Strangulated Inguinal Hernia: Options and Strategies

Abstract

Although inguinal hernias are common, the incidence of strangulated inguinal hernias is low. Strangulated inguinal hernias occur when blood supply to the incarcerated structures is compromised leading to ischemia, necrosis, and perforation. As a result, strangulated inguinal hernias are a surgical emergency to prevent progression to perforation. Operative approaches include open tissue-based repairs, open mesh-based repairs, and minimally invasive repairs. The approach that is selected depends on the patient's presentation, the patient's prior operations, and surgeon experience. Tissue-based repairs should be performed when there is diffuse peritonitis or gross contamination due to concern for infection. Mesh-based repairs should be performed if the entire bowel is viable due to the low rate of hernia recurrence. In the event a bowel resection must be performed, the decision to perform a tissue-based or mesh-based repair should be made on a case-by-case basis. Regardless of the approach selected, immediate intervention is required to obtain the best outcomes.