ABD-HER-FEM-COMP-01 · Bowel resection at emergency femoral repair
of emergency femoral repairs required bowel resection vs of emergency inguinal repairs
Bowel resection during emergency repair
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-FEM-COMP-01 · Bowel resection at emergency femoral repair
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed Basis — n / evidence base 325 resections (femoral) vs 363 (inguinal)
Evidence tier (the registry's wording) National register — abstract verified + guideline full text concordant
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-FEM-COMP-02 · 30-day mortality, emergency vs elective femoral repair in women
30-day mortality by setting
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-FEM-COMP-02 · 30-day mortality, emergency vs elective femoral repair in women
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed Swedish + Danish register data, women
Basis — n / evidence base Register cohorts as pooled in HerniaSurge Ch 16
Evidence tier (the registry's wording) Guideline-carried national register data — full text opened
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-FEM-CTX-01 · Missed femoral hernia found at reoperation
of reoperations in women after anterior "inguinal" repair find a femoral hernia
Femoral hernia found at reoperation for recurrence after an anterior repair performed/booked as "inguinal"
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-FEM-CTX-01 · Missed femoral hernia found at reoperation
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed Women, SHR (Koch et al. 2005; HerniaSurge Ch 16)
Basis — n / evidence base 6,895 women (Koch 2005 cohort)
Evidence tier (the registry's wording) National register studies — review + guideline full texts opened
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-FEM-EMERG-01 · Emergency presentation of femoral hernia
of femoral repairs were emergencies (SHR) — guideline synthesis — vs of inguinal repairs. By sex: of femoral repairs were emergencies
Repairs performed as emergencies (incarcerated/strangulated presentation)
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-FEM-EMERG-01 · Emergency presentation of femoral hernia
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed SHR 1992–2006; Swedish + Danish registers (HerniaSurge Ch 16)
Basis — n / evidence base 3,980 femoral repairs within 138,309 groin repairs
Evidence tier (the registry's wording) National registers via primary paper + guideline — guideline full text opened, primary abstract verified
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-FEM-PREV-01 · Femoral hernia as a share of groin hernia repairs
of groin procedures were femoral (1992–2006), rising to of women's hernias in 2021 ·
Femoral repairs as a proportion of all groin hernia repairs/procedures
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-FEM-PREV-01 · Femoral hernia as a share of groin hernia repairs
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed Swedish Hernia Register 1992–2006 (n=138,309 groin repairs); SHR annual data to 2021; HerniaSurge Ch 17 synthesis
Basis — n / evidence base 3,980 femoral repairs (1,490 men, 2,490 women) in the SHR analysis
Evidence tier (the registry's wording) National register + guideline — register review and guideline full texts opened, register primary abstract verified
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-INC-COMP-01 · Seroma after prophylactic mesh (PRIMA)
wound infection did differ between arms
Clinically detected seroma by arm
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-INC-COMP-01 · Seroma after prophylactic mesh (PRIMA)
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed Basis — n / evidence base Evidence tier (the registry's wording) Multicentre RCT — abstract verified + full-text excerpts
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-INC-PM-01 · Incisional hernia at 2 years after prophylactic mesh at closure
onlay OR 0.37 (0.20–0.69), sublay OR 0.55 (0.30–1.00)
CT/US/examination-detected IH at 2 years
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-INC-PM-01 · Incisional hernia at 2 years after prophylactic mesh at closure
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed High-risk elective midline laparotomy only (AAA or BMI ≥27), 11 hospitals, RCT
Basis — n / evidence base Evidence tier (the registry's wording) Multicentre RCT — abstract verified + full-text excerpts
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-INC-PM-02 · Incisional hernia at 5 years (long-term PRIMA)
HR 0.390 (onlay) / 0.485 (sublay). AAA subgroup with suture closure reached
Radiological-inclusive IH detection (examination + CT/US) at 5 years
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-INC-PM-02 · Incisional hernia at 5 years (long-term PRIMA)
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed Same high-risk RCT cohort, long-term follow-up
Basis — n / evidence base n=480 cohort, 5-year analysis set
