What is the recommended treatment for an inguinal hernia?

From the Guidelines

Surgical repair is the recommended treatment for an inguinal hernia, as it is the only definitive treatment option that can prevent complications like incarceration and strangulation, which are medical emergencies requiring immediate intervention. The two main surgical approaches are open hernia repair and laparoscopic repair. Open repair involves making an incision over the hernia site and either using sutures to close the defect (primary repair) or placing a mesh to reinforce the area (tension-free repair) 1. Laparoscopic repair is less invasive, using small incisions and a camera to place mesh from inside the abdominal cavity.

• The use of mesh in clean surgical fields is associated with a lower recurrence rate, without an increase in the wound infection rate, and is recommended for patients with intestinal incarceration and no signs of intestinal strangulation or concurrent bowel resection (clean surgical field) 1.
• For patients having a complicated hernia with intestinal strangulation and/or concomitant need of bowel resection without gross enteric spillage, emergent prosthetic repair with a synthetic mesh can be performed, without any increase in 30-day wound-related morbidity, and is associated with a significant lower risk of recurrence, regardless of the size of hernia defect 1.
• Local anaesthesia (LA) can be used, providing effective anaesthesia with less postoperative complications for emergency inguinal hernia repair in the absence of bowel gangrene 1. Some key points to consider in the management of inguinal hernias include:
• 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 choice of surgical approach and anaesthesia should be individualized based on the patient's condition and the surgeon's expertise. Recovery typically takes 1-2 weeks for laparoscopic repair and 3-6 weeks for open repair, with restrictions on heavy lifting during this time. Surgery is recommended because inguinal hernias don't heal on their own and can lead to serious complications.

From the Research

Treatment Options for Inguinal Hernia

The recommended treatment for an inguinal hernia is surgical repair, with the goal of reducing recurrence rates and chronic pain 2.

• Surgical Repair: Symptomatic groin hernias should be treated surgically, while asymptomatic or minimally symptomatic male patients may be managed with "watchful waiting" 2.
• Mesh Repair: Mesh repair is recommended as the first choice, either by an open procedure or a laparo-endoscopic repair technique 2.
• Laparo-Endoscopic Repair: Laparo-endoscopic techniques have faster recovery times, lower chronic pain risk, and are cost-effective, provided resources and expertise are available 2, 3, 4.
• Open Repair: Open repair is still a viable option, especially for patients with certain health conditions or limited access to laparo-endoscopic facilities 2, 3, 4.

Considerations for Surgical Repair

When considering surgical repair, the following factors should be taken into account:

• Surgeon's Expertise: The surgeon's expertise and experience with different repair techniques should be considered 2.
• Patient- and Hernia-Related Characteristics: The patient's overall health, hernia size, and location should be evaluated to determine the best course of treatment 2.
• Local and National Resources: The availability of resources, such as equipment and personnel, should be considered when choosing a repair technique 2.

Postoperative Care and Complications

After surgical repair, patients should:

• Resume Normal Activities: Patients should resume normal activities without restrictions as soon as they feel comfortable 2.
• Monitor for Complications: Patients should be monitored for potential complications, such as chronic pain, recurrence, and infection 2, 3, 4.
• Follow-Up Care: Regular follow-up care is essential to ensure proper healing and detect any potential complications early on 2, 3, 4.