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Yang G, Tung KLM, Tumtavitikul S, Li MKW. A new groin hernia classification with clinical relevance. Hernia 2024; 28:1169-1179. [PMID: 38662243 DOI: 10.1007/s10029-024-03000-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/20/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Groin hernia is one of the most commonly managed surgical diseases around the world. The typical question asked by patients is "Does my hernia require urgent surgery?". The currently available classifications are insufficient to stratify patients into different groups. We propose a new classification that incorporates diverse clinical elements together with anatomical and other vital information, which allows us to stratify patients into different groups. METHOD A task force was formed by the Hong Kong Hernia Society, working with international expert hernia surgeons. The framework of the classification system was formulated. Clinical elements that are important in groin disease stratification were identified. A comprehensive literature review was conducted using PubMed. Those which dictate the severity of the disease were selected and compiled to form the new proposed classification. Application of this classification model to a single hernia surgeon's registry in The Hong Kong Adventist Hospital Hernia Centre was done for initial evaluation. RESULT This new classification incorporates important clinical characteristics forming a total of nine grades of differentiation, together with the anatomical details and special information. This comprehensive system allows the stratification of patients into different groups based on disease severity. It also enables more accurate data collection for future audits, comparisons of disease progression over time, and the effect of different management strategies for different-stage patients. CONCLUSION This is the first classification system which incorporates essential clinical parameters, which allows the stratification of groin hernia into different stages. Further studies and validation should be performed to evaluate the usefulness and value of this classification in groin hernia management.
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Affiliation(s)
- George Yang
- Hong Kong Adventist Hospital, Stubbs Road, Hong Kong, China.
| | | | | | - M K W Li
- Hong Kong Sanatorium & Hospital, 2 Village Road, Happy valley, Hong Kong, China
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Zhou Z, Li Y, Li B, Yan L, Lei Y, Tong C. Construction and validation of a predictive model for the risk of bowel resection in adults with incarcerated groin hernia. BMC Surg 2023; 23:375. [PMID: 38082259 PMCID: PMC10714612 DOI: 10.1186/s12893-023-02245-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/18/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND It is difficult to definitively determine the degree of ischemia in the bowel in which an incarcerated groin hernia is embedded. Failure to diagnose and intervene promptly and accurately increases the rate of bowel resection and patient mortality. The aim of this study is to investigate the risk factors for incarcerated inguinal hernia complicating bowel necrosis with resection and to establish a predictive model as a reference for clinical work. METHODS Patients with incarcerated groin hernia who were admitted to our hospital were retrospectively analyzed. They were divided into bowel resection and non-bowel resection groups based on whether bowel resection was performed in the surgical record and postoperative pathological results. Risk factors for the development of bowel resection in incarcerated groin hernia were analyzed by univariate analysis and multivariate logistic regression, respectively. The screened independent risk factors were used to establish a prediction model, and finally, the predictive ability and accuracy of the model were validated and the clinical benefit was analyzed. RESULTS A total of 345 patients with incarcerated groin hernia were included, of whom 58 underwent bowel resection for bowel necrosis and 287 did not. Multifactorial logistic regression analysis identified bowel obstruction (OR, 7.285 [95% CI, 2.254-23.542], P = 0.001), peritonitis (OR, 16.786 [95% CI, 5.436-51.838], P = 0.000), duration of incarcerated groin hernia (OR, 1.009 [95% CI, 1. 001-1.018], P = 0.034), heart rate (OR, 1.109 [95% CI, 1.021-1.205], P = 0.014), and preoperative total protein (OR, 0.900 [95% CI, 0.836-0.969], P = 0.005) were independent risk factors for bowel resection in incarcerated groin hernia. The predictive value of the established prediction model was basically in agreement with the measured value with a consistency index of 0.938 (0.901-0.974) and had a good clinical benefit. CONCLUSION Clinical screening and management of independent risk factors for bowel resection in patients with incarcerated groin hernia should be strengthened. The predictive model developed in this study has high diagnostic efficacy for bowel resection associated with incarcerated inguinal hernia, with the aim of reducing the incidence of bowel resection and unplanned secondary surgery.
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Affiliation(s)
- Zheqi Zhou
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
- Yan'an University, Yan'an, 716000, China
| | - Yujie Li
- Yan'an University, Yan'an, 716000, China
| | - Bin Li
- Department of Gynecology, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Likun Yan
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Yingying Lei
- Tianjin Medical University, Tianjin, 300052, China
| | - Cong Tong
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China.
