Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Mar;49(3):590-604.
doi: 10.1002/wjs.12474. Epub 2025 Jan 24.

Comparison of Hernia Sac Transection and Full Sac Reduction for the Treatment of Inguinal Hernias: A Systematic Review and Meta-Analysis of Clinical Trials

Roberto Cirocchi  1 , Georgi I Popivanov  2 , Maria Chiara Cianci  3 , Antonino Morabito  3 , Matteo Matteucci  4 , Sara Lauricella  5 , Diletta Cassini  6 , Carlo Boselli  1 , Ivan Szergyuk  7 , Giovanni Domenico Tebala  8 , Antonia Rizzuto  9 , Paolo Bruzzone  10
Affiliations
Meta-Analysis

Comparison of Hernia Sac Transection and Full Sac Reduction for the Treatment of Inguinal Hernias: A Systematic Review and Meta-Analysis of Clinical Trials

Roberto Cirocchi et al. World J Surg. 2025 Mar.

Abstract

Background: The history of inguinal hernia repair has been marked by the description of several therapies over ages, each with its own approach to managing the hernial sac. An analysis of hernia sac transection (with or without high ligation) versus reduction (invagination) in adults who underwent Lichtenstein open tension-free inguinal hernia repair and in adult and pediatric patients who underwent suture repair has been the primary aim of this systematic review and meta-analysis.

Methods: The authors conducted a comprehensive review and meta-analysis. A comprehensive literature search yielded 15 publications, consisting of 12 randomized controlled trials (RCTs) including 1598 patients and 3 controlled clinical trials (CCTs) including 243 patients. In total, the included patients amounted to 1.841.

Results: Analysis of the data revealed a lower rate of recurrence in patients who had sac reduction (0.35% in randomized controlled trials and 0 in clinical trials) compared to patients who had sac excision and ligation (0.86% in randomized controlled trials and 0.93% in clinical trials). However, this difference was not statistically significant (RCTs: relative risk 2.94 [0.30, 29.24]-CCTs: relative risk 4.46 [0.18, 111.36]).

Conclusion: The reduction of sacs does not result in a statistically significant decrease in recurrence compared to patients who underwent sac excision and subsequent ligation. This study has demonstrated that the various courses of treatment for the inguinal hernia sac have similar primary and secondary outcomes in both adult and pediatric patients.

Keywords: hernia sac reduction; hernia sac transection; inguinal hernia.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flow chart for systematic review and meta‐analysis.
FIGURE 2
FIGURE 2
Risk of bias domains for included studies RCTs using the Rob2 tool.
FIGURE 3
FIGURE 3
Risk of bias domains for included studies CCTs using the Rob1.
FIGURE 4
FIGURE 4
(a) Postoperative recurrence at 1 year or longer after the initial hernia surgery. (b) Postoperative recurrence at 1 year or longer in different groups of age (adult vs. pediatric).
FIGURE 5
FIGURE 5
Chronic postoperative pain in cases of sac excision and ligation versus sac reduction.
FIGURE 6
FIGURE 6
(a) Postoperative pain at 24 h after sac excision and ligation versus sac reduction. (b) Postoperative pain at 24 days after sac excision and ligation versus sac reduction.
FIGURE 7
FIGURE 7
(a) Postoperative pain at 7 days after sac excision and ligation versus sac reduction. (b) Postoperative pain at 7 days after sac excision and ligation versus sac reduction.
FIGURE 8
FIGURE 8
Hematoma after sac excision and ligation versus sac reduction.
FIGURE 9
FIGURE 9
Wound infection after sac excision and ligation versus sac reduction.
FIGURE 10
FIGURE 10
Wound seroma after sac excision and ligation versus sac reduction.
FIGURE 11
FIGURE 11
Scrotal edema after sac excision and ligation versus sac reduction.
FIGURE 12
FIGURE 12
Urinary retection after sac excision and ligation versus sac reduction.
See this image and copyright information in PMC

References

    1. Köckerling F. and Simons M. P., “Current Concepts of Inguinal Hernia Repair,” Visceral Medicine 34, no. 2 (April 2018): 145–150: Epub 2018 Mar 26. PMID: 29888245; PMCID: PMC5981671, 10.1159/000487278. - DOI - PMC - PubMed
    1. The HerniaSurge Group , “International Guidelines for Groin Hernia Management,” Hernia 22, no. 1 (February 2018): 1–165: Epub 2018 Jan 12. PMID: 29330835; PMCID: PMC5809582, 10.1007/s10029-017-1668-x. - DOI - PMC - PubMed
    1. Hewitt D. B. and Chojnacki K., “Groin Hernia Repair by Open Surgery,” JAMA 318, no. 8 (August 22, 2017): 764: PMID: 28829878, 10.1001/jama.2017.9868. - DOI - PubMed
    1. Stylianidis G., Haapamäki M. M., Sund M., Nilsson E., and Nordin P., “Management of the Hernial Sac in Inguinal Hernia Repair,” British Journal of Surgery 97, no. 3 (March 2010): 415–419, 10.1002/bjs.6890.PMID: 20104504. - DOI - PubMed
    1. Shulman A. G., Amid P. K., and Lichtenstein I. L., “Ligation of Hernial Sac. A Needless Step in Adult Hernioplasty,” International Surgery 78, no. 2 (April‐June 1993): 152–153: PMID: 8354615. - PubMed