[Indications for inguinal hernia repair]

Abstract

The surgical results of inguinal hernia repair depend on the operative indications. When surgery is being discussed, four factors should be taken into account: patient age and sex, the type of hernia (location, age, side, recurrence), and the patient characteristics that favor hernia onset or increase the surgical risk. In females, hernias are for the most part femoral, and inguinal hernias are rarely isolated. Femoral hernias and hernias that have recently appeared are at a high risk for strangulation. The complications of recurring hernias are always serious. These hernias should be treated no matter how old the patient is, with the risk of strangulation increasing above the age of 65. A repair procedure can be done under local anesthesia with no increase in the postoperative complication rate, even in older patients and patients who are at high risk for surgery. On the other hand, interventions done in an emergency situation induce excessive morbidity and mortality, which persist during the year following the surgery. Hernial strangulation multiplies postoperative morbidity by 2.67 and mortality by 10. In cases of asymptomatic bilateral hernia with no risk of complication, the indication should be weighted by age and any associated comorbidities. Finally, with an old hernia, the surgical risk should be compared to the risk of strangulation.