Page 89 - International guidelines for groin hernia management

Hernia

Chapter 21 convalescence, type of anesthesia, and risk of complica-
tions, but description of results after emergency hernia is
scarce’’. 304 Randomized studies (RSs) addressing KQ21.a
Emergency treatment of groin hernia are not available. Several non-randomized studies (NRSs)
with acceptable methodological quality have been pub-
M. Lo ´pez-Cano, S. Morales-Conde, and P. Chowbey lished, however. Most are cohort studies although popu-
lation-based studies exist also.
Introduction Patients who undergo emergent IH surgery had more
Medical evidence is limited about the emergent treatment hospitalizations than elective patients in the year preceding
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of groin hernias and the quality of that evidence is very hernia repair. It has been noted that groin hernias in
low. Future research on the subject should focus on: females have increased incarceration/strangulation
incarceration and strangulation risk factors, diagnostic risk. 22, 305 Femoral hernias in particular have an increased
modalities, and optimal timing for emergency repair of risk of incarceration/strangulation 22, 30, 305–307 and this risk
incarcerated/strangulated groin hernias. seems to be increased if the hernia is right-sided 306 (see
This chapter addresses key questions on best surgical also chapters 16 and 17).
approach (open anterior, posterior, or laparoscopic) and In summary, an increased incarceration/strangulation
repair options (e.g., mesh versus non-mesh). It is important risk is found for groin hernias in adults with the following
to consider the limitations imposed by the state of the features:
currently available literature as we search for definitive • Hernia-related hospitalizations in the year preceding
evidence-based answers to key clinical questions.
hernia repair
The following definitions are used throughout this
• Female gender
chapter.
• Femoral hernias, particularly those on the right side
Incarceration: Inability to reduce the hernia mass into the
abdomen
Strangulation: The blood supply to the herniated tissues is Discussion
compromised Understanding of incarceration/strangulation risks in adults
with groin hernias will be improved by large-scale epi-
Key question demiological studies, preferably based on national and
international registries. However, the statement in KQ21.a
KQ21.a Which groin hernias in adults are at increased risk has been upgraded to ‘‘strong’’, because the incarceration/
for incarceration/strangulation? strangulation risk factors are consistent across the currently
available studies. Even with the acknowledged low level of

Evidence in literature evidence, the benefits of emergent or urgent surgery likely
It has been written that ‘‘most studies concerning hernia outweigh the risks.
focus on recurrence rate, acute and chronic pain,

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