Inguinal hernia surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]


Surgery is the mainstay of treatment for inguinal hernia and there are many types of surgical techniques.


  • Surgery is the first-line treatment option for patients with inguinal hernia. Surgery is usually reserved for patients with either:[1]
    • Large bulges through a small hole
    • Painful hernia
    • High risk for complication such as strangulation, incarceration


  • Surgery is the mainstay of treatment for inguinal hernia. There are 3 general types for inguinal hernia repair:[2][3]
    • Herniotomy (removal of the hernial sac only)
    • Herniorrhaphy (herniotomy plus repair of the posterior wall of the inguinal canal)
    • Hernioplasty (herniotomy plus reinforcement of the posterior wall of the inguinal canal with a synthetic mesh)
  • Classification of current repair techniques for inguinal hernias include:[4][5][6][7]
    • Tension-free prosthetic repairs
      • Anterior repairs
        • lichenstein repair and its modification
        • Plug repairs
        • Patch and plug repairs
        • Double-layer devices
      • Posterior (prepritoneal) repairs
        • Open techniques via inguinal incision
        • Stoppa repair
        • Laparoscopic/endoscopic repairs
          • Transabdominal preperitoneal (TAPP) repair
          • Total extraperitoneal (TEP) repair
          • Intraperitoneal onlay mesh (IPOM) repair
    • Tissue-suture repairs
      • Bassini-Shouldice technique and its modifications
      • Marcy repair

Inguinal hernia
Asymptomatic or minimally symptomatic
Emergency surgery(consider non-mesh when risk of infection
Elective surgery
Consider watchful waiting
Primary unilateral
Primary bilateral
Lichtenstin or endoscopic
endoscopic or Lichtenstin
After anterior technique
After posterior technique
Mesh technique
endoscopic or open posterior approach
Mesh technique

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Related Chapter

Inguinal hernia repair


  1. Mathonnet M, Mehinto D (2007). "[Indications for inguinal hernia repair]". J Chir (Paris) (in French). 144 Spec No 4: 5S11–4. PMID 18065912.
  2. O'Dwyer PJ, Norrie J, Alani A, Walker A, Duffy F, Horgan P (2006). "Observation or operation for patients with an asymptomatic inguinal hernia: a randomized clinical trial". Ann. Surg. 244 (2): 167–73. doi:10.1097/01.sla.0000217637.69699.ef. PMC 1602168. PMID 16858177.
  3. Jenkins JT, O'Dwyer PJ (2008). "Inguinal hernias". BMJ. 336 (7638): 269–72. doi:10.1136/bmj.39450.428275.AD. PMC 2223000. PMID 18244999.
  4. Shouldice EB (2003). "The Shouldice repair for groin hernias". Surg. Clin. North Am. 83 (5): 1163–87, vii. doi:10.1016/S0039-6109(03)00121-X. PMID 14533909.
  5. Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M (2009). "European Hernia Society guidelines on the treatment of inguinal hernia in adult patients". Hernia. 13 (4): 343–403. doi:10.1007/s10029-009-0529-7. PMC 2719730. PMID 19636493.
  6. Wake BL, McCormack K, Fraser C, Vale L, Perez J, Grant AM (2005). "Transabdominal pre-peritoneal (TAPP) vs totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair". Cochrane Database Syst Rev (1): CD004703. doi:10.1002/14651858.CD004703.pub2. PMID 15674961.
  7. Elsebae MM, Nasr M, Said M (2008). "Tension-free repair versus Bassini technique for strangulated inguinal hernia: A controlled randomized study". Int J Surg. 6 (4): 302–5. doi:10.1016/j.ijsu.2008.04.006. PMID 18573702.

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