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Stabilini C, van Veenendaal N, Aasvang E, Agresta F, Aufenacker T, Berrevoet F, Burgmans I, Chen D, de Beaux A, East B, Garcia-Alamino J, Henriksen N, Köckerling F, Kukleta J, Loos M, Lopez-Cano M, Lorenz R, Miserez M, Montgomery A, Morales-Conde S, Oppong C, Pawlak M, Podda M, Reinpold W, Sanders D, Sartori A, Tran HM, Verdaguer M, Wiessner R, Yeboah M, Zwaans W, Simons M. Update of the international HerniaSurge guidelines for groin hernia management. BJS Open 2023; 7:zrad080. [PMID: 37862616 PMCID: PMC10588975 DOI: 10.1093/bjsopen/zrad080] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/05/2023] [Accepted: 07/16/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Groin hernia repair is one of the most common operations performed globally, with more than 20 million procedures per year. The last guidelines on groin hernia management were published in 2018 by the HerniaSurge Group. The aim of this project was to assess new evidence and update the guidelines. The guideline is intended for general and abdominal wall surgeons treating adult patients with groin hernias. METHOD A working group of 30 international groin hernia experts and all involved stakeholders was formed and examined all new literature on groin hernia management, available until April 2022. Articles were screened for eligibility and assessed according to GRADE methodologies. New evidence was included, and chapters were rewritten. Statements and recommendations were updated or newly formulated as necessary. RESULTS Ten chapters of the original HerniaSurge inguinal hernia guidelines were updated. In total, 39 new statements and 32 recommendations were formulated (16 strong recommendations). A modified Delphi method was used to reach consensus on all statements and recommendations among the groin hernia experts and at the European Hernia Society meeting in Manchester on October 21, 2022. CONCLUSION The HerniaSurge Collaboration has updated the international guidelines for groin hernia management. The updated guidelines provide an overview of the best available evidence on groin hernia management and include evidence-based statements and recommendations for daily practice. Future guideline development will change according to emerging guideline methodology.
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Affiliation(s)
| | - Nadine van Veenendaal
- Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Eske Aasvang
- Department of Anaesthesiology, The Centre for Cancer and Organ Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ferdinando Agresta
- Department of Surgery, Vittorio Veneto General Hospital, Vittorio Veneto, Italy
| | - Theo Aufenacker
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Ine Burgmans
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - David Chen
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Andrew de Beaux
- Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Barbora East
- Department of Surgery, Fakultní Nemocnice v Motole, Prague, Czech Republic
| | | | - Nadia Henriksen
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital–Herlev and Gentofte, Herlev, Denmark
| | - Ferdinand Köckerling
- Vivantes Hospital Berlin, Academic Teaching Hospital of Charité University Medicine, Berlin, Germany
| | - Jan Kukleta
- Department of Surgery, Klinik Im Park, Zurich, Zurich, Switzerland
| | - Maarten Loos
- SolviMáx Centre of Excellence for Abdominal Wall and Groin Pain, Eindhoven, The Netherlands
- Department of General Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Manuel Lopez-Cano
- Department of Surgery, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Ralph Lorenz
- Department of Surgery, Hernia Center 3+CHIRURGEN, Berlin, Germany
| | - Marc Miserez
- Department of Surgery, KU Leuven–University Hospital Leuven, Leuven, Belgium
| | | | | | - Chris Oppong
- Department of Surgery, Derriford Hospital Plymouth, Plymouth, UK
| | - Maciej Pawlak
- North Devon Comprehensive Hernia Centre, North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - Mauro Podda
- Department of Surgery, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Wolfgang Reinpold
- Department of Surgery, Gross-Sand Hospital Hamburg, Hamburg, Germany
| | - David Sanders
- North Devon Comprehensive Hernia Centre, North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - Alberto Sartori
- Department of Surgery, Ospedale Civile di Montebelluna, Montebelluna, Italy
| | - Hanh Minh Tran
- Westmead Clinical School, Sydney Medical School, University of Sydney, New Galles, Australia
| | - Mireia Verdaguer
- Department of Surgery, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Reiko Wiessner
- Department of Surgery, Bodden-Kliniken Ribnitz-Damgarten GmbH, Ribnitz-Damgarten, Germany
| | - Michael Yeboah
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, P.M.B., Kumasi, West Africa
| | - Willem Zwaans
- SolviMáx Centre of Excellence for Abdominal Wall and Groin Pain, Eindhoven, The Netherlands
- Department of General Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Maarten Simons
- Department of Surgery, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, The Netherlands
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