Update of the international HerniaSurge guidelines for groin hernia management

Cesare Stabilini¹, Nadine van Veenendaal², Eske Aasvang^{3

4}, Ferdinando Agresta⁵, Theo Aufenacker⁶, Frederik Berrevoet⁷, Ine Burgmans⁸, David Chen⁹, Andrew de Beaux¹⁰, Barbora East¹¹, Jose Garcia-Alamino¹², Nadia Henriksen¹³, Ferdinand Köckerling¹⁴, Jan Kukleta¹⁵, Maarten Loos^{16

17}, Manuel Lopez-Cano¹⁸, Ralph Lorenz¹⁹, Marc Miserez²⁰, Agneta Montgomery²¹, Salvador Morales-Conde²², Chris Oppong²³, Maciej Pawlak²⁴, Mauro Podda²⁵, Wolfgang Reinpold²⁶, David Sanders²⁴, Alberto Sartori²⁷, Hanh Minh Tran²⁸, Mireia Verdaguer¹⁸, Reiko Wiessner²⁹, Michael Yeboah³⁰, Willem Zwaans^{16

17}, Maarten Simons³¹

Affiliations

¹ Department of Surgery (DISC), University of Genoa, Genoa, Italy.
² Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
³ Department of Anaesthesiology, The Centre for Cancer and Organ Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
⁴ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁵ Department of Surgery, Vittorio Veneto General Hospital, Vittorio Veneto, Italy.
⁶ Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
⁷ Department of Surgery, University Hospital Ghent, Ghent, Belgium.
⁸ Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
⁹ David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
¹⁰ Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
¹¹ Department of Surgery, Fakultní Nemocnice v Motole, Prague, Czech Republic.
¹² Department of Surgery, Universitat Ramon Llull, Barcelona, Spain.
¹³ Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark.
¹⁴ Vivantes Hospital Berlin, Academic Teaching Hospital of Charité University Medicine, Berlin, Germany.
¹⁵ Department of Surgery, Klinik Im Park, Zurich, Zurich, Switzerland.
¹⁶ SolviMáx Centre of Excellence for Abdominal Wall and Groin Pain, Eindhoven, The Netherlands.
¹⁷ Department of General Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
¹⁸ Department of Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
¹⁹ Department of Surgery, Hernia Center 3+CHIRURGEN, Berlin, Germany.
²⁰ Department of Surgery, KU Leuven-University Hospital Leuven, Leuven, Belgium.
²¹ Department of Surgery, Skåne University Hospital, Malmö, Sweden.
²² Department of Surgery, Universidad de Sevilla, Sevilla, Spain.
²³ Department of Surgery, Derriford Hospital Plymouth, Plymouth, UK.
²⁴ North Devon Comprehensive Hernia Centre, North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK.
²⁵ Department of Surgery, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy.
²⁶ Department of Surgery, Gross-Sand Hospital Hamburg, Hamburg, Germany.
²⁷ Department of Surgery, Ospedale Civile di Montebelluna, Montebelluna, Italy.
²⁸ Westmead Clinical School, Sydney Medical School, University of Sydney, New Galles, Australia.
²⁹ Department of Surgery, Bodden-Kliniken Ribnitz-Damgarten GmbH, Ribnitz-Damgarten, Germany.
³⁰ Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, P.M.B., Kumasi, West Africa.
³¹ Department of Surgery, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, The Netherlands.

PMID: 37862616
PMCID: PMC10588975
DOI: 10.1093/bjsopen/zrad080

Update of the international HerniaSurge guidelines for groin hernia management

Cesare Stabilini et al. BJS Open. 2023.

. 2023 Sep 5;7(5):zrad080.

doi: 10.1093/bjsopen/zrad080.

