The definitive treatment of all hernias, regardless of their origin or type, is surgical repair . Repair of inguinal or femoral hernia may be the most common operation with over 20 million hernia repairs performed per year worldwide , and over 700,000 in the United States . 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 most patients with inguinal or femoral hernia. Watchful waiting may be appropriate for men with minimally symptomatic inguinal hernia, but femoral hernias should be repaired when identified due to the increased rate of complications. Since women are more likely to have complications related to hernia due to anatomic factors, and have a higher incidence of femoral hernia, hernia repair is generally recommended for all women when the hernia is identified.
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 incarcerated hernia to reduce the risk of subsequent strangulation. Emergency surgery within four to six hours 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".)
Uncomplicated hernia — Patients who have significant symptoms attributable to a groin hernia should undergo elective hernia repair . For patients with no symptoms but with the risk factors for groin hernia incarceration or strangulation that are discussed below, we suggest hernia repair as soon as feasible. Significant symptoms would include pain on lifting or pain with any type of exertion, inability to manually reduce the hernia, or inability to perform routine activities of daily life because of discomfort or pain. Male patients with minimal symptoms can be safely observed; however, female patients, who have a higher risk for complications, should undergo repair. (See 'Watchful waiting' below.)