What are indications for an open inguinal hernia repair?

Updated: Apr 16, 2020
  • Author: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS; Chief Editor: Kurt E Roberts, MD  more...
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Answer

Classically, the existence of an inguinal hernia, in and of itself, has been considered reason enough for operative intervention. However, some studies have shown that the presence of a reducible hernia is not, in itself, an indication for surgery and that the risk of incarceration is less than 1%. [11]

Patients experiencing symptoms (eg, pain or discomfort) should undergo repair; however, as many as one third of patients with inguinal hernias are asymptomatic. [11] The question of observation versus surgical intervention in this asymptomatic or minimally symptomatic population was addressed in two randomized clinical trials. [6, 7] The two trials yielded similar results: After long-term follow-up, no significant difference in hernia-related symptoms was noted, and watchful waiting did not increase the complication rate.

In one study, the substantial patient crossover from the observation group to the surgery arm led the authors to conclude that observation may delay but not prevent surgery. [11] This reasoning holds particularly true in the younger patient population. Thus, even an asymptomatic patient, if medically fit, should be offered surgical repair. A long-term follow-up study determined that most patients with a painless inguinal hernia will develop symptoms over time and concluded that surgery is recommended for medically fit patients. [12]

Koch et al found that recurrence rates were higher in women and that recurrence was 10 times more likely to be of the femoral variety in women than it was in men. [13] Such findings have led some to the conclusion that procedures providing coverage of the femoral space (eg, laparoscopic repair) at the time of initial operation are better suited for women as primary repairs. [14]


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