Evidence tier (the registry's wording) RCT long-term follow-up — full text PDF opened
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-INC-PREV-01 · Incisional hernia after midline laparotomy
(range 0–35.6%) · . Within MA-2: prospective studies vs retrospective — detection method moves the number
Clinically/radiologically detected incisional hernia after midline incision, mixed follow-up
🔴 Disputed · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-INC-PREV-01 · Incisional hernia after midline laparotomy
🔴 Disputed. Sources disagree — the dispute table is on the card
Applies to — the population, exactly as printed MA-1 (2015): 83 study groups, all midline series of the era, weighted mean FU 23.7 months · MA-2 (2026): 20 cohort studies, open midline laparotomy only, mean FU 39.6 months
Basis — n / evidence base MA-1 n=14,618 · MA-2 n=790,800
Evidence tier (the registry's wording) Two SR/MAs — both full texts opened (journal pages)
Dispute — the sources disagree Source · Figure · Population · Definition/detection · Follow-up · Year
Bosanquet et al., PLoS One (DOI 10.1371/journal.pone.0138745) · 12.8% (range 0–35.6%) · 83 study groups, n=14,618 · mixed detection (clinical/imaging) · weighted mean 23.7 months · 2015
Lozada Hernandez et al., JAWS (DOI 10.3389/jaws.2026.15439) · 10.1% (7–15%) · 20 cohort studies, open midline laparotomy only, n=790,800 · mixed; and internally: prospective studies 15.2% vs retrospective 9.5% · mean 39.6 months · 2026
Why they differ
Difference of era and study composition, and above all the detection method: prospective studies with scheduled examination capture hernias that never reach the records at all — the internal difference in the 2026 analysis (15.2% vs 9.5%) explains the difference between the two analyses better than any other explanation.
Adopted
An inclusive range of ~10–13% under both analyses' names together, with the mandatory detection sentence; no single point. (Protocol rule 6: both parties are strong, so the inclusive range is published.)
Grade yourself — spaced repetition
Verification stamp: 🔴 Disputed · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-INC-REC-01 · Recurrence by mesh position, open ventral/incisional repair
, probability of being best ; SSI OR 0.449 (0.12–1.16), probability-best 77.3%
Network meta-analysis odds ratios for recurrence (and SSI) vs reference position
🟡 Qualified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-INC-REC-01 · Recurrence by mesh position, open ventral/incisional repair
🟡 Qualified. Single source, or abstract-level verification — provisional
Applies to — the population, exactly as printed 21 studies, mixed primary/recurrent open ventral repairs
Basis — n / evidence base Evidence tier (the registry's wording) Network meta-analysis — abstract verified (paywalled full text)
Grade yourself — spaced repetition
Verification stamp: 🟡 Qualified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-INC-RISK-01 · Risk factors for incisional hernia after open midline laparotomy
Multivariable pooled hazard ratios, MA of 20 cohort studies (n=790,800)
🟡 Qualified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-INC-RISK-01 · Risk factors for incisional hernia after open midline laparotomy
🟡 Qualified. Single source, or abstract-level verification — provisional
Applies to — the population, exactly as printed Open midline laparotomy cohorts
Evidence tier (the registry's wording) Large MA — full text opened; single pooled source for the HR set
Grade yourself — spaced repetition
Verification stamp: 🟡 Qualified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-INC-RISK-02 · Obesity (BMI ≥30) as a risk factor — disputed
in the pooled open-midline analysis; several component studies also null
Pooled HR for BMI ≥30 vs <30 in the same MA; individual studies used inconsistent cut-offs (≥25 vs ≥30)
🔴 Disputed · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-INC-RISK-02 · Obesity (BMI ≥30) as a risk factor — disputed
🔴 Disputed. Sources disagree — the dispute table is on the card
Applies to — the population, exactly as printed Evidence tier (the registry's wording) Large MA — full text opened
Dispute — the sources disagree Source · Figure/position · Population · Year
Lozada Hernandez MA (DOI 10.3389/jaws.2026.15439) · BMI ≥30: HR 1.34 (0.98–1.85) — not significant; several component studies also null; weight cut-offs inconsistent between studies (≥25 vs ≥30) · open midline laparotomy, n=790,800 · 2026
Composite risk models + PRIMA entry criterion · high weight is a risk component; PRIMA required BMI ≥27 as one of two entry criteria for the 'high risk' category · the PRIMA trial (PMID 28641875) · 2017
Adopted
No single 'obesity OR' is published anywhere in this guide. The adopted patient wording is qualitative ('it often increases the risk, by an unsettled amount'), and for the doctor the full HRs table, where obesity appears in its true place: at the bottom of the list and just above zero.
