Progress in the treatment of inguinal hernia

The aim of surgical treatment of inguinal hernia is to a) reduce post-operative pain and discomfort to a minimum allowing patients to return to the activities as rapidly as possible, and hold the recurrence rate under 1%. The Shouldice technique remains the gold standard; its real recurrence rate is about 5%. Applying a mesh in the retroperitoneal space by laparaoscopy is a good approach and can theoretically reach both aims. In current practice however, laparoscopy is not always favorable : general anesthesia is mandatory, technical pitfalls lead to morbidity and later to recurrences. Tension-free procedures would provide the best compromise of achieving the two advantages of: a) reducing pain, discomfort and recurrence risks by eliminating tension and, b) local and or loco-regional anesthesia.