Treatment of Reducible Inguinal Hernia
Surgical repair with mesh is the definitive treatment for your reducible inguinal hernia, as it significantly reduces recurrence rates (0% vs 19% with tissue repair) without increasing infection risk. 1
Understanding Your Hernia Type
Your hernia that "goes in and out" is classified as reducible, meaning the contents can be pushed back into the abdomen. 1 This distinguishes it from:
- Incarcerated hernias (stuck and cannot be reduced) - require urgent surgery 1
- Strangulated hernias (blood supply compromised) - require emergency surgery to prevent bowel death 1, 2
Treatment Decision: Surgery vs. Watchful Waiting
While watchful waiting is technically an option for minimally symptomatic hernias, with conversion rates to surgery ranging from 35-57.8% over time 3, mesh repair is strongly recommended as the standard approach to prevent serious complications including incarceration, bowel necrosis, and gonadal infarction. 2
Key considerations:
- Delaying repair until symptoms worsen is associated with higher risk of emergency presentation and complications 1, 2
- Acute incarceration can occur unpredictably, requiring emergency surgery with higher morbidity and mortality 1
- Elective repair has significantly better outcomes than emergency repair 4, 1
Recommended Surgical Approach
Laparoscopic mesh repair (TEP or TAPP) is the preferred first-line approach when expertise is available, offering superior outcomes compared to open repair. 1, 2
Laparoscopic advantages:
- Significantly lower wound infection rates (P<0.018) 4, 1
- Reduced postoperative pain and faster return to activities 1, 2
- Lower analgesic requirements 2
- Ability to identify and repair occult contralateral hernias (present in 11.2-50% of cases) 1, 2
- No increase in recurrence rates compared to open repair 4, 1
Open Lichtenstein repair remains excellent when:
- Laparoscopic expertise is unavailable 2
- Patient has significant comorbidities 2
- Local anesthesia is preferred (particularly in elderly patients) 2, 5
Mesh Selection
Synthetic mesh is the gold standard for clean surgical fields (your reducible hernia qualifies as clean). 4, 1 Standard polypropylene mesh remains the primary choice, though partially absorbable lightweight meshes may offer some advantages. 6
Common Pitfalls to Avoid
- Do not delay repair if you develop sudden inability to reduce the hernia, severe pain, nausea, or vomiting - these indicate possible strangulation requiring emergency surgery. 1, 2
- Predictors of strangulation include systemic inflammatory response, elevated lactate, CPK, and D-dimer levels. 1, 2
- Delayed diagnosis beyond 24 hours significantly increases mortality. 1, 2
Expected Postoperative Course
Pain management:
- Acetaminophen and NSAIDs as primary pain control 1
- Limited opioid prescribing: 15 tablets of hydrocodone/acetaminophen 5/325mg or 10 tablets of oxycodone 5mg for laparoscopic repair 1