Treatment Approach for Inguinal Hernias

Diagnostic Assessment

Systemic inflammatory response syndrome, contrast-enhanced CT findings, and elevated biomarkers are predictive of bowel strangulation and should guide urgency of intervention, according to the World Journal of Emergency Surgery 2, 3
High white blood cell count and fibrinogen levels are significantly predictive of complications in incarcerated hernias, as reported by the World Journal of Emergency Surgery 3

Immediate surgical intervention is required when intestinal strangulation is suspected, with prosthetic repair using synthetic mesh recommended for clean surgical fields, as stated by the World Journal of Emergency Surgery 1, 5
For clean-contaminated fields, emergent prosthetic repair with synthetic mesh is still recommended, with significantly lower risk of recurrence, according to the World Journal of Emergency Surgery 5, 6
For contaminated or dirty fields, primary tissue repair is recommended for small defects, with biological mesh or polyglactin mesh repair as alternatives, as reported by the World Journal of Emergency Surgery 5, 6

Hernioscopy is effective for evaluating viability of the herniated loop in incarcerated hernias, with decreased morbidity in high-risk patients, according to the World Journal of Emergency Surgery 2, 3
Component separation technique may be useful for large defects, as stated by the World Journal of Emergency Surgery 6

Short-term prophylaxis is recommended for intestinal incarceration without ischemia, with 48-hour antimicrobial prophylaxis for intestinal strangulation and/or concurrent bowel resection, as reported by the World Journal of Emergency Surgery 6

Local anesthesia can be used for emergency inguinal hernia repair in the absence of bowel gangrene, with fewer postoperative complications, according to the World Journal of Emergency Surgery 5, 6
General anesthesia should be preferred when bowel gangrene is suspected, intestinal resection is needed, or in cases of peritonitis, as stated by the World Journal of Emergency Surgery 5