Editing Hernia (section)

==Treatment==
{{Main article|Hernia repair|Inguinal hernia surgery}}

[[File:US Navy 081117-N-1512O-119 Lt. Christie Quietmeyer performs hernia repair surgery with the aid of Lt. Craig Fossee and Hospital Corpsman 3rd Class Zack Mikesell.jpg|thumb|[[Hernia repair]] being performed aboard the amphibious assault ship [[USS Bataan (LHD-5)|USS ''Bataan'']].]]

===Truss===

The benefits of the use of an external device to maintain reduction of the hernia without repairing the underlying defect (such as hernia [[Truss (medicine)|trusses]], trunks, belts, etc.) are unclear.<ref name="NEJM15" />

===Surgery===
[[File:Inguinal Hernia Patch.png|thumb|Inguinal hernia repair with mesh diagram]]
[[File:Lap-HerniaMesh-Sambalis.jpg|thumb|Laparoscopic hernia repair with mesh]]
Surgery is recommended for some types of hernias to prevent complications such as obstruction of the bowel or strangulation of the tissue, although umbilical hernias and hiatus hernias may be watched, or are treated with medication.<ref>{{cite web |url=http://www.nhs.uk/conditions/hernia/Pages/Introduction.aspx |title= Hernia | work = U.K. National Health Service |access-date=2017-07-23 |url-status=live |archive-url=https://web.archive.org/web/20170714182318/http://www.nhs.uk/conditions/hernia/Pages/Introduction.aspx |archive-date=2017-07-14 }}</ref> Most abdominal hernias can be surgically repaired, but surgery has complications. Prior to surgery patients should be medically optimized receive guidance about changing factors that can be controlled, such as quitting smoking, managing medical conditions like diabetes effectively, and working on losing weight.

Three primary methods can be utilized: open surgery, [[laparoscopy]], or robotic techniques. Fixing an inguinal hernia using [[laparoscopy]] causes less pain, speeds up recovery, and shows similar low rates of the hernia coming back compared to the traditional open repair method. However, open surgery can be done sometimes without general anesthesia. Using local anesthesia for open groin hernia repair, particularly in patients with additional health issues, leads to fewer complications and reduced costs.<ref>{{Cite journal |last1=Balentine |first1=Courtney J. |last2=Meier |first2=Jennie |last3=Berger |first3=Miles |last4=Reisch |first4=Joan |last5=Cullum |first5=Munro |last6=Lee |first6=Simon C. |last7=Skinner |first7=Celette Sugg |last8=Brown |first8=Cynthia J. |date=February 2021 |title=Using Local Anesthesia for Inguinal Hernia Repair Reduces Complications in Older Patients |journal=The Journal of Surgical Research |volume=258 |pages=64–72 |doi=10.1016/j.jss.2020.08.054 |issn=1095-8673 |pmc=7968932 |pmid=33002663}}</ref> Studies show that compared to regional or general anesthesia, local anesthesia results in less postoperative pain, shorter recovery times, and decreased unplanned overnight stays.<ref>{{Cite journal |last1=van Veen |first1=Ruben N. |last2=Mahabier |first2=Chander |last3=Dawson |first3=Imro |last4=Hop |first4=Wim C. |last5=Kok |first5=Niels F. M. |last6=Lange |first6=Johan F. |last7=Jeekel |first7=Johannus |date=March 2008 |title=Spinal or local anesthesia in lichtenstein hernia repair: a randomized controlled trial |url=https://pubmed.ncbi.nlm.nih.gov/18376185/ |journal=Annals of Surgery |volume=247 |issue=3 |pages=428–433 |doi=10.1097/SLA.0b013e318165b0ff |issn=0003-4932 |pmid=18376185|s2cid=22487510 }}</ref> However, it might not be enough for repairing large hernias or in patients with abdominal domain loss, where general anesthesia is preferred.
{| class="wikitable"
|+'''Laparoscopic mesh surgery''', as compared to open mesh surgery
!Advantages
!Disadvantages
|-
|
* Quicker recovery<ref name=":2">{{cite book | last=Klingensmith | first=Mary E. | title=The Washington Manual of Surgery | publisher=Lippincott Williams & Wilkins | publication-place=Philadelphia | date=2008 | isbn=978-0-7817-7447-5 | page=}}</ref>
* Less pain during the first few days following the procedure
* Fewer postoperative complications such as infections, bleeding and [[seroma]]s<ref name=":3">{{Cite web |date=2004-09-22 |title=Overview {{!}} Laparoscopic surgery for inguinal hernia repair {{!}} Guidance {{!}} NICE |url=https://www.nice.org.uk/guidance/TA83 |access-date=2023-11-09 |website=www.nice.org.uk}}</ref>
* Lower risk of chronic pain<ref name=":3" />
|
* Needs a surgeon who is highly experienced in inguinal hernia repair (>200 operations/year){{Citation needed|date=November 2023}}
* Longer operation time<ref name=":2" />
* Increased recurrence of primary hernias if a surgeon is not experienced enough<ref name=":2" />
|}
[[Robot-assisted surgery|Robot-assisted]] hernia surgery has also recently gained popularity as safe alternatives to open surgery. Robotic surgery for inguinal hernia repair shows outcomes comparable to laparoscopic surgery. The rates of overall complications, long-lasting postoperative pain, urinary retention, and 30-day re-admission are very similar between these two methods.<ref name=":1">{{Cite journal |last1=Solaini |first1=Leonardo |last2=Cavaliere |first2=Davide |last3=Avanzolini |first3=Andrea |last4=Rocco |first4=Giuseppe |last5=Ercolani |first5=Giorgio |date=2022 |title=Robotic versus laparoscopic inguinal hernia repair: an updated systematic review and meta-analysis |journal=Journal of Robotic Surgery |volume=16 |issue=4 |pages=775–781 |doi=10.1007/s11701-021-01312-6 |issn=1863-2483 |pmc=9314304 |pmid=34609697}}</ref> Just like in other areas of general surgery, it has been noted that robotic surgery for inguinal hernia repair takes more time in the operating room compared to the laparoscopic approach.<ref name=":1" />

