- Hernia cannot be treated by any means other than medication or surgery!
- Wearing a “hernia truss” can only provide external pressure, temporarily preventing internal organs or tissues such as intestines or omentum from falling into the hernia sac, but it is not a fundamental solution; however, it can be used temporarily if the current physical condition is not suitable for surgery.
- Hernia will not close or disappear on its own, and surgery is necessary to cure it. If there are no conditions that make surgery unsuitable, it should be treated with surgery as soon as possible.
When is surgery necessary for hernia treatment?
The Asia Pacific Hernia Society completed the development of the Inguinal hernia repair: Toward Asian guidelines in 2014 to improve medical quality.
Indications, age, and gender
All adult hernias, regardless of age or gender, should undergo hernia repair surgery. Adult hernias should be scheduled for surgery to minimize the risk of surgery. If the general health condition does not affect the risk of surgery, there is no age limit for surgery. According to multiple studies, artificial mesh repair seems to have better long-term clinical results and is less likely to recur. Regarding different genders, there is basically no difference in surgery. Artificial mesh repair should be used for adult hernias.
Conclusion of the discussion (evidence level 2B-C)
Adult hernias over 21 years old should use mesh repair, but there is still controversy over whether artificial mesh repair is necessary for adult hernias between 18 and 21 years old. For individuals under 18 years old with large abdominal wall defects, multiple recurrences, and weak abdominal wall tissues, it is still recommended to use artificial mesh repair. Synthetic artificial mesh materials are superior to biological mesh materials.
Recommendation (Recommendation level B)
All adult hernias should use mesh repair. There is no difference in treatment between men and women.
Symptomatic and asymptomatic hernias.
Conclusion of the discussion (evidence level 1B): Observation and waiting are one of the options for completely asymptomatic hernias, but most patients’ symptoms will gradually become apparent and eventually require surgical repair. Conclusion of the discussion (evidence level 4): Astley Cooper (1804) defined a hernia as an organ protruding from its original body cavity. Even if there are currently no symptoms, it is highly likely that symptomatic hernias will occur in the future. Once a hernia appears, even if there is no pain or discomfort or bulging symptoms, treatment will still be required later. If a hernia is discovered during another surgery, the local medical legal regulations should be considered before dealing with the hernia.
Recommendation (Recommendation level D):
All inguinal hernias should be repaired surgically. Symptomatic hernias require surgical repair. For asymptomatic hernias, surgery is still recommended because most hernias will gradually become symptomatic over time.
When is surgery not necessary?
Patients in the terminal or severe stage usually do not require surgery; patients with ascites (such as severe cirrhosis) should wait until the ascites is under control before considering surgery. Other exceptional circumstances need to be discussed with the surgeon.
Carefully evaluate the possible complications and persistent symptoms of not having surgery and the safety of modern surgery. Once an inguinal hernia is detected, if the general health condition does not affect the risk of surgery, even if there are currently no symptoms, it is still recommended to have surgery repair as soon as possible.
References.
1.Lomanto D, Cheah WK, Faylona JM, Huang CS, Lohsiriwat D, Maleachi A, Yang GP, Li MK, Tumtavitikul S, Sharma A, Hartung RU, Choi YB, Sutedja B. Inguinal hernia repair: toward Asian guidelines. Asian J Endosc Surg. 2015 Feb;8(1):16-23. doi: 10.1111/ases.12141. PMID: 25598054.