Inguinal hernia repair

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Most common surgical condition encountered by primary physicians, with 1.6 million diagnosed annually.

One of the most common surgical procedures performed in the U.S. with almost a million operations occurring each year.

Lifetime risk of a groin hernia ranges from 27% for men to 3% for women with a distribution bimodally at the extremes of life.

Following repair 10% have a hematoma or wound infection complications.

Surgeons are taught that inguinal hernias should be repaired at the time of diagnosis, even if the patient is asymptomatic to prevent strangulation.

Recent study of 720 men comparing watchful waiting or standard open tension free repair with mesh in patients with minimally symptomatic disease revealed that at 2 years watchful waiting is a reasonable approach.

In the above study at two years after randomization similar numbers of patients in a watchful waiting group or in a surgical repair group had pain that limited activities and physical functions were similar.

Surgical correction of inguinal hernias is currently not recommended in minimally symptomatic hernias.

Watchful waiting is advised in minimally symptomatic hernias due to the risk of post herniorraphy pain syndrome.

Groin hernia encompasses three types: indirect inguinal, direct inguinal, and femoral.

It is difficult to determine which type of groin hernia is present prior to surgery.

Operative repair is similar for three types of groin hernias.

Surgery is commonly performed as outpatient surgery.

Surgical options include: open repair, laparoscopic repair, use of mesh, and type of anesthesia.

There are various surgical strategies which may be considered in the planning of inguinal hernia repair. These include the consideration of mesh use (e.g. synthetic or biologic), open repair, use of laparoscopy, type of anesthesia (general or local), appropriateness of bilateral repair, etc.

Minimal surgery includes laparoscopic and robotic repairs.

Preventing constipation is important postoperatively.

In a VA database the mean age of patients having hernia emergencies was 77 years with a death rate after repair of only 2.2% and a low accident rate of 1.8 per 1000 patients also indicates det2242ing surgery is a reasonable option.

Gangrenous strangulation associated with mortality about 10 times compared to elective inguinal herniorrhaphy.

Mortality of herniorrhaphy without obstruction 0.005% and with obstruction 0.04%.

11-30% of patients experience chronic groin pain for 1-2 years following surgery.

Following repair one third will have groin or testicular pain or numbness in the inguinal or upper thigh region at one year.

The cause of pain is unknown but may be related to nerve injury or nerve entrapment, scar tissue formation, or reaction to the prosthetic material.

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