Can an elderly female patient with a complex medical history undergo inguinal hernia repair only, without adrenal gland removal, given her desire to avoid the latter procedure?

Can Inguinal Hernia Repair Be Performed Without Adrenal Gland Removal?

Yes, inguinal hernia repair can and should be performed independently of adrenal gland removal—these are anatomically and surgically distinct procedures that do not require simultaneous intervention.

Anatomical and Surgical Independence

• Inguinal hernia repair addresses a defect in the abdominal wall at the groin level, while adrenal gland removal (adrenalectomy) involves a retroperitoneal organ in the upper abdomen—these are completely separate anatomical regions with no surgical interdependence 1, 2

• The standard surgical approaches for inguinal hernia (open mesh repair, laparoscopic TEP, or TAPP) do not involve or require access to the adrenal glands 1, 3

Treatment Algorithm for Inguinal Hernia in Elderly Patients

Determine Urgency of Hernia Repair

Emergency indications (immediate surgery required):

• Strangulated hernia with suspected bowel compromise—look for systemic inflammatory response syndrome (SIRS), elevated lactate, CPK, D-dimer levels, or contrast-enhanced CT findings showing bowel wall ischemia 4, 5
• Incarcerated hernia that cannot be manually reduced, especially with peritoneal signs, skin changes (erythema, warmth, discoloration), or firm tender irreducible mass 2, 5
• Delayed diagnosis beyond 24 hours significantly increases mortality rates 4, 5

Elective indications:

• Reducible symptomatic hernias can be scheduled electively, which is particularly safe in elderly patients when regional anesthesia is used 6, 7
• Femoral hernias carry an 8-fold higher risk of requiring bowel resection and should be repaired promptly even if currently reducible 1

Safety in Elderly Patients

• Inguinal hernia surgery in patients older than 75 years is safe and effective in an elective setting, with complications classified as mild (Clavien-Dindo 1-2) when regional anesthesia is used 6

• Emergency hernia repair in elderly patients carries significantly higher risk—in one study, 50% of emergency cases developed complications versus only 8.6% of elective cases, with severe medical complications (Clavien-Dindo 4) frequent in the emergency group 6

• Local or regional anesthesia is recommended for elderly patients and those with significant comorbidities, as it can be performed safely even in high-risk patients without increasing postoperative complication rates 1, 6, 8

Surgical Approach Selection

• 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) without increased infection risk 1, 2, 5

• Laparoscopic approaches (TEP or TAPP) offer advantages including reduced postoperative pain, lower wound infection rates, and ability to identify occult contralateral hernias (present in 11.2-50% of cases) 1, 2

• Open repair with local anesthesia is particularly appropriate for elderly patients with comorbidities who cannot tolerate general anesthesia 1, 6

Critical Considerations for Patient Autonomy

• The patient's refusal of adrenal gland removal does not contraindicate or complicate inguinal hernia repair—these decisions are completely independent 1, 2

• If the hernia is strangulated or incarcerated, immediate repair is mandatory regardless of other planned procedures, as delayed diagnosis increases mortality by 10-fold 4, 5, 8

• For reducible hernias in elderly patients, elective repair under regional anesthesia is a low-risk intervention with excellent outcomes when performed in a non-emergency setting 6, 7

Common Pitfalls to Avoid

• Never delay hernia repair for strangulated or incarcerated hernias to coordinate with other procedures—elapsed time from symptom onset to surgery is the most important prognostic factor for morbidity and mortality 4, 5

• Do not assume that elderly age alone is a contraindication to hernia repair—careful preoperative examination and identification of risk factors associated with comorbidities are vital, but age itself should not preclude surgery 6, 8, 7

• Avoid general anesthesia when possible in elderly patients—regional or local anesthesia significantly reduces complications while maintaining excellent surgical outcomes 1, 6, 8