Page 25 - herina surgery and possible lawsuits

• Most of the classifications suggested type and defect size as important, but pre
operatively accurate defect size measurement is difficult. Some believes that extent of
hernia will determine the tissue dissection while surgery.
Surgeons with a range of competencies perform inguinal hemiorrhplasty. No currently exist

clinical classification allow the competency level of surgeon to match the predicted difficulty
of the hernia repair. A system of classification that stratifies hernia patients before operation
to enable complex cases to be treated by the most skilled surgeons. Two clinical factors

increase the difficulty of the operation: hernia size, which is readily quantifiable and patient
obesity in the operative area (groin-fat thickness) which is not. Subscapular skin-fold
thickness correlated well with groin-fat thickness (P=0.027) with a positive predictive value

of 0.76. On these principles Kingsnorth had propped new classification.
Kingsnorth’s new classification system proposed a score of 2-8, predicting grade of difficulty
of repair can be generated as below.

Hernia size (H1-H4)
Groin only, reduces spontaneously on lying down (HI)
Grom only, reduces completely with gentle manual pressure (H2)

Inguinoscrotal, reducible with manual manipulation (H3)
Irreducible (H4)
Groin fat thickness (F1-F4) (Subscapular skin-fold thickness, an indirect measurement)

<15 mm (FI)
15-25 mm (F2)
25- 35 mm (F3)
>35 mm (F4)

• A thin patients with hernias that reduce spontaneously (HlFl=score of 2) can be
designated to operating lists of trainees.

• A fatty patients with irreducible hernias (H4F4=score of 8) can be designated to more
expenenced surgeons. [59]

31