Uncomplicated hernias are principally repaired by pushing back, or "reducing", the herniated tissue, and then mending the weakness in muscle tissue (an operation called [[Hernia repair|herniorrhaphy]]). If complications have occurred, the surgeon will check the viability of the herniated organ and remove part of it if necessary.
[[File:WBAMC first in DoD to use robot for surgery 160426-A-EK666-506.jpg|thumb|da Vinci Surgical System]]
Muscle reinforcement techniques often involve synthetic materials (a [[Inguinal hernia repair#Meshes|mesh prosthesis]]).<ref>{{cite journal | vauthors = Kamtoh G, Pach R, Kibil W, Matyja A, Solecki R, Banas B, Kulig J | title = Effectiveness of mesh hernioplasty in incarcerated inguinal hernias | journal = Wideochirurgia I Inne Techniki Maloinwazyjne = Videosurgery and Other Miniinvasive Techniques | volume = 9 | issue = 3 | pages = 415–9 | date = September 2014 | pmid = 25337167 | pmc = 4198637 | doi = 10.5114/wiitm.2014.43080 | doi-access = free }}</ref> The mesh is placed either over the defect (anterior repair) or under the defect (posterior repair). At times [[Surgical staple|staples]] are used to keep the mesh in place. These [[Inguinal hernia repair#Mesh repairs|mesh repair methods]] are often called "tension free" repairs because, unlike some [[Surgical suture|suture]] methods (e.g., Shouldice), muscle is not pulled together under tension. However, this widely used terminology is misleading, as there are many [[Inguinal hernia repair#Tension-free repairs|tension-free suture methods]] that do not use mesh (e.g., Desarda, Guarnieri, Lipton-Estrin, etc.).

Evidence suggests that tension-free methods (with or without mesh) often have lower percentage of recurrences and the fastest recovery period compared to [[Inguinal hernia repair#Tension repairs|tension suture methods]]. However, the use of prosthetic mesh appears to have a higher likelihood of causing long-term pain and can also lead to infections.<ref>{{cite journal | vauthors = Sohail MR, Smilack JD | title = Hernia repair mesh-associated Mycobacterium goodii infection | journal = Journal of Clinical Microbiology | volume = 42 | issue = 6 | pages = 2858–60 | date = June 2004 | pmid = 15184492 | pmc = 427896 | doi = 10.1128/JCM.42.6.2858-2860.2004 }}</ref>

