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Published online by Cambridge University Press: 12 January 2010
Inguinal herniorrhaphy is performed for indirect (lateral to the inferior epigastric vessels) or direct (medial to the inferior epigastric vessels in Hesselbach's triangle) groin hernias in over 750 000 patients in the USA each year. Elective procedures for symptomatic reducible hernias are preferred, but urgent and emergency operations are still required for irreducible hernias and strangulated (ischemic bowel) hernias, respectively.
Routine open inguinal herniorrhaphy through a transverse inguinal incision is performed under general, regional, or local anesthesia in an outpatient setting. Rectangular or oval pieces of permanent mesh are inserted in all adult patients to prevent recurrent hernias. Some surgeons also use a shuttlecock-shaped second prosthesis (plug) inserted under the flat sheet mentioned above. Patients are discharged home when they can void. General anesthesia is appropriate for patients with large hernias that are difficult to reduce, those with multiple recurrent hernias in whom orchiectomy is a consideration, and those who prefer to be asleep. The stress of a routine open inguinal herniorrhaphy performed in 1 hour is minimal, and blood transfusions are essentially never required. In contrast, an emergent repair of a strangulated inguinal hernia in which resection of the small bowel is necessary through a separate midline laparotomy incision may be life threatening to elderly patients because of the risk of perioperative sepsis.
Laparoscopic inguinal herniorrhaphy is performed under general anesthesia in an outpatient setting, as well. The three main operative approaches include intraperitoneal onlay of mesh, transabdominal preperitoneal approach, and the totally extraperitoneal approach.
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