Inguinal Hernia

Optimal treatment of hernias can be controversial. Obviously, all patients with strangulated inguinal hernias need immediate surgery. Femoral hernias also are prone to strangulation and should be repaired electively, if possible. Many small, direct inguinal hernias and painless, indirect inguinal hernias with relatively large openings do not represent immediate threats. However, the only hernias that are safe to simply observe are small, direct, nonpainful hernias that reduce spontaneously when the patient is recumbent. Otherwise, hernias should be repaired, unless surgery is contraindicated.

Often, the operation can be performed using local anesthesia with or without light sedation. Preoperatively, the patient should be led to expect that postoperative pain will be mild to moderate. Postoperative opiate use should be judicious, because the elderly are more sensitive to the disorienting effects of opiate agonists. With current tension-free repair techniques and appropriate analgesia, the elderly patient should expect to return to the activities of daily living within 24 hours after inguinal surgery; however, the patient's functional status, living arrangement, and home support system must be assessed before surgery to ensure postdischarge safety.