Differences in the outcomes of scrotal vs. lateral vs. medial inguinal hernias: a multivariable analysis of registry data

Köckerling, F.; Hantel, E; Adolf, Daniela; Kuthe, A.; Lorenz, R.; Niebuhr, H.; Stechemesser, Bernd; Marusch, F.

doi:10.1007/s10029-020-02281-9

Cited by 13 publications

(16 citation statements)

References 18 publications

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“…Compared with elective groin hernia repair at 11-25% (17,21), for emergency repair at 31% the registry analysis identified a higher number of larger defects as classified by European Hernia Society (EHS III: >3 cm) (22). Likewise, the proportion of scrotal hernias at 5.5% was higher for the emergency groin hernia repairs than the elective procedures at 2.7% (23). Hence, in the presence of the risk factors outlined here surgery should be indicated and watchful waiting practiced only with extreme caution, as otherwise the risk of needing emergency operations would rise (24).…”

Section: Discussionmentioning

confidence: 91%

Trends in Emergent Groin Hernia Repair—An Analysis From the Herniamed Registry

Köckerling

Heine²,

Adolf

et al. 2021

Front. Surg.

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Introduction: While the proportion of emergency groin hernia repairs in developed countries is 2.5–7.7%, the percentage in developing countries can be as high as 76.9%. The mortality rate for emergency groin hernia repair in developed countries is 1.7–7.0% and can rise to 6–25% if bowel resection is needed. In this present analysis of data from the Herniamed Registry, patients with emergency admission and operation within 24 h are analyzed.Methods: Between 2010 and 2019 a total of 13,028 patients with emergency admission and groin hernia repairs within 24 h were enrolled in the Herniamed Registry. The outcome results were assigned to the year of repair and summarized as curves. The total patient collective is broken down into the subgroups with pre-operative manual reduction (taxis) of the hernia content, operative reduction of the hernia content without bowel resection and with bowel resection. The explorative Fisher's exact test was used for statistical assessment of significant differences with Bonferroni adjustment for multiple testing.Results: The proportion of emergency admissions with groin hernia repair within 24 h was 2.7%. The percentage of women across the years was consistently 33%. The part of femoral hernias was 16%. The proportion of patients with pre-operative reduction (taxis) remained unchanged at around 21% and the share needing bowel resection was around 10%. The proportion of TAPP repairs rose from 21.9% in 2013 to 38.0% in 2019 (p < 0.001). Between the three groups with pre-operative taxis, without bowel resection and with bowel resection, highly significant differences were identified between the patients with regard to the rates of post-operative complications (4% vs. 6.5% vs. 22.7%; p < 0.0001), complication-related reoperations (1.9% vs. 3.8% vs. 17.7%; p < 0.0001), and mortality rate (0.3% vs. 0.9% vs. 7.5%; p < 0.001). In addition to emergency groin hernia repair subgroups female gender and age ≥66 years are unfavorable influencing factors for perioperative outcomes.Conclusion: For patients with emergency groin hernia repair the need for surgical reduction or bowel resection, female gender and age ≥66 years have a highly significantly unfavorable influence on the perioperative outcomes.

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Section: Discussionmentioning

confidence: 91%

Trends in Emergent Groin Hernia Repair—An Analysis From the Herniamed Registry

Köckerling

Heine²,

Adolf

et al. 2021

Front. Surg.

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“…Non-licensed mesh is only suggested if there is no commercial mesh available (1). Discussion: Endoscopic inguinal hernia repair rates have approached some 70% in one large registry yet for scrotal hernia repair (5) in the same countries the anterior approach is used in around 75% of cases, suggesting that it remains the default operation. A specialized hernia center reported TAPP repair in 193 patients with scrotal hernia with 2 recurrences after a follow-up of 30 months (6).…”

Section: Suture Repairmentioning

confidence: 99%

“…Strength of recommendation: Upgrade to Strong. Discussion: The operating time for scrotal hernia is longer compared to a standard inguinal hernia (5,6) and as the urinary bladder fills during surgery, this will place it at increased risks of injury also during anterior approach. For endoscopic approach, urinary catheterization does not negate the risks of bladder injuries (17).…”

