Dieter Berger1. 1. Clinic of Abdominal, Thoracic and Pediatric Surgery, Klinikum Mittelbaden/Balg, Baden-Baden.
Abstract
BACKGROUND: Inguinal hernia repair is the most common general surgical procedure in industrialized countries, with a frequency of about 200 operations per 100 000 persons per year. Suture- and mesh-based techniques can be used, and the procedure can be either open or minimally invasive. METHODS: This review is based on a selective search of the literature, with interpretation of the published findings according to the principles of evidence-based medicine. RESULTS: Inguinal hernia is diagnosed by physical examination. Surgery is not necessarily indicated for a primary, asymptomatic inguinal hernia in a male patient, but all inguinal hernias in women should be operated on. For hernias in women, and for all bilateral hernias, a laparoscopic or endoscopic procedure is preferable to an open procedure. Primary unilateral hernias in men can be treated either by open surgery or by laparoscopy/endoscopy. Patients treated by laparoscopy/endoscopy develop chronic pain less often than those treated by open surgery. A mesh-based repair is generally recommended; this seems reasonable in view of the pathogenesis of the condition, which involves an abnormality of the extracellular matrix. CONCLUSION: The choice of procedure has been addressed by international guidelines based on high-level evidence. Surgeons should deviate from their recommendations only in exceptional cases and for special reasons. Guideline conformity implies that hernia surgeons must master both open and endoscopic/laparoscopic techniques.
BACKGROUND:Inguinal hernia repair is the most common general surgical procedure in industrialized countries, with a frequency of about 200 operations per 100 000 persons per year. Suture- and mesh-based techniques can be used, and the procedure can be either open or minimally invasive. METHODS: This review is based on a selective search of the literature, with interpretation of the published findings according to the principles of evidence-based medicine. RESULTS:Inguinal hernia is diagnosed by physical examination. Surgery is not necessarily indicated for a primary, asymptomatic inguinal hernia in a male patient, but all inguinal hernias in women should be operated on. For hernias in women, and for all bilateral hernias, a laparoscopic or endoscopic procedure is preferable to an open procedure. Primary unilateral hernias in men can be treated either by open surgery or by laparoscopy/endoscopy. Patients treated by laparoscopy/endoscopy develop chronic pain less often than those treated by open surgery. A mesh-based repair is generally recommended; this seems reasonable in view of the pathogenesis of the condition, which involves an abnormality of the extracellular matrix. CONCLUSION: The choice of procedure has been addressed by international guidelines based on high-level evidence. Surgeons should deviate from their recommendations only in exceptional cases and for special reasons. Guideline conformity implies that hernia surgeons must master both open and endoscopic/laparoscopic techniques.
Authors: M Miserez; E Peeters; T Aufenacker; J L Bouillot; G Campanelli; J Conze; R Fortelny; T Heikkinen; L N Jorgensen; J Kukleta; S Morales-Conde; P Nordin; V Schumpelick; S Smedberg; M Smietanski; G Weber; M P Simons Journal: Hernia Date: 2014-03-20 Impact factor: 4.739
Authors: H Mason Hedberg; Tyler Hall; Matthew Gitelis; Brittany Lapin; Zeeshan Butt; John G Linn; Stephen Haggerty; Woody Denham; JoAnn Carbray; Michael B Ujiki Journal: Surg Endosc Date: 2017-08-04 Impact factor: 4.584
Authors: Francesco Proietti; Davide La Regina; Ramon Pini; Matteo Di Giuseppe; Agnese Cianfarani; Francesco Mongelli Journal: Surg Endosc Date: 2020-11-30 Impact factor: 4.584
Authors: Joshua M Lawrenz; James P Norris; Marcus C Tan; Eric T Shinohara; John J Block; Elizabeth J Davis; Vicki L Keedy; Jennifer L Halpern; Ginger E Holt; Herbert S Schwartz Journal: Int J Surg Oncol Date: 2020-12-07