recurrence rate for laparoscopic surgery is similar to that of open surgery, with some studies suggesting a slightly lower recurrence rate for laparoscopic surgery 2, 5.
Special Considerations
In certain cases, such as recurrent inguinal hernias or hernias in pediatric patients, the treatment approach may differ.
- For recurrent inguinal hernias, both laparoscopic and open surgery can be effective, with similar outcomes 4.
- In pediatric patients, laparoscopic surgery may be preferred due to its minimally invasive nature and reduced risk of complications 5.
- A thorough knowledge of inguinofemoral anatomy, mature surgical judgment, and meticulous surgical technique are essential for preventing complications and ensuring a successful outcome 6.