Page 30 - International guidelines for groin hernia management

Hernia

Evidence in literature Additional recommendations for individualization
There are no reviews, RCTs or cohort studies comparing
different techniques in specific situations. Since no mesh In the different chapters of these guidelines some recom-
technique is proven to be superior, technique chosen often mendations are made with regard to indicated surgical
depends on surgeons’ preferences. technique. We have outlined these recommendations in this
One 2012 publication addresses surgical preferences in chapter, but refer to these specific chapters for detailed
IH repair. 294 A survey questionnaire was distributed to 100 background information. In addition to these recommen-
endoscopic surgeons at the 2010 European Association of dations the consensus-based recommendations are
Endoscopic Surgery (EAES) annual meeting. The partici- outlined.
pating surgeons were asked to indicate preferred surgical For recurrent IHs, use the opposite approach (e.g. for
technique in specific clinical scenarios, including patient recurrence after anterior repair use a posterior technique,
age, gender, physical activity capabilities, physical char- and vice versa) (Chapter 10).
acteristics, emergency situations, and hernia size and type. In high-risk IH patients with extensive comorbidities
Surgeons were able to choose between open, TAPP or TEP consider an open mesh repair under local anesthesia
repair in a variety of patient scenarios. Eighty-two percent (Chapter 16).
of the surgeons chose a tailored approach and indicated that For IH patients with high preoperative pain, consider
their choice of repair depended on the listed patient char- laparo-endoscopic repair (Chapter 18).
acteristics. Interestingly, only 6% of the surgeons were able Consider a laparo-endoscopic approach in active young
to routinely offer patients all three techniques. patients with IHs (Chapter 18).
In femoral hernia patients, a pre-peritoneal mesh repair
Discussion, consensus and grading clarification is recommended (Chapter 25).
In female patients with IHs a laparo-endoscopic repair is
The HerniaSurge Group has identified possible factors recommended, providing expertise and resources are
influencing the type of IH repair. These factors involve: available (Chapter 26).
patient characteristics, surgical expertise, local/national Use a laparo-endoscopic approach in patients with
resources, and logistics (Table 2). Future research must bilateral IHs (Chapter 6h).
address the issue of individualized treatment in specific In male patients with a large scrotal or irreducible her-
cases. The HerniaSurge Group currently offers consensus- nia, an open mesh repair or a trans-abdominal laparoscopic
based examples of tailored surgical approaches in specific repair (TAPP) is recommended (HerniaSurge consensus).
circumstances.

Table 2. Determinants of surgeons’ preferences

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