A clinical classification for patients with inguinal hernia

Excerpt

Surgeons with a range of competencies perform inguinal herniorrhaphy. A system of classification that stratifies hernia patients before operation would enable more complex cases to be delegated to treatment by the most skilled surgeons. Two clinical factors increase the difficulty of the operation: hernia size, which is readily quantifiable, and patient obesity in the operative area (groin-fat thickness), which is not. We correlated actual groin-fat thickness found at operation with skin-fold thickness at three sites and body mass index (BMI). Subscapular skin-fold thickness correlated well with groin-fat thickness (P=0.027), with a positive predictive value of 0.76. A score of 2–8, predicting grade of difficulty of repair can be generated from the size of the hernia (H1–H4) and the subscapular skin-fold thickness (F1–F4), which enables preoperative stratification into groups of difficulty to match the competency level of the operator. …