Inguinal Hernia

Primary care should refer
Secondary care
Mesh use

• Symptomatic hernia is defined as a hernia causing groin discomfort/ pain at rest or when moving, or mass interfering with normal activity.
• Asymptomatic, incidental or minimally symptomatic inguinal hernias may be safely observed, and need not be referred to SOPD
• Femoral hernias should be repaired, as their incidence of strangulation is significantly higher
• Preoperative investigations should be kept to a minimum.
• There is no role for routine imaging tests to confirm the diagnosis of a hernia

Primary care should refer

• children <18 years with inguinal hernia to a paediatric surgical provider 
• incarcerated or strangulated inguinal hernia as an emergency
• irreducible hernias should be referred as urgent
• symptomatic inguinal hernia should be referred for routine SOPD evaluation

Secondary Care

• the majority (ideally > 80%) of inguinal hernias should be repaired as a same day procedure, with loco-regional anaesthesia.
• Inguinal hernias should be repaired by an open approach using a mesh technique (Lichtenstein repair)
• Laparoscopic repair of inguinal hernia is supported in specific circumstances, such as bilateral hernias or recurrence. Local expertise is essential if laparoscopic hernia repair is considered.
• Antibiotic prophylaxis is not required for an elective inguinal hernia repair.
• Early mobilisation is mandatory, opiates and urinary catheters should be avoided
• Outpatient follow up is not usually required after inguinal hernia repair

Mesh use

The use of synthetic mesh substantially reduces the risk of groin hernia recurrence irrespective of the placement method (open or laparoscopic). Mesh repair appears to reduce the chance of persisting pain rather than increase it

Mesh type:

• There are currently more than 200 commercial meshes on the market, each with major and minor variations in polymer and structure.
• Since most manufacturers make similar claims about the superiority of their product, it is left to the surgeon and healthcare facility to decide which material to use.
• Synthetic meshes vary in their chemical composition (polymer type, addition of coating agents or additives), physical properties (filament weave, pore size, mesh weight and density) and mechanical properties (tensile strength, bursting force).
• Irrespective of structural differences, mesh materials should be able to withstand the tensile stresses placed on the abdominal wall, which are in the order of 16N/cm for hernia repair and 32N/cm for complete abdominal wall reconstruction
• Monofilament polypropylene and polyester meshes appear to produce comparable results