Grade yourself — spaced repetition
Verification stamp: 🔴 Disputed · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-INC-SUC-01 · Small-bites vs large-bites fascial closure
adjusted OR 0.52 (0.31–0.87)
Incisional hernia at 1 year (clinical ± US)
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-INC-SUC-01 · Small-bites vs large-bites fascial closure
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed STITCH trial: elective midline laparotomy, multicentre RCT
Basis — n / evidence base Evidence tier (the registry's wording) Multicentre RCT — abstract verified + Lancet commentary full text; technique endorsed by the updated EHS/AHS abdominal-wall closure guideline (Deerenberg et al., *Br J Surg*, 2022;109:1239-50; DOI 10.1093/bjs/znac302)
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-INC-WW-01 · Emergency repair risk on watchful waiting, incisional
any later repair
Same cohort definition
🟡 Qualified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-INC-WW-01 · Emergency repair risk on watchful waiting, incisional
🟡 Qualified. Single source, or abstract-level verification — provisional
Applies to — the population, exactly as printed Danish nationwide cohort: 569 incisional referrals (WW 58.1%)
Evidence tier (the registry's wording) Nationwide cohort — abstract verified
Grade yourself — spaced repetition
Verification stamp: 🟡 Qualified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-ING-COMP-01 · Clinically significant chronic postoperative inguinal pain (CPIP)
Bothersome moderate pain impacting daily activities, ≥3 months postoperatively, decreasing over time (HerniaSurge definition)
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-ING-COMP-01 · Clinically significant chronic postoperative inguinal pain (CPIP)
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed Adults after groin hernia repair, guideline evidence synthesis
Evidence tier (the registry's wording) International guideline — full text opened
Dispute — the sources disagree Source · Figure · Definition/tool · Population
HerniaSurge 2018 (PMID 29330835) · 10–12% clinically significant; 0.5–6% disabling (and the first chapter's text: severe ~1–3%) · CPIP: moderate bothersome pain affecting daily activity ≥3 months · the guideline's pooling of repair studies
Jakobsson 2022 via the SHR review (PMID 38312425) · women 18.4% / men 15.2% at one year · postal IPQ questionnaire (threshold 'cannot be ignored/affects activities') · 4,021 women + comparators, SHR PROM
Why they differ
Three measurement tools, three time points and three populations — not three measurements of one thing. The postal questionnaire's rate exceeding the guideline estimate is expected (a self-report threshold), and the femoral-only rate after ~5 years cannot be compared with the rate for all repairs at one year.
Adopted
The three figures are published, each with its definition tied to it as on the cards; and strictly forbidden in every product of the guide is a headline of the type 'chronic pain after hernia X%' without a definition. - [x] The adopted-source box and the side-sources box are both present; and a 'not issued' section with eight explicit items.
