Management of the hernial sac in inguinal hernia repair

The British Journal of Surgery
G StylianidisP Nordin

Abstract

There is no consensus on the best management of the indirect hernial sac in groin hernia surgery. The aim of this study was to investigate to what extent different management options are associated with reoperation for recurrence. This study used data from the Swedish Hernia Register. Surgeons registered whether the indirect hernial sac was managed by division (leaving the distal part in place), excision or invagination. An indirect hernia was found in 48 433 operations; the sac was excised in 49.5 per cent, invaginated in 37.6 per cent and divided in 12.9 per cent of operations. The 5-year cumulative reoperation incidence was 1.7 per cent for hernial sac excision, 1.7 per cent for division and 2.7 per cent for invagination. For indirect hernia repair, the relative risk of reoperation for recurrence was 0.63 (95 per cent confidence interval 0.51 to 0.79) for excision of the sac and 0.72 (0.53 to 0.99) for division compared with invagination. Lichtenstein repair combined with hernial sac excision had a 5-year cumulative reoperation incidence of only 1.0 per cent. Excision of the indirect hernial sac in inguinal hernia repair is associated with a lower risk of hernia recurrence than division or invagination.

References

Apr 1, 1984·The Surgical Clinics of North America·S G SmedbergA Gullmo
Jun 5, 2001·Hernia : the Journal of Hernias and Abdominal Wall Surgery·A J AldridgeA G Nash
May 11, 2002·Hernia : the Journal of Hernias and Abdominal Wall Surgery·S Haapaniemi
Apr 23, 2008·BMJ : British Medical Journal·Pär Nordin, Willem van der Linden
Sep 26, 2009·Nature·Jared Diamond

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Citations

Feb 8, 2011·Hernia : the Journal of Hernias and Abdominal Wall Surgery·B van den HeuvelH J Bonjer
Oct 23, 2016·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·U A DietzA Wiegering
Jan 14, 2018·Hernia : the Journal of Hernias and Abdominal Wall Surgery·UNKNOWN HerniaSurge Group
Feb 26, 2019·Frontiers in Surgery·Ferdinand KöckerlingRalph Lorenz
Apr 13, 2017·Innovative Surgical Sciences·Henning Niebuhr, Ferdinand Köckerling
Jan 31, 2017·Innovative Surgical Sciences·Ferdinand Köckerling

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