The Outcomes of Siriraj’s Classification for Giant Inguinal Hernia: A Literature Review and Metaanalysis

Watsaphon   Tangkullayanone; Chawisa  Nampoolsuksan; Thikhamporn   Tawantanakorn; Tharathorn   Suwatthanarak; Nicha   Srisuworanan; Voraboot   Taweerutchana; Thammawat  Parakonthun; Chinarong  Phalanusitthepha; Jirawat  Swangsri; Thawatchai  Akaraviputh; Asada  Methasate; Vitoon  Chinswangwatanakul; Atthaphorn  Trakarnsanga

doi:10.33192/smj.v78i5.280511

Authors

Watsaphon Tangkullayanone Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Chawisa Nampoolsuksan Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Thikhamporn Tawantanakorn Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Tharathorn Suwatthanarak Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Nicha Srisuworanan Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Voraboot Taweerutchana Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Thammawat Parakonthun Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Chinarong Phalanusitthepha Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Jirawat Swangsri Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Thawatchai Akaraviputh Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Asada Methasate Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Vitoon Chinswangwatanakul Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Atthaphorn Trakarnsanga Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.33192/smj.v78i5.280511

Keywords:

Giant inguinal hernia, hernia repair, surgical outcomes, postoperative complications, classification, meta-analysis

Abstract

Objective: Giant inguinal hernia is a rare condition associated with high perioperative morbidity. Siriraj’s classification was developed to guide surgical management according to hernia extent; however, clinical outcome data remain limited. This study aimed to evaluate postoperative complications associated with giant inguinal hernia repair according to Siriraj’s classification.

Materials and Methods: A literature review and proportion meta-analysis were conducted to assess the surgical outcomes of giant inguinal hernia repair. PubMed and Google Scholar were systematically searched for studies reporting surgical management and complications of giant inguinal hernia. Studies were included if the hernia type could be classified according to Siriraj’s classification or sufficient clinical information was available. The primary outcome was postoperative complications. Pooled complication rates with 95% confidence intervals (CI) were calculated using fixed- or random-effects models based on heterogeneity.

Results: Ten studies involving 101 giant inguinal hernias were included in the meta analysis. The overall postoperative complication rate was 35% (95% CI: 0.17–0.59). Type I giant inguinal hernia showed a complication rate of 43%, while non-Type I hernias demonstrated a complication rate of 37%. Although overall complication rates were comparable, major complications were predominantly observed in cases not adhering to Siriraj’s classification. Protocol adherence was significantly associated with reduced risk of major complications (odds ratio 0.007, 95% CI: 0.0003–0.142; p=0.0013).

Conclusion: Siriraj’s classification provides a practical framework for guiding surgical management of giant inguinal hernia and may reduce major postoperative complications. Further large-scale studies are required to validate these findings.

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