Should This Inguinal Hernia Be Repaired?
Yes, this reducible right inguinal hernia containing fat should be surgically repaired with mesh, as symptomatic inguinal hernias warrant surgical intervention to prevent future complications including incarceration and strangulation. 1, 2
Rationale for Surgical Repair
All symptomatic inguinal hernias, including those that are reducible, should undergo surgical repair. 1, 3, 4 The presence of a hernia that manifests during Valsalva maneuver indicates it is symptomatic and will likely progress over time. 5
Key Clinical Considerations
Indirect inguinal hernias (which fat-containing hernias typically represent) require surgery to prevent incarceration and strangulation, regardless of current reducibility. 3
The hernia neck diameter of 1.6 cm is small enough to pose a risk of incarceration if bowel eventually enters the hernia sac, as smaller necks have higher risk of trapping contents. 1
Watchful waiting is only appropriate for asymptomatic or minimally symptomatic hernias in male patients, and even then, the majority will eventually require surgery. 4 Since this hernia is visible during Valsalva, it is not truly asymptomatic.
Recommended Surgical Approach
Mesh repair is strongly recommended as the standard approach for all non-complicated inguinal hernias, with significantly lower recurrence rates compared to tissue repair. 1, 6, 4
Technique Selection
Either laparoscopic (TAPP or TEP) or open Lichtenstein repair are appropriate first-line options, with comparable long-term outcomes. 1, 4
Laparoscopic approaches offer advantages including: 1, 4
- Reduced postoperative pain
- Faster return to normal activities
- Lower wound infection rates
- Ability to identify occult contralateral hernias (present in 11.2-50% of cases)
Open Lichtenstein repair remains an excellent option, particularly if performed under local anesthesia, which has many advantages including cost-effectiveness and suitability for day surgery. 4
Common Pitfalls to Avoid
Do not delay repair based solely on reducibility - reducible hernias can become incarcerated, and delayed diagnosis of strangulation (>24 hours) is associated with significantly higher mortality rates. 2
Do not assume a fat-containing hernia will remain benign - the hernia defect can enlarge over time, allowing bowel to enter and potentially incarcerate. 5
Ensure the patient understands that without repair, the hernia will likely progress and may eventually require emergency surgery with higher complication rates. 4
Timing and Setting
Elective repair is recommended, as this is a reducible, non-complicated hernia. 3, 4
Day surgery is appropriate for the majority of groin hernia repairs, provided aftercare is organized. 4
Patients should be counseled to resume normal activities without restrictions as soon as they feel comfortable postoperatively. 4