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  • Recent literature suggests that patients who are asymptomatic or "minimally symptomatic" may be managed without surgical intervention.
  • All symptomatic inguinal hernias (pain, neurologic symptoms) should be repaired unless a specific contraindication exists.
  • Inguinal hernias that are incarcerated and are reduced in a timely fashion should be repaired on an urgent basis.
  • Hernias that are unable to be reduced should be treated as a surgical emergency and repaired expeditiously.

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  • There are no absolute contraindications.
  • In the event the patient cannot undergo general or spinal anesthetic, the repair can be performed under local anesthetic with sedation.

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  • The patient should be supine.

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  • Uncomplicated open or laparoscopic hernia repair is performed on an outpatient basis.
  • Postoperative pain control is achieved with anti-inflammatory medications and narcotics for severe pain.

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  • Bleeding can range from a subcutaneous hematoma to hemoscrotum.
    • This rarely requires reoperation, but patients must be informed about potential groin or scrotal bruising.
  • Life-threatening hemorrhage is exceedingly rare but may occur if an unrecognized retroperitoneal arterial injury occurs.
    • Typical manifestations are hypotension, decreased urine output, and possibly flank bruising.
  • Damage to the ilioinguinal or genitofemoral nerves may result in paraesthesia to the inner thigh or scrotum, or both.
    • This complication is often temporary when caused by traction but may be permanent if caused by transection.
  • Chronic groin pain is believed to be caused by nerve entrapment during repair. Occasionally, the pain is debilitating enough to require reexploration.
    • Some surgeons electively transect the ilioinguinal nerve when it is encountered to avoid this complication, although this has not been proven to be effective.

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