title: Management of the hernial sac in inguinal hernia repair.
abstract: BACKGROUND
  There is no consensus on the best management of the indirect hernial sac in groin hernia surgery. The aim of this study was to investigate to what extent different management options are associated with reoperation for recurrence.
  
  
  METHODS
  This study used data from the Swedish Hernia Register. Surgeons registered whether the indirect hernial sac was managed by division (leaving the distal part in place), excision or invagination.
  
  
  RESULTS
  An indirect hernia was found in 48 433 operations; the sac was excised in 49.5 per cent, invaginated in 37.6 per cent and divided in 12.9 per cent of operations. The 5-year cumulative reoperation incidence was 1.7 per cent for hernial sac excision, 1.7 per cent for division and 2.7 per cent for invagination. For indirect hernia repair, the relative risk of reoperation for recurrence was 0.63 (95 per cent confidence interval 0.51 to 0.79) for excision of the sac and 0.72 (0.53 to 0.99) for division compared with invagination. Lichtenstein repair combined with hernial sac excision had a 5-year cumulative reoperation incidence of only 1.0 per cent.
  
  
  CONCLUSIONS
  Excision of the indirect hernial sac in inguinal hernia repair is associated with a lower risk of hernia recurrence than division or invagination.
authors.affiliation: Department of Surgery, Umeå University Hospital, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Stylianidis
authors.forename: M M
authors.initials: MM
authors.lastname: Haapamäki
authors.forename: M
authors.initials: M
authors.lastname: Sund
authors.forename: E
authors.initials: E
authors.lastname: Nilsson
authors.forename: P
authors.initials: P
authors.lastname: Nordin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D055815:Young Adult