Current Concepts of Inguinal Hernia Repair

Area of Science:

• Surgery
• Gastroenterology
• Public Health

Background:

• Inguinal hernia repair is a common global surgery with high recurrence and chronic pain rates.
• Over 100 repair techniques exist, but outcomes remain suboptimal.
• International hernia societies aim to standardize care and improve surgical outcomes through evidence-based guidelines.

Purpose of the Study:

• To present the new International Guidelines of the Hernia-Surge Group for inguinal hernia repair.
• To recommend specific surgical techniques and a tailored approach for optimal patient outcomes.
• To emphasize the importance of considering patient- and hernia-related factors in treatment selection.

Main Methods:

• Review and synthesis of existing evidence on inguinal hernia repair techniques.
• Development of evidence-based guidelines and recommendations by international hernia societies.
• Classification of repair techniques into tissue repair, open mesh repair, and laparo-endoscopic mesh repair.

Main Results:

• The guidelines recommend only totally extraperitoneal patch plasty (TEP), transabdominal preperitoneal patch plasty (TAPP), and Lichtenstein techniques.
• A generally accepted technique for all inguinal hernias does not exist; surgeons should offer both anterior open (Lichtenstein) and posterior laparo-endoscopic (TEP or TAPP) options.
• Tailored treatment based on surgeon expertise, resources, and patient/hernia factors is strongly recommended.

Conclusions:

• The new guidelines aim to standardize care and improve outcomes for inguinal hernia repair.
• Surgeons must offer a choice of open and laparo-endoscopic approaches.
• A personalized approach considering specific patient and hernia characteristics is crucial for successful inguinal hernia repair.