What is the most appropriate treatment for a left reducible inguinal hernia in an otherwise healthy patient?

Open Mesh Repair (Option B)

For an otherwise healthy patient with a reducible inguinal hernia, open mesh repair is the most appropriate treatment, as mesh repair is strongly recommended as the standard approach for all non-complicated inguinal hernias with significantly lower recurrence rates (0% vs 19% with tissue repair) compared to tissue repair alone. 1, 2

Why Mesh Repair is Superior

• Mesh repair demonstrates a 50-75% reduction in recurrence risk compared to non-mesh techniques, with recurrence rates of 0% versus 19% for tissue repair in clean surgical fields 1, 3
• The use of prosthetic mesh is strongly recommended (Grade 1A) by the European Hernia Society for all non-complicated inguinal hernias 1, 4
• Mesh repair allows quicker return to usual activities and shorter hospital stays compared to tissue repair 1, 3

Open vs Laparoscopic Approach

While both open mesh repair and laparoscopic repair (TAPP/TEP) are acceptable options, open mesh repair (Lichtenstein technique) remains the most universal, reliable, and cost-effective method for a straightforward unilateral reducible hernia in an otherwise healthy patient. 5, 6

When to Choose Open Mesh Repair:

• Unilateral primary hernia in a healthy patient (the scenario described) 6
• Can be performed under local anesthesia if needed 1, 4
• Shorter operative time compared to laparoscopic approaches 3
• Lower cost and wider availability 5, 6

When Laparoscopic Would Be Preferred:

• Bilateral hernias 2, 6
• Recurrent hernias 2, 6
• Patient specifically desires reduced postoperative pain and faster return to activities 2
• Need to identify occult contralateral hernias (present in 11.2-50% of cases) 1

Why Simple Repair (Option A) is Inadequate

• Tissue repair without mesh has unacceptably high recurrence rates of 19% compared to 0% with mesh 1, 3
• Modern guidelines no longer recommend tissue repair for routine inguinal hernias 6

Why Non-Surgical Treatment (Option D) is Inappropriate

• Surgical repair is the definitive treatment for inguinal hernias 1, 2
• Delaying repair risks progression to incarceration or strangulation, which significantly increases morbidity and mortality 2, 4

Critical Pitfall to Avoid

• Never delay surgical repair in a patient fit for surgery, as progression to strangulation can lead to bowel necrosis with delayed diagnosis beyond 24 hours significantly increasing mortality rates 2, 4