Section: Kq11: Should Urinary Catheterization Be Routinely Recommende...mentioning

confidence: 99%

Systematic Review and Guidelines for Management of Scrotal Inguinal Hernias

Tran

MacQueen

Chen

et al. 2023

J. Abdom. Wall Surg.

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Introduction: Of the more than 20 million patients undergoing groin hernia repair annually worldwide, 6% are scrotal hernias in high resource countries rising to 67% in low resource countries which represents a heavy disease burden on relatively young men during their most productive period of life. There are many open questions concerning management of scrotal hernia. These guidelines aim to improve the care for scrotal hernia patients by reducing recurrence rates, chronic pain and infection.Methods: After developing 19 key questions a systematic literature review was performed till 31 March 2021 for all relevant publications with search terms related to Scrotal Hernia. The articles were scored by all co-authors according to Oxford, SIGN and Grade methodologies. Statements and recommendations were formulated. Online Consensus meetings with 25 HerniaSurge members were organised with voting and grading Recommendations as “strong” (recommendations) or “weak” (suggestions) and by consensus, in some cases upgraded.Results: Only 23 articles (two level 2 registry and 21 level 3–5) were selected. It is proposed to define scrotal hernia as an inguinal hernia which has descended into and causes any scrotal distortion. A new classification for scrotal hernias was proposed based on hernia size, SI for upper third thigh, SII for middle thigh and SIII for lower third thigh or below. Irreducibility is denoted with IR. Despite weak evidence antibiotic prophylaxis is recommended. Urinary catheterization is recommended (upgraded) in complex cases (S2-3) due to prolonged operative time. Scrotal hernia repairs have higher associated morbidity and mortality compared to non-complex groin hernia repairs irrespective of surgical experience. Open anterior (mesh) approach is commonest technique and suture techniques in low resource countries. For minimally invasive approaches, TAPP resulted in less conversion to open approach compared to TEP.Conclusion: Although the evidence is scarce and often low quality scrotal hernia management guidelines aim to lead to better surgical outcomes irrespective of where patients live. This necessarily means a more tailored approach based on available resources and appropriate skills. The guidelines provide an impetus for future research where adoption of proposed classification will enable more meaningful comparison of different techniques for different hernia sizes.

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“…Scrotal hernia management is difficult because of the higher morbidity and mortality compared to usual groin hernia repair. The open (anterior) approach is the default approach for scrotal hernia repair, although in some registries, the endoscopic approach is predominant (2,3).…”

mentioning

confidence: 99%

“…The laparoscopic techniques used for hernia repair include transabdominal peritoneal (TAPP) and extraperitoneal (TEP) approaches. Some authors recommend TAPP (4), whereas others suggest TEP (2,3,5); however, the choice depends on the surgeon's expertise. Usually, the difficulties encountered in TEP repair lead to conversion to TAPP; therefore, TAPP is probably better in some cases, especially in irreducible scrotal hernias (3).…”

mentioning

confidence: 99%

Large Symptomatic Inguinoscrotal Seroma Occurred Early after Laparoscopic Total Extraperitoneal Hernia Repair (TEP): a Case Report and Literature Review

UNGUREANU,

STANCULEA,

GINGHINA

et al. 2024

Maedica

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Inguinoscrotal hernia (ISH) is an entity for which treatment is under debate. Open surgery is the standard approach, but the laparoscopic technique has a great outcome when used by experienced surgeons. Seroma is one of the complications following laparoscopic hernia repair for these scrotal hernias, which is due to the large hernia sac, usually transected, leaving in place a remnant of the sac. Conservative measures can be applied for the treatment of seroma; however, in symptomatic cases, puncture and aspiration of fluid are recommended. Sometimes, these seromas can reach a large size and require surgery to remove the remnant sac. Herein, we report the case of a 49-year-old male with a large seroma that occurred four days after the laparoscopic approach -total extraperitoneal repair (TEP) for inguinoscrotal hernia. Conservative measures failed, and

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Differences in the outcomes of scrotal vs. lateral vs. medial inguinal hernias: a multivariable analysis of registry data

Cited by 13 publications

References 18 publications

Trends in Emergent Groin Hernia Repair—An Analysis From the Herniamed Registry

Trends in Emergent Groin Hernia Repair—An Analysis From the Herniamed Registry

Systematic Review and Guidelines for Management of Scrotal Inguinal Hernias

Large Symptomatic Inguinoscrotal Seroma Occurred Early after Laparoscopic Total Extraperitoneal Hernia Repair (TEP): a Case Report and Literature Review

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