Complications of open groin hernia repairs.

As large numbers of patients undergo hernioplasty each year the surgical technique should be a simple one. The results obtained by general surgeons using various open, tension-free techniques, irrespective of the anesthetic used, are excellent and appear to approach those of specialists. This can not be said for laparoscopic hernioplasty, which has a well-known learning curve, is more expensive and is not without complications, some of which may be serious or life threatening. Although proper training in laparoscopic techniques is essential, the same applies to open repair with mesh. Surgical residents should be taught open-mesh repairs under local anesthesia before embarking on training in laparoscopic techniques if they show interest in pursuing this approach. Indeed, we may soon be faced with an increasing number of patients who are not fit for a general anesthetic. Not all hernias need be repaired by specialists and visiting centers with experience in the use of different prosthetic devices allows you to draw your own conclusions. Finally, when consulting a patient with an inguinal hernia, primary or recurrent, the surgeon should pose the question "which combination of anesthetic and hernia repair is the safest and best for my patient?" Local anesthesia with appropriate analgesia and sedation is the safest of all techniques and is suitable for most if not all open repairs. Using this approach, any type of open-mesh repair makes the ideal combination and all can be safely carried out on an ambulatory basis. Attention to surgical technique is paramount, and given the number of hernias repaired annually, it is pertinent to recall the words of Wakely, who said "A surgeon can do more for the community by operating on hernia cases, and seeing that his recurrence rate is lower, than he can by operating on cases of malignant disease."