Inguinal Hernias: an Algorithmic Approach to Procedure Selection

Abstract

Employing a minimally invasive or open inguinal hernia repair for a primary inguinal hernia remains debatable. It has been clearly established that in experienced hands, both the open and minimally invasive (MIS) techniques can produce excellent short- and long-term results while understanding that all inguinal hernia operations carry a small risk of chronic pain and recurrences. With a large variety of open repairs including tissue-only repairs, plug and patch techniques, or Lichtenstein repairs, and with a variety of minimally invasive approaches including both laparoscopic and robotic total extraperitoneal (TEP) or transabdominal preperitoneal (TAPP) repairs, hernia repair options are really numerous and tough to compare and contrast. Weighing the benefits of open versus MIS repair for any new patient presenting with a primary inguinal hernia will remain an academic pursuit, but practical focus needs to shift to establishing the best technique to utilize at different times, depending on the patient, with the goal being outcome optimization. Treatment algorithms for the many different types of patients presenting with inguinal hernias can help guide surgeons toward this objective.