Outcomes in the surgical management of giant inguinal hernias: A systematic review

Giant inguinal hernia presents a range of unique challenges in its treatment. Detailing the potential complications and outcomes of treatment can motivate patients with giant inguinal hernias (GIH) to seek an early surgical intervention and raise awareness of the risks of neglecting the condition. The aim of this review is to identify the rates of complications, especially the abdominal compartment syndrome, and the causes of mortality encountered in the treatment of GIH. Furthermore, a new classification system for GIH is proposed. The search resulted in 1,926 papers, and 10 papers were included in the study. The majority of the studies were conducted on subjects living in sub-Saharan Africa. The most frequently performed procedure was Nylon Darning, accounting for 46.5% and only 53 (12.5%) were laparoscopic repair. There were four deaths reported in two studies. Two were caused by pulmonary embolism, whereas renal failure and abdominal compartment syndrome were the causes of one death each. After a proportional meta-analysis, the pooled complication rate of the surgical interventions was 39% (95% confidence interval: 0.18-0.59) with a random effect model I-2 = 82.6%. There was no recurrence in any of the studies. The complication rate for treating giant inguinal hernia is high but mortality is low. There was zero recurrence despite some subjects undergoing modified Bassini repair. Further research is needed to identify predictors of abdominal compartment syndrome and intra-abdominal hypertension. The proposed classification also requires further study on a large scale.