Inguinal hernia repair

Inguinal hernia surgery refers to a surgical operation for the correction of an inguinal hernia. Surgery is not generally advised in most cases if the hernia produces no symptoms; watchful waiting being the recommended option. In particular, elective surgery is no longer recommended for the treatment of minimally symptomatic hernias due to the significant risk (>10%) of chronic pain (Post herniorraphy pain syndrome) and the low risk of incarceration (ca. 2% per year). As general advice in surgery, the choice of the surgeon and hospital are more important than the choice of a particular surgical technique or material.

The most commonly performed inguinal hernia repair today is the Lichtenstein repair. A flat mesh is placed on top of the defect.

It is a "tension-free" repair that does not put tension on muscles, contrary to Bassini and Shouldice suture repairs (but there are also tension-free suture repairs, like Desarda). It involves the placement of a mesh to strengthen the inguinal region. Patients typically go home within a few hours of surgery, often requiring no medication beyond paracetamol (Tylenol/acetaminophen). Patients are encouraged to walk as soon as possible postoperatively, and they can usually resume most normal activities within a week or two of the operation. Complications include chronic pain (varying from 10-50% depending on source), foreign-body sensation, stiffness, ischemic orchitis, testicular atrophy, dysejaculation, anejaculation or painful ejaculation in around 12%. They are often under-reported. Recurrence rate is low, <2%.. In contrast to this however, benefits for patients with pre-existing erectile dysfunction or general sexual dysfunctions have been reported.

There are two main methods of laparoscopic repair: transabdominal preperitoneal (TAPP) and totally extra-peritoneal (TEP) repair. When performed by a surgeon experienced in hernia repair, laparoscopic repair causes fewer complications than Lichtenstein, particularly less chronic pain. However, if the surgeon is experienced in general laparoscopic surgery but not in the specific subject of laparoscopic hernia surgery, laparoscopic repair is not advised as it causes more recurrence risk than Lichtenstein while also presenting risks of serious complications, as organ injury. Indeed, the TAPP approach needs to go through the abdomen. All that said, many surgeons are moving to laparoscopic methodologies as they cause smaller incisions, resulting in less bleeding, less infection, faster recovery, reduced hospitalization, and reduced chronic pain.

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