Critical issues in groin hernia management.

Today's surgeon faces multiple decisions for each patient who presents with an inguinal hernia. The natural history of an untreated inguinal hernia is still unclear for a particular individual. Given the low risk of emergency and death from an inguinal hernia, observation alone is now becoming an acceptable approach for many. For those that desire or require repair, the age of the patient and their comorbidities will influence the choices of anesthetic and surgical technique. Despite our rapid advances in surgical technology, a consensus can not be reached locally or globally on one solution for inguinal hernia repair. Currently, more than six uniquely different surgical techniques are used for the repair of an inguinal hernia. Through the 1980s, the endpoint focused on by hernia surgeons was the incidence of recurrence. Though many experienced operators proved to have near-flawless results with a given technique, it has been difficult to duplicate these results by all surgeons. Over the past 10 years, there has been a greater emphasis on the prevention of postoperative pain and potential long-term mesh-related issues. Laparoscopic technique and the use of flat, lightweight mesh are showing promise in improving inguinal hernia repair results.