Hernia Society Guidelines on the Treatment of Inguinal Hernias

In my practice, we strive to follow ‘evidence based medicine’ for our treatment of abdominal wall hernias. What is evidence based medicine, or EBM? EBM uses prior medical research studies to determine whats the best approach to a specific medical disease. This goes for cancers, trauma, medications, and for hernia repairs. In 2009, one of the biggest guidelines for inguinal hernia repairs was published in the journal ‘Hernia’.  Many hernia surgeons still use some of the evidence based medicine published in this article. Although it’s too long to focus on each topic, a couple of the more important ones I will summarize here:

• Watching your hernia instead of surgery is reasonable:  If your hernia is not causing you any symptoms, then you can safely just watch your hernia and not have it repaired. The incidence of an ’emergency’ is only 0.3% to 3% per year.
• Some patients decide to have surgery while watching their hernia: About 25% – 50% of patients will eventually develop symptoms or the hernia will get larger necessitating a surgical repair.
• Should mesh be used during your surgery?  Absolutely. Not only are recurrence rates 10 times less, but chronic pain is actually lower in patients who had a mesh repair.
• Laparoscopic or open repair? In large medical studies, the recurrence rates for open and laparoscopic surgery are the same.  So whether you have laparoscopic or open is usually a personal preference. We perform a high volume of both.
• Surgical volume makes a difference in outcomes: Although studies specific to inguinal hernias have not been performed, there has been some data to demonstrate that a surgeon who performs a high volume of surgery does a better job with less complications.

This article is over 60 pages long, but provides a lot of great evidence based medical decisions.