The most recent recommendations for the surgical treatment of inguinal hernia

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Authors: A. Drs ¹; P. Horák ²; J. Chlupáč ^1,3; J. Froněk ^1,3
Authors place of work: Klinika transplantační chirurgie, Institut klinické a experimentální medicíny, Praha ¹; Chirurgická klinika 1. lékařské fakulty Univerzity Karlovy v Praze a Nemocnice Na Bulovce ²; 2. lékařská fakulta Univerzity Karlovy v Praze ³
Published in the journal: Rozhl. Chir., 2019, roč. 98, č. 7, s. 268-272.
Category: Review

Summary

Introduction: The publication of new guidelines in recent years shows that surgical treatment of inguinal hernia remains topical. The main goal is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain. The main purpose of this article is to summarize the latest recommendations in surgical treatment of the groin hernias, especially in the case of strangulation.

Methods: The authors made literature review of all the guidelines published by the hernia societies, including related articles, in the last ten years.

Results: The use of the EHS classification system is suggested. In elective operations, mesh repair is recommended. The Lichtenstein technique is the standard in open inguinal hernia repair. Transabdominal preperitoneal and totally extraperitoneal approach have comparable outcomes. Their clear advantages include minimal invasiveness. Mesh repair is recommended also in the case of strangulation, but only in clean and clean-contaminated operations. A laparoscopic approach should be considered as well. Inter alia, it allows an assessment of bowel viability during the whole procedure. The need of bowel resection is hence lower compared to open surgery. If it is not possible to use the mesh, the Shouldice method is regarded as the best non-mesh repair technique. If there is concern about bowel viability, visualization, either by formal laparoscopy, hernia sac laparoscopy or laparotomy, is recommended. Hernioscopy is a simple and safe procedure that uses the hernia sac for insertion of a port following insufflation and diagnostic examination. It requires less advanced laparoscopic skills than does emergency laparoscopic hernia repair. It can be performed even by surgeons who lack sufficient experience with laparoscopy.

Conclusion: In elective procedures, the mesh repair is recommended. It is recommended also in the case of strangulation, but not in a contaminated-dirty surgical field. If there is concern about bowel viability, visualization, either by formal laparoscopy, hernia sac laparoscopy or laparotomy, is needed.

Keywords:

laparoscopy – inguinal hernia treatment – strangulation – hernioscopy

Zdroje

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