The following statement(s) is/are true concerning the indications for treatment of an inguinal hernia

b. There is a direct correlation between the length of time that a hernia is present and the risk of major complications

c. The morbidity and mortality associated with emergent operation due to hernia complications is significantly greater than for elective repair of the identical hernia

The indications for hernia repair must be individualized for each patient and the particular situation. In general, the presence of a hernia may be considered an adequate indication for hernia repair. Certainly the presence of complications due to hernia necessitates the correction of those complications and usually the repair of the hernia. As with any treatment, the benefits of operative repair must be weighed against the natural history of the disease, the extent to which the treatment can correct the problem, the possibility of treatment-related injury, and the interference of concomitant disease with the treatment results. With a few exceptions, the natural history of an abdominal wall hernia is that the size of the defect and the sac enlarges over time, and this enlargement increases the difficulty of adequate repair and the chances of recurrence of the hernia. The risk of major complications is greater in an individual patient, the longer the exposure to a hernia and the larger the sac relative to the hernia defect. In addition, major complications necessitate an emergent operation with attended high mortality and morbidity relative to that experienced with an elective repair. The use of a truss, an external support device using a system of straps to exert regional pressure over the hernia defect, should generally be avoided. Trusses do not consistently maintain a hernia in the reduced state, and they may put an unreduced hernia in greater jeopardy of strangulation. The pressure exerted induces edema by decreasing lymphatic and venous flow out of the herniated bowel. Trusses may also lead to injury to the skin overlying the hernia.