Treatment and Repair
Patients with asymptomatic or minimally symptomatic hernias conservative treatment is recommended. However, when a symptomatic hernia is suspected elective surgery is recommended and when a strangulated hernia is suspected emergency surgery is essential.
There are several techniques in use for the repair of inguinal hernias but these are only carried out if the inguinal hernia does not reduce through conservative treatment or there is a suspected strangulated hernia. However the purpose of any surgery is to reduce or excise the sac with minimal tension. When surgery is necessary, the classification system for inguinal hernias aids in determining which type of repair should be used however there is still a lack of consensus on these classification systems and subsequently many systems are used with the most popular being Nyhus (1991), Gilbert (1989) and Aachen, also known as the Schumpelick-Arit (1995). |
Repairs can be divided into laparoscopic and open repairs, with open repairs further divided into tissue (sutured) and prosthetic (mesh) repairs. Laparoscopic repairs can be divided into groups based on the method of either accessing the abdomen, an intraperitoneal approach, which includes the intraperitoneal onlay mesh repair (IPOM), the transabdominal preperitoneal approach (TAPP) without entering the abdominal cavity, an extraperitoneal approach, which is the totally extraperitoneal approach (TEP).
However, where there is a suspected irreducible hernia or it is a large hernia laparoscopic surgery is not recommended. Open repairs require one large incision and can be done under general, spinal, or local anesthesia but laparoscopic repairs require several small incisions, are done under general anesthesia and require more time compared with the open repair technique. |
Video describing inguinal hernias and the two approaches of repair - click here to review this video
Current research has shown conflicting results where some indicate that in procedures involving laparoscopic techniques demonstrate a far higher risk of the hernia reoccurring together with an increased risk for serious complications compared with open-mesh treatments where these complications are far less and the risk of recurrence is far lower. In other studies these complications and differences do not differ significantly, however laparoscopic repair has been recommended only for bilateral and recurrent inguinal hernias.