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from Section 17 - General Surgery
Published online by Cambridge University Press: 05 September 2013
Groin hernias are a common surgical problem. They can be indirect (lateral to the inferior epigastric vessels) or direct (medial to the inferior epigastric vessels in Hesselbach's triangle). Inguinal herniorrhaphy is performed for these hernias in over a million 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. Mesh can be placed as an overlay, as a combined over/underlay in the preperitoneal space or as a combination of 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; for patients with multiple recurrent hernias in whom orchiectomy is a consideration; and for patients who prefer to be asleep. The stress of a routine open inguinal herniorrhaphy is minimal, and blood transfusions are essentially never required. In contrast, an emergent repair of a strangulated inguinal hernia in elderly patients may become life threatening. This is due to severe stress and possible perioperative sepsis of ischemic bowel in such patients.
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