Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

28. Prevention of Pain Optimizing the Open Primary Inguinal…
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(and in the case of PIPS the complete approach we suggested previously).
The surgeon is always reminded that a proper physical examination
and clinical history investigation can avoid mistakes in the choice
of optimal technique.
Choosing the operative technique means not only selecting the right
approach, but also identifying the right anesthesia, the right mesh, and
the correct fixation technique for each patient (tailored approach).
It is usually preferable to use local anesthesia in adult patients (on the
condition that the surgeon is experienced in its use), while sedation or
general anesthesia in the case of anxious and apprehensive patients or
with large scrotal hernias can be used.
The anterior open approach is recommended for primary inguinal hernias
[or in case of a first recurrence, “high” lateral (indirect) reducible
hernia with a small defect in the thin patient, recurrence R1 according to
the Campanelli classification] [ 57 ]. The posterior open preperitoneal
approach with general anesthesia (Wantz or Stoppa) is reserved for the
treatment of very large, incarcerated hernias, femoral hernias, postoperative
chronic pain, and recurrent R2 [first recurrence, “low” medial (direct)
reducible hernia with a small (