Curriculum · Surgery
Groin hernia repair in adults
What the standard repair is
For an adult with a primary groin hernia, mesh repair is the standard of care, whether open or laparoscopic. The material states it as a rule with almost no limit: mesh-based repair, open or lap, is first-line for almost all adult primary groin hernias. The worked case is a 38-year-old male with a primary indirect inguinal hernia, ASA I and no contamination, and the repair there is the Lichtenstein mesh-based repair.
The named alternatives are all tissue repairs, and each is a wrong answer in that setting: Shouldice, Bassini and McVay. Tissue repairs are reserved for specific cases, above all contamination, or where shared decision points that way. Age is not one of those cases: a tissue repair for all patients under 40 years is listed as the wrong answer.
Open or laparoscopic
The open mesh repair is the Lichtenstein repair; the laparoscopic routes are TAPP and TEP. For a primary hernia on one side the choice between them depends on the surgeon's expertise and on what the patient prefers, not on a rule.
Two cases do carry a rule, and both point laparoscopic:
- Bilateral primary inguinal hernia. In a fit 40-year-old male the preferred technique is TAPP or TEP repair. The reason given is that laparoscopy offers less pain and quicker recovery with comparable recurrence. Open Lichtenstein on both sides, Shouldice bilateral, plug-and-patch bilateral open and McVay repair are the answers to leave.
- Recurrent after an open repair. Bilateral or recurrent after open repair goes laparoscopic.