The European hernia society groin hernia classication: simple and easy to remember

Adult groin hernia surgery in sub-Saharan Africa: a 20-year systematic review and meta-analysis

PURPOSE

To realize a systematic review to evaluate groin hernia surgery for adults in sub-Saharan Africa.

METHODS

We conducted a systematic review and meta-analysis, the primary objective of which was to determine the surgical techniques used for unilateral groin hernia surgery in sub-Saharan Africa. Studies published in the last 20 years were considered. A meta-analysis estimated the pooled prevalence with 95% confidence interval (CI) of mortality, chronic pain and recurrence. A subgroup analysis compared the rate of complications between complicated or uncomplicated hernia.

RESULTS

We included 113 articles. The most used technique was Bassini in 40.1%, followed by Lichtenstein in 29.9% and Shouldice in 12.6%. The overall mortality rate was 0.6% (95% CI 0.4-0.9). The pooled recurrence rate was 1.4% (95% CI 1.05-1.9). The pooled rate of chronic pain was 2.7% (95% CI 1.9-3.7). We found that mortality rate for complicated hernias (6.4%) was higher compared to uncomplicated hernias (0.2%). This difference was statistically significant [p ≤ 0.001; OR = 47.7; 95 CI (27.2-83.47)].

CONCLUSION

This review showed that pure tissue repairs are the most used techniques with Bassini and Shouldice as leading procedures. The post-operative rates of recurrence and chronic pain are low. However, there is a high heterogeneity between studies than can underestimate these pooled prevalences. The consultation at complication stage remains frequent and associated with a higher mortality. Futures studies should focus on improving the quality of studies in terms of design and follow-up to increase the degree of evidence.

Primary ventral or groin hernia in pregnancy: a cohort study of 20,714 women

BACKGROUND

Prevalence, management, and risk of emergency operation for primary ventral or groin hernia in pregnancy are unknown. The objective of this study was to estimate the prevalences of primary ventral or groin hernia in pregnancy and the potential risks for elective and emergency repair.

METHODS

This single-institutional retrospective study included all pregnant women attending one or more prenatal consultations at Hvidovre Hospital, Denmark, during a 3-year period. Patients' medical records were electronically retrieved. A free-text search algorithm and subsequent manual review was conducted to identify patients registered with a primary ventral or groin hernia in pregnancy. Follow-up was conducted by review of medical record notes within the Capital Region of Denmark supplemented with structured telephone interviews on indication.

RESULTS

In total, 20,714 pregnant women were included in the study cohort. Seventeen (0.08%) and 25 (0.12%) women were registered with a primary ventral and groin hernia, respectively. None underwent elective or emergency repair in pregnancy, and all had uncomplicated childbirth. In 10 women, the groin bulge disappeared spontaneously after delivery. During postpartum follow-up of median 4.4 years (range 0.2-6.0 years), five (0.02%) and four (0.02%) underwent elective primary ventral and groin hernia repair, respectively.

CONCLUSION

Primary ventral or groin hernia seems rare in pregnancy, and the incidence of emergency repair is extremely low. Watchful waiting strategy is recommended during pregnancy in women suspected for a primary ventral or groin hernia.