Page 61 - International guidelines for groin hernia management

Hernia

this estimate is skewed by the high percentage of surgically recommendation. Watchful waiting is discouraged, since
treated femoral hernias compared to IHs. Medical literature the risks of serious and potentially lethal complications
focused on femoral hernias is scant and studies lack suf- such as strangulation and bowel resection are unacceptably
ficient power to draw firm conclusions. However, large high. 27–30 Several clinically significant differences were
systematic reviews on IHs provide data that can inform found in outcomes following elective and emergent
decision-making about femoral hernia management. 26, 27 femoral hernia repair. When compared to elective repair,
Some topics in this chapter (e.g., suture and mesh emergent femoral hernia repair is associated with a greater
choice, prevention, and treatment of complications) were risk of small bowel resection and a longer length of hos-
assumed to be comparable to IH repair and were not pital stay. 22, 31, 32
evaluated separately. In contrast to IH repair, primary suture repair of femoral
hernia is still an accepted technique in elective and emer-
Key questions gency settings. A cohort study from a specialized hernia
center concluded that there were no significant differences
KQ17.a Does tissue repair in femoral hernia have a higher regarding recurrence rate between tissue-based and mesh
recurrence rate than mesh repair? repair of femoral hernias. 29 However, studies from the
KQ17.b Following femoral hernia repair are there differ- Danish Hernia Database and the Swedish Hernia Registry
ences in recurrence rates or the incidence of chronic pain all concluded that recurrence and reoperation rates after
between open anterior mesh repair and open posterior mesh mesh repair were significantly lower. 10, 33
repair? Which mesh or plug should be used in open femoral
KQ17.c Following open and endoscopic femoral hernia hernia repair was investigated in two RCTs and a large
33–35
repairs are there differences in recurrence rates and or national database study. Significantly better results
postoperative pain? concerning recurrence, postoperative pain, and foreign-
KQ17.d Should asymptomatic femoral hernias always be body sensation were found in the RCT for preperitoneal
treated surgically? mesh repair compared to plug repair. 35 No differences in

Two systematic reviews (SRs) were identified that hernia recurrence were found in a retrospective study. The
focused on IH repair but included data and recommenda- large database study showed no differences in postopera-
tions on femoral hernias. 26, 27 KQ 17.d, concerning whe- tive pain between different mesh types and anatomical
ther an asymptomatic femoral hernia should be electively locations for the mesh devices.
repaired, received the strongest consensus

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