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Health Dictionary

Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Inguinal hernia surgery

Introduction

Overview

Overview

Surgery is the mainstay of treatment for inguinal hernia and there are many types of surgical techniques.

Indications

Indications

  • Surgery is the first-line treatment option for patients with inguinal hernia. Surgery is usually reserved for patients with either:[1]
    • Large bulges through a small hole
    • Painful hernia
    • High risk for complication such as strangulation, incarceration
Surgery

Surgery

  • Surgery is the mainstay of treatment for inguinal hernia. There are 3 general types for inguinal hernia repair:[2][3]
    • Herniotomy (removal of the hernial sac only)
    • Herniorrhaphy (herniotomy plus repair of the posterior wall of the inguinal canal)
    • Hernioplasty (herniotomy plus reinforcement of the posterior wall of the inguinal canal with a synthetic mesh)
  • Classification of current repair techniques for inguinal hernias include:[4][5][6][7]
    • Tension-free prosthetic repairs
      • Anterior repairs
        • lichenstein repair and its modification
        • Plug repairs
        • Patch and plug repairs
        • Double-layer devices
      • Posterior (prepritoneal) repairs
        • Open techniques via inguinal incision
        • Stoppa repair
        • Laparoscopic/endoscopic repairs
          • Transabdominal preperitoneal (TAPP) repair
          • Total extraperitoneal (TEP) repair
          • Intraperitoneal onlay mesh (IPOM) repair
    • Tissue-suture repairs
      • Bassini-Shouldice technique and its modifications
      • Marcy repair
 
 
 
 
 
Inguinal hernia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Strangulated
 
Symptomatic
 
Asymptomatic or minimally symptomatic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Emergency surgery(consider non-mesh when risk of infection
 
Elective surgery
 
Consider watchful waiting
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Primary unilateral
 
Primary bilateral
 
Recurrent
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mesh
Lichtenstin or endoscopic
 
Mesh
endoscopic or Lichtenstin
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
After anterior technique
 
 
 
 
After posterior technique
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mesh technique
endoscopic or open posterior approach
 
 
 
 
Mesh technique
Lichenstein


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Related Chapter

Inguinal hernia repair

References

References

  1. ↑ Mathonnet M, Mehinto D (2007). “[Indications for inguinal hernia repair]”. J Chir (Paris) (in French). 144 Spec No 4: 5S11–4. PMID 18065912.
  2. ↑ O’Dwyer PJ, Norrie J, Alani A, Walker A, Duffy F, Horgan P (2006). “Observation or operation for patients with an asymptomatic inguinal hernia: a randomized clinical trial”. Ann. Surg. 244 (2): 167–73. doi:10.1097/01.sla.0000217637.69699.ef. PMC 1602168. PMID 16858177.
  3. ↑ Jenkins JT, O’Dwyer PJ (2008). “Inguinal hernias”. BMJ. 336 (7638): 269–72. doi:10.1136/bmj.39450.428275.AD. PMC 2223000. PMID 18244999.
  4. ↑ Shouldice EB (2003). “The Shouldice repair for groin hernias”. Surg. Clin. North Am. 83 (5): 1163–87, vii. doi:10.1016/S0039-6109(03)00121-X. PMID 14533909.
  5. ↑ Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M (2009). “European Hernia Society guidelines on the treatment of inguinal hernia in adult patients”. Hernia. 13 (4): 343–403. doi:10.1007/s10029-009-0529-7. PMC 2719730. PMID 19636493.
  6. ↑ Wake BL, McCormack K, Fraser C, Vale L, Perez J, Grant AM (2005). “Transabdominal pre-peritoneal (TAPP) vs totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair”. Cochrane Database Syst Rev (1): CD004703. doi:10.1002/14651858.CD004703.pub2. PMID 15674961.
  7. ↑ Elsebae MM, Nasr M, Said M (2008). “Tension-free repair versus Bassini technique for strangulated inguinal hernia: A controlled randomized study”. Int J Surg. 6 (4): 302–5. doi:10.1016/j.ijsu.2008.04.006. PMID 18573702.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]