According to the European Hernia Society (EHS) 2018 guidelines on inguinal hernia repair, which of the following recommendations is CORRECT regarding mesh use in primary inguinal hernia?
- A Tissue-based repair (e.g., Shouldice) is recommended over mesh for all primary inguinal hernias in adults
- B Laparoscopic TEP repair is contraindicated in primary unilateral hernia and reserved for bilateral or recurrent cases only
- C Lightweight mesh (< 35 g/m²) should be avoided due to higher chronic pain rates compared to heavyweight mesh
- D Mesh repair is recommended for all male adults with primary or recurrent inguinal hernia due to lower recurrence rates; Shouldice can be considered for small indirect hernias in young men ✓
Explanation
EHS 2018 guidelines recommend mesh-based repair for all adult males with primary inguinal hernia due to significantly lower recurrence rates (0.5-2% vs. 5-15% for tissue repair). Lichtenstein (open mesh) and laparoscopic approaches (TEP/TAPP) are equally recommended for primary repairs, with laparoscopy offering advantages of faster recovery and lower chronic pain. Shouldice repair is a legitimate non-mesh option specifically considered for small indirect hernias in young males concerned about long-term mesh effects. Laparoscopic repair is also recommended for primary unilateral hernias — not restricted to bilateral/recurrent. Lightweight mesh reduces chronic pain rates compared to heavyweight mesh.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.