HerniaSurge just released a comprehensive treatment guideline regarding best practices in inguinal hernia repair. HerniaSurge is an international collection of major hernia societies from the Americas, Asia, Europe, and Australia. The highlights and my takeaways from the guidelines are below:

• Ultrasound is rarely needed
• Asymptomatic individuals may be managed with “watchful waiting”, however, the majority will eventually require surgery
• Mesh repair is recommended as first choice
• Flat mesh is recommended, plugs and other configurations are not
• Surgeons should offer both anterior (open) and posterior (laparoscopic) repairs. One technique for all hernias does not exist
• Laparoscopic techniques have faster recovery times, lower chronic pain risk and are cost effective
• The incidence of erosion seems higher with plug versus flat mesh. It is suggested not to use plug repair techniques
• It is suggested that women with groin hernias undergo laparoscopic repair in order to decrease the risk of chronic pain and avoid missing a femoral hernia

I agree with the findings here and my practice choices align with them. While not every patient fits into the mold of a guideline, the majority of hernias should be repaired following these criteria unless specific situations or indications warrant deviating from them.

The guidelines have been endorsed by the following societies: European Hernia Society (EHS), Americas Hernia Society (AHS), Asia Pacific Hernia Society (APHS), Afro Middle East Hernia Society (AMEHS), Australasian Hernia Society, International Endo Hernia Society (IEHS), European Association for Endoscopic Surgery and Other Interventional Techniques (EAES).

Read the guidelines here.