Non operative/watchful waiting in the management of inguinal hernias

Ilioinguinal nerve division does not reduce pain after hernia surgery

Chronic groin pain can be a troubling and on occasion disabling symptom that affects between 5-10% of patients who undergo an inguinal hernia repair. Reasons for this are unclear although a number of patient and operative factors have been identified. It was thought that entrapment of the ilio-inguinal nerve might be a factor leading surgeons to plan to divide the nerve at surgery to prevent it becoming trapped.

Although planned division of the nerve may reduce severity and frequency of pain for up to 6 months after surgery, this effect is not maintained and after 12 months there is no differences in pain between those who underwent nerve division and those where the nerve was not dividied. However, not unsurprisingly, this group has a loss of sensation.

Open vs. Laparoscopic repair of inguinal hernias: Lap. repair may be better.

A recent study published in the March issue of Archives of Surgery 2012 suggests that patients who undergo a laparoscopic inguinal hernia repair (Total extraperitoneal inguinal hernia repair (TEP)), report higher patient satisfaction, less chronic pain and less impairment of inguinal (groin) sensation compared to those who undergo a tension-free open Lichtenstein repair.
Hernia Surgery. Two surgeons performing an operation

Mesh vs. suture repair of small umbilical hernias. Strong evidence supporting mesh repair

Although there is good evidence that large umbilical hernias should be repaired with a mesh, it is not clear how smaller hernias should be managed i.e. those with a diameter 1-4 cm. Many surgeons continue to suture repair these smaller hernias.