What is the efficacy of open inguinal hernia repair?

Updated: Jan 17, 2018
  • Author: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS; Chief Editor: Kurt E Roberts, MD  more...
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Answer

Since the widespread acceptance of mesh-based repair, the rate of hernia recurrence has fallen substantially, to 1% or less. Consequently, more attention is being paid to other complications, such as postherniorrhaphy chronic pain. [36]

Large studies examining mortality risk from various groin operations found that elective inguinal herniorrhaphy was safe and had a low mortality risk that was similar to or even lower than the standardized mortality in the studied population. [1, 37]

Although pain is more common in the acute postoperative period, it remains chronically severe in 3% of patients, having significant effects on their work and social activities. [38] A large Swedish study found that 30% of postherniorrhaphy patients reported long-term pain or discomfort, 6% of whom experienced pain intense enough to alter their activities of daily living. [39]

Another phenomenon that can be experienced after hernia repair is groin numbness. In a large Scottish study that included more than 5500 patients, this was reported to various degrees in as many as 9%. [39]

Other complications include seroma formation, bruising and hematoma (7% of cases), and wound infection (1-7% of cases). [1, 40]

Ischemic orchitis leading to testicular atrophy or even necrosis is a catastrophic but well-known complication of inguinal hernia repair. Symptoms include painful testicular swelling and fever commencing 2-3 days after surgery. [41] The exact cause of this rare complication is unclear, but it is thought to be secondary to venous thrombosis rather than arterial injury. A high index of suspicion for postoperative ischemic orchitis, in conjunction with emergency testicular ultrasonography, may help avoid orchiectomy.


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