[Treatment of inguinal hernias: indications]

Inguinal hernia represents the second most frequent indication in general surgery after appendectomy in France. The dogma in France is to operate all inguinal hernia. Inguinal hernia repair is responsible for 500,000 hospital days and 3,500,000 days off work per year, to which must be added the operative costs, a 15% postoperative complication rate, and 6 to 12% reoperations for recurrence. Hernia strangulation and surgery are the only circumstances which can be fatal whereas otherwise, inguinal hernia is a functional disorder. Socio-economical analysis of routine inguinal hernia repair, once diagnosed, has to come with ends as regard costs, risks, and benefits of treatment. In view of the multiplicity of factors such as the type of hernia, medical status of patients, functional compromise, and socio-economical impact which can influence indications for inguinal hernia repair, it seems likely that one same technique might not the best for all patients. The Shouldice repair is cited as being the best because it is the only technique whose results have been validated with rigor. In future trials, other techniques, and notably laparoscopic hernia repair, must therefore be compared to the Shouldice technique.