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Overview of treatment for inguinal and femoral hernia in adults

INTRODUCTION

The definitive treatment of all hernias, regardless of their origin or type, is surgical repair [1]. Repair of inguinal or femoral hernia may be the most common operation with over 20 million hernia repairs performed per year worldwide [2], and over 700,000 in the United States [3]. Urgent/emergent repair is indicated for patients who develop complications (eg, bowel obstruction, bowel perforation) related to an inguinal or femoral hernia. For uncomplicated hernias, the optimal timing of repair (watchful waiting versus immediate) and the optimal technique for repair (open versus laparoscopic) remain controversial.

An overview of the treatment of inguinal and femoral hernias is presented here. The epidemiology, pathogenesis, clinical manifestations, and diagnosis of inguinal and femoral hernias in adults, hernias in children, and other hernias are discussed elsewhere. (See "Classification, clinical features and diagnosis of inguinal and femoral hernias in adults" and "Overview of inguinal hernia in children".)

INDICATIONS FOR REPAIR

Inguinal or femoral hernia repair has minimal short-term morbidity and patients generally have a rapid return to presurgical health. These excellent surgical outcomes, even among elderly individuals (particularly if local anesthesia can be used), have led to recommendations to offer surgical repair to patients with inguinal or femoral hernia who are symptomatic. Historically, recommendations were that the mere presence of a groin hernia was indication for repair due to the perception that complications were common and increased operative morbidity. Two studies conducted at the turn of the century compared watchful waiting to open mesh repair of inguinal hernia. Both studies showed a negligible rate of hernia accidents (acute incarceration with or without strangulation), but there was a measurable progression of symptoms (pain, discomfort) in the watchful waiting group that led to eventual repair. There was no apparent “penalty” for delaying repair until symptoms developed. (See 'Watchful waiting' below.)

Most large randomized trials have included only men; therefore, caution should be used when extrapolating these data and recommendations to women with groin hernias. Femoral hernias may have a higher rate of incarceration, due to anatomy, but we have no data to support repair over watchful waiting in asymptomatic or minimally symptomatic patients

Strangulated/incarcerated hernia — Urgent/emergent hernia repair should be undertaken for patients with symptoms and signs of strangulated hernia (inguinal or femoral), and in those with acutely incarcerated hernia to reduce the risk of subsequent strangulation. In patients with an acutely incarcerated inguinal hernia who do not have signs of strangulation (skin changes, peritonitis), an attempt at reduction is reasonable as long as the patient is accessible for follow-up over the next day or two. Emergency surgery within four to six hours of onset of symptoms may prevent loss of bowel from a strangulated hernia. The clinical manifestations and diagnosis of incarcerated/strangulated inguinal or femoral hernias are discussed elsewhere. (See "Classification, clinical features and diagnosis of inguinal and femoral hernias in adults".)

                          

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Literature review current through: Mar 2014. | This topic last updated: Oct 31, 2013.
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