Interpretation of the updated international guidelines for groin hernia management (2023)

doi:10.16139/j.1007-9610.2024.04.08

Abstract

Abstract:

Since the International guidelines for groin hernia management were published in 2018, many new evidences have been published. In October 2023, the HerniaSurge Group published Update of the international HerniaSurge guidelines for groin hernia management. It updated eight chapters of the last guidelines, proposed 20 key questions, and 39 new statements and 32 recommendations, of which 16 were strong recommendations. This article combined clinical concerns to sort out and interpret the updated version.

Key words: Groin hernia, Hernia repair, Guidelines interpretation

CLC Number:

R656.21

XU Jing, ZHUANG Qiulin, DONG Ruizhao, YANG Ziang. Interpretation of the updated international guidelines for groin hernia management (2023)[J]. Journal of Surgery Concepts & Practice, 2024, 29(04): 316-322.

Figures/Tables 1

Tab 1

recommendations of Updated international guidelines for groin hernia management

编号	推荐意见	推荐强度
1	对于大多数病人，推荐使用补片行腹股沟疝修补。	强
2	腹股沟疝修补术的无补片修复，如有专业知识，建议在仔细选择病人和共同决策后推荐行组织修复。	弱
3	推荐在无补片腹股沟疝修补术中使用 Shouldice技术。	强
4	在开放手术中，在有专业知识和能力的前提下，腹膜前平补片技术似乎是Lichtenstein术一种可接受的替代方案，至少两者的结果相同。	弱
5	对于初发单侧腹股沟疝病人（所有性别），推荐使用腹腔镜技术，因为术后疼痛发生率较低，慢性疼痛发生率较低，前提是外科医师具有特定专业知识和足够的资源。然而，仍有特定的病人和特殊类型的疝需以Lichtenstein为首选。	强（升级）
6	在知情同意时，建议与病人讨论是否对腹腔镜修复单侧疝中发现的对侧隐匿疝行修复。	弱
7	根据大多数随机对照试验，推荐将区分聚丙烯补片类型的阈值定义为：轻量型补片(LWM)<50 g/m²；重量型补片（HWM）>70 g/m²。	强（升级）
8	在Lichtenstein修复中，推荐使用LWM以减少术后慢性疼痛和异物感的发生。	强
9	在腹腔镜修补术中，推荐使用HWM，尤其是在大型直疝中，以降低复发风险。不推荐使用LWM，因为其不会降低术后疼痛的风险，但会增加复发的风险。	强（升级）
10	在低感染风险的环境中，不推荐在平均风险病人的择期开放性腹股沟疝修补术中应用预防性抗生素。	强
11	建议在感染风险较低的环境中，对高危病人进行选择性开放性腹股沟疝修补术，应用预防性抗生素。	弱
12	对于高危环境中的任何病人，推荐在选择性开放性腹股沟疝修补术中应用预防性抗生素。	强
13	在任何病人和任何风险环境中，都不建议在选择性腹腔镜腹股沟疝修补术中应用预防性抗生素。	弱
14	推荐使用一代头孢菌素和β-内酰胺酶抑制剂作为预防性抗生素药物。	强
15	对于有经验的外科医师/团队，推荐局部麻醉用于开放可复性腹股沟疝的修复。	强
16	如正确应用，局部麻醉是体弱或有合并症的病人全身或区域麻醉的替代方法。	弱
17	对于65岁及以上的病人，建议全身或局部麻醉，而不是区域麻醉。	弱
18	推荐明确告知病人术后慢性腹股沟疼痛（CPIP）手术有效性的证据级别很低，且有疼痛加剧和其他并发症的风险。	强（升级）
19	推荐根据最初的疝修补方法、外科医师的经验、疼痛的分布及症状、体格检查结果和潜在的放射学图像，建议采用定制的CPIP手术方法（神经切除术，开放式网片切除或组合）。	弱
20	显微精索去神经术仅在研究环境中进行。	弱
21	CPIP的处理很复杂。推荐根据当地情况，由经验丰富的多学科团队将CPIP评估和治疗集中在专科中心。	强（升级）
22	推荐药物和介入措施（包括治疗性注射治疗）至少持续3个月（疝手术后至少6个月）。	弱
23	嵌顿疝一词应弃用，因其不能正确描述急性疝的问题，可用急性不可复疝代替。	强(升级）
24	管理急性症状性腹股沟疝中潜在的肠缺血时，建议将临床症状与生化参数结合使用，因为后者的特异性较低，不应单独使用，可结合临床症状和体征来帮助决定急性症状性腹股沟疝的治疗。	弱
25	建议在所有急性不可复性疝中尝试手动复位，而无需顾虑肠缺血。成功复位后，应对病人观察一段时间，直到镇痛/镇静药物作用消失，病人仍无不适才能离院。如手动复位不成功，则需行紧急手术。	弱
26	当怀疑有绞窄或手动复位不成功时，推荐立即进行紧急手术。	强(升级）
27	推荐了急诊腹股沟疝处理流程。
28	处理急性难复性腹股沟疝时，如有专业知识和资源且病人的条件允许，推荐使用诊断性腹腔镜检查。	弱
29	如有专业知识，可尝试腹腔镜疝修补术。无论是否存在肠绞窄，推荐对腹股沟疝行个体化平面补片修补术，以提供尽可能好的预后。	弱
30	对于肠绞窄和（或）同时行肠切除（清洁-污染的手术区域）的病人，可以使用补片，尤其是大网孔补片修补。	弱
31	当使用未经许可的低成本补片时，推荐在当地层面的相关部门进行结果审计。	弱
32	当使用未经许可的低成本补片时，推荐充分了解补片的类型、来源和最安全的消毒方法。	强（升级）

Tab 1

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