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KEY POINTS

Key Points

  • image Conservative management of asymptomatic inguinal hernias is recommended.

  • image A thorough understanding of groin anatomy is essential to successful surgical treatment of inguinal hernias.

  • image Elective repair of inguinal hernias can be undertaken using a laparoscopic, robotic, or open approach.

  • image Robotic-assisted hernia surgery is quickly becoming adopted by general surgeons because of its better ergonomics and visualization.

  • image The use of prosthetic mesh as a reinforcement significantly improves recurrence rates, whether the repair is open or laparoscopic.

  • image Recurrence, pain, and quality of life are the metrics by which hernia repair outcomes are measured.

  • image Laparoscopic inguinal hernia repair results in less pain; however, mastery of this technique has a longer learning curve.

INTRODUCTION

Inguinal herniorrhaphy is one of the most commonly performed operations in the United States.1 Based on estimates made by the National Center for Health Statistics, in 2010 nearly 515,000 inguinal hernia operations were performed in hospitals, and an additional 450,000 were performed in ambulatory surgery centers.1

Approximately 75% of abdominal wall hernias occur in the groin. Of inguinal hernia repairs, 90% are performed in men, and 10% are performed in women. This is thought to be because the lifetime risk of inguinal hernia is 27% in men and 3% in women.2 The incidence of inguinal hernia in men has a bimodal distribution, with peaks before the first year of age and after age 40. Abramson demonstrated the age-dependence of inguinal hernias in 1978. Those age 25 to 34 years had a lifetime prevalence rate of 15%, whereas those age 75 years and over had a rate of 47% (Table 37-1).3 Approximately 70% of femoral hernia repairs are performed in women; however, the most common subtype of groin hernia in men and women is still the indirect inguinal hernia. Inguinal hernias are five times more common than femoral hernias.4

Table 37-1Inguinal hernia prevalence by age

Globally, the inguinal hernia repair has become one of the most important procedures in improving quality of life and preventing disability. In one study, an international cooperative organization performed over 1033 hernia repairs on 926 patients, and their impact was measured in disability adjusted life years (DALYs). They were able to avoid 5014 DALYs or 5.41 DALYs per patient.5

History

Surgical repair of hernias has been documented as far back as in ancient Egyptian and Greek civilizations.4 In the past, early management of inguinal hernias often involved a conservative approach with operative management reserved only for complications. Surgery often ...

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