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-ING-COMP-02 · Debilitating chronic pain
(guideline results summary); the guideline's Ch 1 text phrases severe chronic pain as "approximately 1–3%" — both wordings shown, see D5 note
Chronic pain affecting normal daily activities or work
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-ING-COMP-02 · Debilitating chronic pain
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed Adults after groin hernia repair
Evidence tier (the registry's wording) International guideline — full text opened
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-ING-COMP-03 · Patient-reported chronic groin pain at 1 year, by sex
reported chronic pain; reoperation *for pain* is rare overall ( ) but risk is higher in women (HR 2.13, 1.41–3.21)
Chronic pain on the Inguinal Pain Questionnaire (IPQ), SHR postal PROM at 1 year; moderate–severe = pain that cannot be ignored / affects daily activities
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-ING-COMP-03 · Patient-reported chronic groin pain at 1 year, by sex
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed SHR PROM cohort 2012–2018: 4,021 women with unilateral primary repair + male comparators
Evidence tier (the registry's wording) National register PROM studies — full text of the register review opened; primaries not individually opened
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-ING-CTX-01 · Occult contralateral inguinal hernia
of patients
Asymptomatic contralateral hernia found at laparoscopy during unilateral repair
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-ING-CTX-01 · Occult contralateral inguinal hernia
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed Adults at TAPP exploration
Basis — n / evidence base Studies pooled in HerniaSurge Ch 8 (TEP series range wider, 5–58%, definition-dependent)
Evidence tier (the registry's wording) Guideline synthesis — full text opened
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-ING-EMERG-01 · Share of groin hernia repairs performed as emergencies, by sex
Emergency (unplanned, acute) repair as a proportion of all groin repairs
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-ING-EMERG-01 · Share of groin hernia repairs performed as emergencies, by sex
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed Swedish Hernia Register: Nilsson et al. era (to 2006) and cumulative 1992–2022
Evidence tier (the registry's wording) Guideline + national register review — both full texts opened
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-ING-EMERG-02 · Bowel resection during emergency inguinal repair
of emergent inguinal repairs (HerniaSurge rounds this to ~5%) — vs for emergent femoral (Part B)
Small/large bowel resection at emergency repair for incarcerated/strangulated inguinal hernia
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-ING-EMERG-02 · Bowel resection during emergency inguinal repair
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed Swedish Hernia Register, emergency repairs
Evidence tier (the registry's wording) National register — abstract verified + guideline full text concordant
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-ING-EMERG-03 · Mortality, elective vs emergency groin repair
(SRs); average mortality for emergent inguinal repair in the emergency-chapter review; morbidity 8% elective vs 32% emergency
30-day / perioperative mortality by setting
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-ING-EMERG-03 · Mortality, elective vs emergency groin repair
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed Systematic reviews pooled in HerniaSurge Ch 5 + emergency chapter review (18 publications, 7,404 emergency operations)
Evidence tier (the registry's wording) Guideline-carried SRs — full text opened
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-ING-PREV-01 · Lifetime occurrence of groin hernia
Occurrence of a groin hernia (inguinal or femoral) at any point in life
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-ING-PREV-01 · Lifetime occurrence of groin hernia
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed Adults, population data underlying the international guideline
Basis — n / evidence base Guideline synthesis of population studies (Primatesta-type data)
Evidence tier (the registry's wording) International guideline — full text opened
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-ING-REC-01 · Reoperation after repair of a recurrent hernia
(vs 1.7% after primary repair — SUC-02)
Reoperation for re-recurrence within 24 months
🟡 Qualified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-ING-REC-01 · Reoperation after repair of a recurrent hernia
🟡 Qualified. Single source, or abstract-level verification — provisional
Applies to — the population, exactly as printed Basis — n / evidence base Register cohort as pooled in HerniaSurge Ch 20
Evidence tier (the registry's wording) Single register system, guideline-carried
Grade yourself — spaced repetition
Verification stamp: 🟡 Qualified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-ING-SUC-01 · Recurrence, mesh vs non-mesh
(RR 0.46, 95% CI 0.26–0.80; NNT 46); neurovascular/visceral injury also lower with mesh (RR 0.61)
Clinically detected hernia recurrence, RCT follow-up (up to 5 years)
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-ING-SUC-01 · Recurrence, mesh vs non-mesh
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed Adults, primary inguinal (± femoral) repair, 21 RCTs
Basis — n / evidence base 5,575 participants (recurrence analysis); 6,293 total
Evidence tier (the registry's wording) Cochrane SR/MA — abstract + Summary of Findings table verified; mesh-first-choice position concordant in HerniaSurge full text
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-ING-SUC-02 · Reoperation for recurrence (registry proxy)
reoperation ·
Reoperation for recurrence as a proportion of primary repairs — a proxy: true recurrence is up to ~twice the reoperation rate (HerniaSurge)
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-ING-SUC-02 · Reoperation for recurrence (registry proxy)
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed National registers: Denmark (long-term, 2014 analysis); Sweden (24-month cumulative)
Basis — n / evidence base Register cohorts as pooled in HerniaSurge Ch 20
Evidence tier (the registry's wording) Guideline-carried national register data — full text opened
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-ING-WW-01 · Hernia accident rate during watchful waiting
at 2 years (Fitzgibbons JAMA 2006); over the 10-year follow-up — i.e.