Authors

Affiliations

¹ Department of Surgery (DISC), University of Genoa, Genoa, Italy.
² Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
³ Department of Anaesthesiology, The Centre for Cancer and Organ Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
⁴ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁵ Department of Surgery, Vittorio Veneto General Hospital, Vittorio Veneto, Italy.
⁶ Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
⁷ Department of Surgery, University Hospital Ghent, Ghent, Belgium.
⁸ Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
⁹ David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
¹⁰ Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
¹¹ Department of Surgery, Fakultní Nemocnice v Motole, Prague, Czech Republic.
¹² Department of Surgery, Universitat Ramon Llull, Barcelona, Spain.
¹³ Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark.
¹⁴ Vivantes Hospital Berlin, Academic Teaching Hospital of Charité University Medicine, Berlin, Germany.
¹⁵ Department of Surgery, Klinik Im Park, Zurich, Zurich, Switzerland.
¹⁶ SolviMáx Centre of Excellence for Abdominal Wall and Groin Pain, Eindhoven, The Netherlands.
¹⁷ Department of General Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
¹⁸ Department of Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
¹⁹ Department of Surgery, Hernia Center 3+CHIRURGEN, Berlin, Germany.
²⁰ Department of Surgery, KU Leuven-University Hospital Leuven, Leuven, Belgium.
²¹ Department of Surgery, Skåne University Hospital, Malmö, Sweden.
²² Department of Surgery, Universidad de Sevilla, Sevilla, Spain.
²³ Department of Surgery, Derriford Hospital Plymouth, Plymouth, UK.
²⁴ North Devon Comprehensive Hernia Centre, North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK.
²⁵ Department of Surgery, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy.
²⁶ Department of Surgery, Gross-Sand Hospital Hamburg, Hamburg, Germany.
²⁷ Department of Surgery, Ospedale Civile di Montebelluna, Montebelluna, Italy.
²⁸ Westmead Clinical School, Sydney Medical School, University of Sydney, New Galles, Australia.
²⁹ Department of Surgery, Bodden-Kliniken Ribnitz-Damgarten GmbH, Ribnitz-Damgarten, Germany.
³⁰ Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, P.M.B., Kumasi, West Africa.
³¹ Department of Surgery, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, The Netherlands.

PMID: 37862616
PMCID: PMC10588975
DOI: 10.1093/bjsopen/zrad080

Erratum in

Corrigendum to: Update of the international HerniaSurge guidelines for groin hernia management.
[No authors listed] [No authors listed] BJS Open. 2024 Mar 1;8(2):zrae034. doi: 10.1093/bjsopen/zrae034. BJS Open. 2024. PMID: 38484113 Free PMC article. No abstract available.

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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Figures

**Fig. 1**
The proposed algorithm for the treatment of acute hernias

See this image and copyright information in PMC

References

1. HerniaSurge Group . International guidelines for groin hernia management. Hernia 2018;22:1–165 - PMC - PubMed
1. van Veenendaal N, Simons M, Hope W, Tumtavitikul S, Bonjer J; HerniaSurge Group . Consensus on international guidelines for management of groin hernias. Surg Endosc 2020;34:2359–2377 - PubMed
1. Vu JV, Gunaseelan V, Krapohl GL, Englesbe MJ, Campbell DA Jr, Dimick JB et al. Surgeon utilization of minimally invasive techniques for inguinal hernia repair: a population-based study. Surg Endosc 2019;33:486–493 - PMC - PubMed
1. Ehlers AP, Thumma JR, Howard R, Davidson GH, Waljee JF, Dimick JB et al. Guideline-discordant care among females undergoing groin hernia repair: the importance of sex as a biologic variable. Hernia 2022;26:823–829 - PubMed
1. Ehlers AP, Vitous CA, Sales A, Telem DA. Exploration of factors associated with surgeon deviation from practice guidelines for management of inguinal hernias. JAMA Netw Open 2020;3:e2023684. - PMC - PubMed

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Update of the international HerniaSurge guidelines for groin hernia management

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Update of the international HerniaSurge guidelines for groin hernia management

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