Page 1 - International guidelines for groin hernia management

Hernia
DOI 10.1007/s10029-017-1668-x
ORIGINAL ARTICLE

International guidelines for groin hernia management

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The HerniaSurge Group

Received: 5 February 2017 / Accepted: 13 September 2017
Ó The Author(s) 2018. This article is an open access publication

Abstract Methods An expert group of international surgeons (the
Introduction Worldwide, more than 20 million patients HerniaSurge Group) and one anesthesiologist pain expert
undergo groin hernia repair annually. The many different was formed. The group consisted of members from all
approaches, treatment indications and a significant array of continents with specific experience in hernia-related
techniques for groin hernia repair warrant guidelines to research. Care was taken to include surgeons who perform
standardize care, minimize complications, and improve different types of repair and had preferably performed
results. The main goal of these guidelines is to improve research on groin hernia surgery. During the Group’s first
patient outcomes, specifically to decrease recurrence rates meeting, evidence-based medicine (EBM) training occur-
and reduce chronic pain, the most frequent problems fol- red and 166 key questions (KQ) were formulated. EBM
lowing groin hernia repair. They have been endorsed by all rules were followed in complete literature searches (in-
five continental hernia societies, the International Endo cluding a complete search by The Dutch Cochrane data-
Hernia Society and the European Association for Endo- base) to January 1, 2015 and to July 1, 2015 for level 1
scopic Surgery. publications. The articles were scored by teams of two or
three according to Oxford, SIGN and Grade methodolo-
gies. During five 2-day meetings, results were discussed
with the working group members leading to 136 statements
and 88 recommendations. Recommendations were graded
The guidelines have been endorsed by the following societies: as ‘‘strong’’ (recommendations) or ‘‘weak’’ (suggestions)
European Hernia Society (EHS), Americas Hernia Society (AHS), and by consensus in some cases upgraded. In the Results
Asia Pacific Hernia Society (APHS), Afro Middle East Hernia Society and summary section below, the term ‘‘should’’ refers to a
(AMEHS), Australasian Hernia Society, International Endo Hernia
Society (IEHS), European Association for Endoscopic Surgery and recommendation. The AGREE II instrument was used to
Other Interventional Techniques (EAES). validate the guidelines. An external review was performed
The full list of collaborator names from the Steering Committee and by three international experts. They recommended the
HerniaSurge Group are listed in the Acknowledgements section at the guidelines with high scores.
end of the article.
Results and summary The risk factors for inguinal hernia
The comments to this article are available at https://doi.org/10.1007/ (IH) include: family history, previous contra-lateral hernia,
s10029-017-1673-0, https://doi.org/10.1007/s10029-017-1674-z, male gender, age, abnormal collagen metabolism, prosta-
https://doi.org/10.1007/s10029-017-1675-y, https://doi.org/10.1007/
tectomy, and low body mass index. Peri-operative risk
s10029-017-1676-x, https://doi.org/10.1007/s10029-017-1677-9,
factors for recurrence include poor surgical techniques, low
https://doi.org/10.1007/s10029-017-1678-8, https://doi.org/10.1007/
s10029-017-1679-7. surgical volumes, surgical inexperience and local anes-
thesia. These should be considered when treating IH
& The HerniaSurge Group patients. IH diagnosis can be confirmed by physical
m.p.simons@olvg.nl
examination alone in the vast majority of patients with
1 appropriate signs and symptoms. Rarely, ultrasound is
HerniaSurge Group, OLVG Hospital, Eerste Oosterparkstraat
9, 1091 AC Amsterdam, The Netherlands necessary. Less commonly still, a dynamic MRI or CT scan

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