Treatment

Inguinal hernias should always be repaired unless there are specific contraindications. For indirect hernias, this is because the complications of incarceration, obstruction and strangulation are greater than those of operation. In infants and children, only the hernial sac needs to be excised - herniotomy. For other groups, the posterior inguinal wall must be repaired also - herniorrhaphy.

Direct hernias do not carry the same risks but the difficulty in reliably differentiating them from indirect hernias makes repair advisable.

When surgery is not advised, a truss may be used. Contraindications to surgery include:

• extremes of age
• general debility
• large direct hernia that is easily reduced and patient elects to use truss

Reference

1. Aiolfi A, Cavalli M, Micheletto G, et al. Primary inguinal hernia: systematic review and Bayesian network meta-analysis comparing open, laparoscopic transabdominal preperitoneal, totally extraperitoneal, and robotic preperitoneal repair. Hernia. 2019 Jun;23(3):473-84.