What are the indications for laparoscopic inguinal hernia repair?

Updated: Apr 16, 2020
  • Author: Danny A Sherwinter, MD; Chief Editor: Kurt E Roberts, MD  more...
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Answer

The general indications for laparoscopic inguinal hernia repair as opposed to watchful waiting are the same as those for open inguinal hernia repair.

Classically, the existence of an inguinal hernia has been considered sufficient reason for operative intervention. However, studies have shown that the presence of a reducible hernia is not, in itself, an indication for surgery and that the risk of incarceration is less than 1%. [20]

Symptomatic patients (with pain or discomfort) should undergo repair; however, as many as one third of patients with inguinal hernias are asymptomatic. [20] The issue of observation versus surgical intervention in this asymptomatic or minimally symptomatic population was addressed in two randomized clinical trials, both of which found that there were no significant differences in hernia-related symptoms after long-term follow-up and that watchful waiting did not increase the complication rate. [21, 22]

In one study, the substantial patient crossover from the observation group to the surgery arm led the authors to conclude that observation may delay but not prevent surgery. [20] This reasoning holds particularly true for younger patients. Thus, even an asymptomatic patient, if medically fit, should be offered surgical repair. In another study, the authors determined that most patients with a painless inguinal hernia will develop symptoms over time and that surgery is therefore recommended for medically fit patients. [23]


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