Surgical options in the management of groin hernias

Inguinal and femoral hernias are the most common conditions for which prima ry care physicians refer patients for surgical management. Hernias usually present as swelling accompanied by pain or a dragging sensation in the groi n. Most hernias can be diagnosed based on the history and clinical examinat ion, but ultrasonography may be useful in differentiating a hernia from oth er causes of groin swelling. Surgical repair is usually advised because of the danger of incarceration and strangulation, particularly with femoral he rnias. Three major types of open repair are currently used, and laparoscopi c: techniques are also employed. The choice of technique depends on several factors, including the type of hernia, anesthetic considerations, cost, pe riod of postoperative disability and the surgeon's expertise. Following ini tial herniorrhaphy, complication and recurrence rates are generally low. La paroscopic techniques make it possible for patients to return to normal act ivities more quickly, but they are more costly than open procedures. In add ition, they require general anesthesia, and the long-term hernia recurrence rate with these procedures is unknown.