An ideal method of inguinal hernia repair – a never-ending story
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|MU Faculty or unit
|Hernia is a very common disorder. Its incidence ranges from 3 to 5 % of the population in different countries. Inguinal hernia represents 75 % of all hernias. The only therapeutic option is surgical repair, which is one of the most frequent operations performed in general surgery. Today there are 3 groups of surgical procedures: conventional (Shouldice), open tension-free (Lichtenstein), and laparoscopic tension-free (TAPP). These groups were compared using meta-analyses of 61 randomised trials to find out which group is the best for inguinal hernia repair. The methods of anaesthesia (local, regional, general) for open inguinal hernia repair were also compared using the results of two randomised trials. All methods of hernia repair have disadvantages and complications. Meta-analyses confirm that open tension-free methods are the best option today. There are no differences between mesh (tensionfree) and non-mesh (conventional) open repair groups in complications including infections, and it is confirmed that the use of mesh is associated with a substantial reduction in the risk of recurrence. The laparoscopic approach has yet to await further analysis. A comparison of the forms of open inguinal hernia repair anaesthesia confirms considerable advantages of local anaesthesia over regional or general anaesthesias. We can conclude that an ideal method of inguinal hernia repair does not exist. Much work remains ahead of us to develop it. The best methods that we have today are open tension-free techniques. We can also expect a renaissance of local anaesthesia for open inguinal hernia repair.