Oblique or Transverse Incision in Inguinal Hernia Surgery: What Matters More for Patients, Study Reveals

The findings were published online in the Indian Journal of Surgery on January 8, 2025.

The researchers note that since Kocher recommended aligning surgical incisions with Langer’s lines in 1892, various skin lines and incision techniques have been developed, each with its advantages and drawbacks. When choosing a surgical incision for open inguinal hernia repair, the goal is to provide optimal access, restore soft tissue function and structural support, and achieve the most natural cosmetic appearance with minimal distortion after healing.

Against the above background, Deep Shah, Santosh Deemed to Be University, Ghaziabad, Uttar Pradesh, India, and colleagues compared the outcomes of two common incision types used in open inguinal hernia repair in India: the transverse incision, which follows Langer’s lines, and the oblique incision, which is traditionally made parallel to the inguinal ligament.

For this purpose, the researchers included 74 patients aged 18 to 70 years, who were equally divided into two groups. Group 1 underwent oblique incisions, while Group 2 received transverse incisions. The researchers measured various parameters, including operative time, postoperative pain (using VAS scores), patient satisfaction (assessed with POSAS v2.0), and complication rates.

The study uncovered the following findings:

• The median operative time was shorter for the oblique incision group than the transverse incision group.
• Transverse incisions provided better cosmetic outcomes and had similar complication rates to oblique incisions.
• Postoperative pain was similar between both groups.
• Transverse incisions resulted in a superior scar appearance, while oblique incisions saved operative time.

Based on the study, the authors revealed distinct advantages to each technique. The oblique incision group had a shorter median operative time, making it an attractive option for surgeons looking to reduce the duration of the procedure. This could lead to quicker recovery times and fewer complications related to prolonged surgery. On the other hand, the transverse incision group demonstrated superior cosmetic outcomes, with patients reporting better scar appearance. The transverse incision, which follows the body’s natural skin lines, resulted in less noticeable scars after healing.

Despite the differences in cosmetic results, the study found that postoperative pain was comparable between the two groups. Both incision types had similar complication rates, indicating that neither approach posed a significantly higher risk in terms of post-surgical issues. 

"Both incision types have their merits, and the decision should be made on a case-by-case basis, balancing the need for surgical efficiency with the desire for an aesthetically pleasing result," the researchers concluded. 

Reference:

Gupta, S., Shah, D., Solanki, N.K. et al. Oblique Incision Versus Transverse Incision in Open Inguinal Hernia Repair — A Comparative Study. Indian J Surg (2025). https://doi.org/10.1007/s12262-024-04269-6