Page 94 - International guidelines for groin hernia management

Hernia

Evidence in literature risk patients (poorly defined, ASA class IV excluded), it
No medical literature addresses this question; therefore, the may decrease major morbidity. However, this study suffers
statements and recommendations are based on expert from the fact that is a preliminary report with risks of bias
opinion. (no fully explained concealment allocation, no sample size
calculation, major complications not fully defined, and
Key question small sample size).
A second publication is a review of ‘‘all published
KQ21.i Should adult patients with acutely incarcerated/ articles’’ about hernioscopy in adults and children. Data on
strangulated groin hernias receive antibiotic prophylaxis or 58 adults are included from one RCT, seven case reports,
treatment? and two case series. The review concluded that in adults

Evidence in literature with incarcerated groin hernias, hernioscopy is useful to
No medical literature directly addresses this question. assess bowel viability after spontaneous hernia reduction.
However, most papers addressing other KQs related to Furthermore, hernioscopy lessened the need for explora-
emergent operations for incarcerated/strangulated groin tory laparoscopy. However, the conclusion must be inter-
hernias reference the use of intravenously antibiotics for preted cautiously, because—in our opinion—the
5 days postoperatively. Antibiotic choice varied across the publication represents a narrative review based on the
studies. authors’ subjective analysis.
The current medical literature does not address the
Key question question concerning the value of laparoscopic
visualization.
KQ21.j In adults with acutely incarcerated/strangulated
groin hernias, does hernia sac laparoscopy (hernioscopy)
PART 3
reduce morbidity and mortality in cases with spontaneous
reduction of the hernia before viability assessment? Quality * Research * Global Management
Quality Aspects
KQ21.k In adults with acutely incarcerated/strangulated
groin hernias, is laparoscopy useful to check bowel via- 22. Training and the learning curve
bility even when an anterior approach is done? 23. Specialized centers and hernia specialists

Evidence in literature 24. Costs
One randomized study concludes that hernia sac laparo- 25. Registries
scopy seems to be an accurate and safe procedure with the 26. Outcomes and quality assessment
potential to prevent unnecessary laparotomies after spon- 27. Implementation: present and future aspects
taneous incarcerated IH reduction. 327 Particularly in high-

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