Acute incarceration requiring emergency surgery ("hernia accident") per person-time on WW
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-ING-WW-01 · Hernia accident rate during watchful waiting
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed Men with asymptomatic / minimally symptomatic inguinal hernia, RCT cohorts
Basis — n / evidence base n=720 (JAMA 2006); long-term cohort (Ann Surg 2013)
Evidence tier (the registry's wording) RCT + long-term RCT follow-up, carried in the international guideline — guideline full text opened
Dispute — the sources disagree Source · Figure · Population · Year
Traditional teaching / the general-practice chapter in HerniaSurge · incarceration 'less than 3% per year' (and the old teaching 3–5%) · pre-trial estimates, mixed symptomatic patients · before 2006 and around it
Fitzgibbons JAMA 2006 + Ann Surg 2013 follow-up (within HerniaSurge Ch 5, full text) · 1.8 per 1,000 patient-years at two years; 0.2 per 100 person-years over 10 years · men with no/minimal symptoms in a randomised trial · 2006/2013
Why they differ
The old figure was born of series of patients who had already arrived with symptoms and emergencies (a selected denominator), while the new figure measured a population defined by waiting from day one.
Adopted
The trial-measured figure (~0.2% per year) alone is fit for counselling; the old figure is kept here only as a documented correction of a widespread piece of information.
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-ING-WW-02 · Crossover from watchful waiting to surgery, time-anchored
(95% CIs 25.2–32.5 / 47.4–55.6 / 66.2–74.9). Reasons: increased pain 57.6% of crossovers; incarceration only 4.4%
Cumulative proportion of WW patients undergoing repair (overwhelmingly elective, for pain)
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-ING-WW-02 · Crossover from watchful waiting to surgery, time-anchored
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed Men, asymptomatic/minimally symptomatic; IPD meta-analysis of the 3 WW RCTs (Fitzgibbons, O'Dwyer, INCA)
Basis — n / evidence base 3 RCTs, 592 participants; FU 3.2–12.0 years
Evidence tier (the registry's wording) IPD meta-analysis — publisher's abstract verified; component trials' long-term data verified in HerniaSurge full text (Fitzgibbons KM estimate 68% at 10 years; O'Dwyer 54% at 5 years)
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-PST-PM-01 · Prophylactic mesh vs no mesh at permanent end colostomy formation
updated SR/MA of (EHS/ESCP/EAES): PSH , I²=74%, moderate certainty; EHS rapid-guideline GRADE absolutes: long-term PSH , surgery for PSH 5% vs 2%. EHS position moved from to recommendation. STOMAMESH (largest double-blind multicentre RCT, n=232): in clinical (p=0.866) or radiological (p=0.748) PSH at 1 year, confirmed at 3 years; long-term MA + trial sequential analysis (Surgery 2024, 175:441-450) concluded prophylactic mesh does prevent PSH long-term
🔴 Disputed · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-PST-PM-01 · Prophylactic mesh vs no mesh at permanent end colostomy formation
🔴 Disputed. Sources disagree — the dispute table is on the card
Applies to — the population, exactly as printed Parastomal hernia (clinical ± radiological), RCT evidence
Evidence tier (the registry's wording) Guideline SR/MA + rapid guideline full texts opened · STOMAMESH abstract verified + 3-year result and 2024 MA/TSA carried via secondary sources (flagged)
Dispute — the sources disagree Source · Figure · Population/design · Definition · Follow-up · Year
