Page 57 - International guidelines for groin hernia management

Hernia

Key question sports. 210, 246, 254, 292, 697, 703 (low-to-moderate level of
evidence).
KQ15.a What is the recommended duration of convales- The available medical evidence supports the idea that
cence following uncomplicated inguinal hernia repair? work and leisure activities can be resumed by most patients

Evidence in literature within 3–5 days following elective laparoscopic or open IH
The literature search identified 327 studies of which we repair without risk of hernia recurrence or other compli-
included one systematic review, 14 RCTs, three cohort cations. The recommendations have been upgraded by
studies and four case–control studies. HerniaSurge.

Discussion PART 2
Surgeons’ recommendations for physical activity restric- Specific aspects of Groin Hernia Management
tions and/or sick leave duration are highly variable, rarely 16. Groin hernias in women
evidence-based, and greatly affect the duration of absence 17. Femoral hernias
from normal activity. 146, 694–696 No study has demonstrated 18. Complications: prevention and treatment
that early return to normal activities and work after IH 19. Pain: prevention and treatment
repair increases hernia recurrence risk or complications. 20. Recurrent inguinal hernias
In a nationwide multicentre prospective questionnaire 21. Emergency treatment of groin hernia
study with controls from the Danish Hernia Database of
2365 patients with convalescence duration as the primary
outcome found that a short duration of convalescence (even
Chapter 16
as short as 1 day) following open IH repair may be rec-
ommended without increasing hernia recurrence risk. 146
Pain and wound-related problems are the most often cited
Groin hernias in women
reasons for not resuming work or leisure activities as recom-
146
mended (evidence level—high). A 2012 study of 162
N. Schouten, H. Eker, K. Bury, and F. Muysoms
laparoscopic IH repair patients found that convalescence
duration was a median of 5 days (range 1–40) from work and
Introduction
3 days (range 1–49) from leisure activities when the recom-
mendationwasfor1 day. 695 Patientexpectationpreoperatively Groin hernia repairs are 8–10 times more common in men
1, 2
fortimeoffworkwastheonlyindependentfactorthatpredicted compared with women. Inguinal hernias (IHs) occur
prolonged convalescence. Postoperatively, self-arranged 9–12 times more commonly in men, whereas femoral
planned sick leave, and complaints of pain and fatigue were the hernias occur approximately 4 times more commonly in
primary reasons for not resuming normal activities within the women. 3 These differences may be explained by the
695
first 3 days after operation (evidence level—low). greater distance between the pubic tubercle and the internal
In studies where duration of convalescence was sec- ring and the wider rectus abdominis muscle in females. 4
ondary outcome using non-restricted recommendations No systematic reviews or randomized controlled trials
(B 2 days) reported 1 week absence from domestic activ- (RCTs) specifically address groin hernia repair in women.
ities, 210, 223, 245, 246, 260, 697–699 1–2 weeks absence from Data are collected mainly from subgroup analyses of epi-
work, 210, 223, 246, 250, 254, 257, 260, 281, 292, 697, 699–704 and demiological studies from national databases. Reoperation
1–3 weeks after physical activities including rates after anterior hernia repairs in women are higher

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