What is the most appropriate treatment for a healthy patient with a left reducible inguinal hernia?

Treatment Recommendation for Reducible Inguinal Hernia

For a healthy patient with a left reducible inguinal hernia, open mesh repair (Option B) is the most appropriate treatment, as mesh repair is the standard approach for all non-complicated inguinal hernias with significantly lower recurrence rates compared to tissue repair alone. 1, 2

Rationale for Mesh Repair

Mesh repair is strongly recommended (Grade 1A) as the definitive standard for non-complicated inguinal hernias, demonstrating a 0% recurrence rate compared to 19% with tissue repair alone, without any increase in wound infection risk. 1, 3

The European Hernia Society and American Hernia Society both establish mesh repair as the foundation for inguinal hernia treatment in clean surgical fields, making simple tissue repair (Option A) obsolete for routine cases. 1, 2

Open vs. Laparoscopic Approach

While both open mesh repair and laparoscopic repair (TAPP/TEP) demonstrate comparable recurrence rates, open mesh repair is the most universally appropriate choice for several practical reasons:

Advantages of Open Mesh Repair:

• Can be performed under local anesthesia, providing effective anesthesia with fewer cardiac and respiratory complications, shorter hospital stays, lower costs, and faster recovery compared to general anesthesia. 1
• Does not require specialized laparoscopic expertise or equipment. 2
• Suitable for patients who cannot tolerate general anesthesia. 2
• More widely available across all surgical settings. 1

When Laparoscopic Repair (Option C) Would Be Preferred:

• Bilateral hernias are present (allows simultaneous repair and detection of occult contralateral hernias present in 11.2-50% of cases). 1, 2
• Patient specifically desires reduced postoperative pain and faster return to activities. 2
• Recurrent hernia after previous open repair. 1
• Surgeon has established laparoscopic expertise. 2

However, laparoscopic approaches require general anesthesia, which adds unnecessary risk for a healthy patient with a straightforward unilateral reducible hernia. 1

Why Other Options Are Inappropriate

Option A (Simple Repair): Tissue repair without mesh is associated with a 19% recurrence rate compared to 0% with mesh repair—this approach is no longer acceptable as standard care for inguinal hernias. 1, 3

Option D (Non-surgical Treatment): Surgical repair is the definitive treatment for inguinal hernias, and watchful waiting is not appropriate for a patient who has already been advised to undergo surgical treatment. 1 Delaying repair risks progression to incarceration or strangulation, which significantly increases morbidity and mortality. 2, 3

Critical Clinical Pearls

• Always confirm the hernia is truly reducible before proceeding with elective repair, as incarcerated or strangulated hernias require emergency intervention. 2, 3
• Synthetic mesh is safe and strongly recommended in clean surgical fields (CDC wound class I), with extensive evidence supporting its use without increased infection risk. 4, 1
• Local anesthesia for open repair should be strongly considered when the surgeon is experienced in this technique, as it offers multiple advantages including reduced complications and costs. 1
• Examine for bilateral hernias preoperatively, as occult contralateral hernias are present in up to 50% of cases—if bilateral disease is suspected, laparoscopic approach becomes more advantageous. 1, 2