Inguinal hernia repair: current surgical techniques

Abstract

Introduction: Selection of an optimal surgical technique for inguinal hernia repair, allowing safe performance and rapid recovery without long-term complaints, may contribute significantly to the reduction of national health care costs.

Methods: An analysis of current literature regarding surgical techniques, properties of modern meshes, operative complications, recurrence rates, occurrence of chronic pain, and quality of life after different surgical procedures was made. Evidence-based comparisons of suture and mesh techniques of open mesh and laparoscopic mesh repair and of laparoscopic (TAPP) and endoscopic (TEP) operation were made.

Results: Recurrence rates after mesh implantation are significantly lower than after suture repair. Recurrence rates after flat open mesh repair are similar to those of laparoscopic techniques, but there is a significantly faster recovery after laparoscopy, and chronic pain is also present less frequently. Both TAPP and TEP are acceptable treatment options, but there is insufficient evidence to show superiority of one technique over the other. Material-reduced meshes seem to have advantages, at least during the early postoperative period. Besides the properties of the mesh implanted, the surgical technique applied and the skills of the surgeon performing the operation are the most important factors for achieving optimal and cost-efficient results.

Conclusion: With regard to recovery and occurrence of chronic pain, TAPP and TEP are superior to open mesh repair in most cases. Greater efforts should be undertaken to make laparoscopic repair easier, safer, and less expensive. If this can be achieved, health care costs could ultimately be reduced.