The frequency of surgical correction ranges from 10 per 100,000 (U.K.) to 28 per 100,000 (U.S.).<ref name="NEJM15" /> After elective surgery, the 30-day mortality rate for inguinal or femoral hernia repair stands at 0.1 percent, but it increases to 2.8 to 3.1 percent after urgent surgery.<ref>{{Cite journal |last1=Arenal |first1=Juan J. |last2=Rodríguez-Vielba |first2=Paloma |last3=Gallo |first3=Emiliano |last4=Tinoco |first4=Claudia |date=2002 |title=Hernias of the abdominal wall in patients over the age of 70 years |journal=The European Journal of Surgery = Acta Chirurgica |volume=168 |issue=8–9 |pages=460–463 |doi=10.1080/110241502321116451 |issn=1102-4151 |pmid=12549685|doi-access=free }}</ref> When a bowel resection is part of the hernia repair, the mortality rate is even higher.<ref>{{Cite journal |last1=Abi-Haidar |first1=Youmna |last2=Sanchez |first2=Vivian |last3=Itani |first3=Kamal M. F. |date=September 2011 |title=Risk factors and outcomes of acute versus elective groin hernia surgery |url=https://pubmed.ncbi.nlm.nih.gov/21680204/ |journal=Journal of the American College of Surgeons |volume=213 |issue=3 |pages=363–369 |doi=10.1016/j.jamcollsurg.2011.05.008 |issn=1879-1190 |pmid=21680204}}</ref> Older age, femoral hernias, female sex, and urgent repair are identified as other factors linked to a higher risk of mortality.<ref>{{Cite journal |last1=Nilsson |first1=Hanna |last2=Stylianidis |first2=Georgios |last3=Haapamäki |first3=Markku |last4=Nilsson |first4=Erik |last5=Nordin |first5=Pär |date=April 2007 |title=Mortality after groin hernia surgery |journal=Annals of Surgery |volume=245 |issue=4 |pages=656–660 |doi=10.1097/01.sla.0000251364.32698.4b |issn=0003-4932 |pmc=1877035 |pmid=17414617}}</ref>

'''<big>Post-Operative Complications</big>'''

Some complications from surgery in order of prevalence include a [[seroma]]/[[hematoma]] formation, urinary retention, [[neuralgia]]s, testicular pain/swelling, mesh infection/wound infection, and recurrence.<ref name=":0">{{Cite journal |last1=Chowbey |first1=Pradeep K |last2=Pithawala |first2=Murtaza |last3=Khullar |first3=Rajesh |last4=Sharma |first4=Anil |last5=Soni |first5=Vandana |last6=Baijal |first6=Manish |date=September 2006 |title=Complications in groin hernia surgery and the way out |journal=Journal of Minimal Access Surgery |volume=2 |issue=3 |pages=174–177 |doi=10.4103/0972-9941.27734 |issn=0972-9941 |pmc=2999781 |pmid=21187992 |doi-access=free }}</ref> A seroma is often seen after an indirect hernia repair and resolves spontaneously over 4–6 weeks. To prevent a seroma it's important to reduce the amount of cutting around the hernia sac where it's connected to the cord structures.<ref name=":0" /> Additionally, securely attaching the hernia sac to the pubic bone and creating small openings in the tissue around a direct hernia can help.<ref name=":0" /> In cases of heavy bleeding or extensive cutting, certain surgeons may opt to insert a drain.<ref name=":0" /> Urinary retention is often seen in elderly patients, these patients can be catheterized prior to surgery if there is a risk.<ref name=":0" /> Other complications may arise [[Surgery#Postoperative care|post-operatively]], including rejection of the [[Surgical mesh|mesh]] that is used to repair the hernia. In the event of a mesh rejection, the mesh will very likely need to be removed. Mesh rejection can be detected by obvious, sometimes localized swelling and pain around the mesh area. Continuous discharge from the scar is likely for a while after the mesh has been removed. A surgically treated hernia can lead to complications such as [[inguinodynia]].

===Recovery===
Many patients are managed through [[day surgery]] centers and are able to return to work within a week or two, though intense activities are prohibited for a longer period. People who have their hernias repaired with mesh often recover within a month, but pain can last longer. Surgical complications may include pain that lasts more than three months, surgical site infections, nerve and blood vessel injuries, injury to nearby organs, and hernia recurrence. Pain that lasts more than three months occurs in about 10% of people following hernia repair.<ref name="NEJM15" />