Tzanis et al. SR/MA (DOI 10.3389/jaws.2023.11550) · OR 0.33 (0.18–0.62), I²=74% · 12 randomised trials · clinical ± imaging parastomal hernia · variable · 2023
EHS Rapid Guideline GRADE (DOI 10.3389/jaws.2023.11549) · long-term: 32% → 11%; hernia surgery 5% → 2% · the same trial base (in GRADE style) · mainly clinical · long · 2023
STOMAMESH (PMID 29064900) · no difference: clinical p=0.866, imaging p=0.748; confirmed at 3 years (PMID 35837972) · the largest blinded multicentre trial, n=232 · clinical and imaging separately · 1 then 3 years · 2019/2023
Verdaguer-Tremolosa et al., Surgery 175:441-450 · meta-analysis + trial sequential analysis: no long-term prevention · long-follow-up trials · mixed · long · 2024
Why they differ
The pooling gathers many small single-centre trials in a positive direction (heterogeneity I²=74%, high), while the largest blinded trial has a null result; and differing follow-up windows and detection definitions (imaging vs clinical) widen the gap. EHS's shift from 'strong' in 2018 to 'conditional' in 2023 is official recognition of this split.
Adopted
The EHS 2023 conditional position, verbatim; there is no green figure for prophylactic mesh around a stoma in this guide, and the patient card presents the same disagreement. Any future update of this card starts from a new large blinded trial or an EHS update, not from an additional pooling of the same trials.
Grade yourself — spaced repetition
Verification stamp: 🔴 Disputed · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-PST-PREV-01 · Parastomal hernia incidence over time
Clinical ± radiological parastomal hernia after stoma formation; end colostomy = highest-risk type
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-PST-PREV-01 · Parastomal hernia incidence over time
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed EHS guideline evidence statement; corroborated by the EHS/ESCP/EAES updated SR/MA introduction ("up to 50% long-term") and the EHS methodology overview ("as high as 41%" long-term in end colostomy)
Evidence tier (the registry's wording) Society guideline + two full texts — guideline statement verified, two corroborating full texts opened
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-UMB-COMP-01 · Early wound events, mesh vs suture (same RCT)
Seroma · Haematoma · Wound infection
Seroma, haematoma, wound infection — trial definitions; no statistically significant difference between arms
🟡 Qualified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-UMB-COMP-01 · Early wound events, mesh vs suture (same RCT)
🟡 Qualified. Single source, or abstract-level verification — provisional
Applies to — the population, exactly as printed Basis — n / evidence base Evidence tier (the registry's wording) Single RCT — full text opened
Grade yourself — spaced repetition
Verification stamp: 🟡 Qualified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-UMB-SUC-01 · Recurrence at 2 years, mesh vs suture repair
HR 0.31 (0.12–0.80); . Crude: 6/146 (4%) vs 17/138 (12%)
Recurrence (clinical ± imaging) — 2-year Kaplan–Meier actuarial estimates; crude rates shown alongside
🟢 Verified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-UMB-SUC-01 · Recurrence at 2 years, mesh vs suture repair
🟢 Verified. Confirmed in 2+ independent sources, full text opened
Applies to — the population, exactly as printed Adults, primary umbilical hernia 1–4 cm, double-blind multicentre RCT, median FU 25.1 months
Basis — n / evidence base n=300 randomised (150/150); 146/138 analysed
Evidence tier (the registry's wording) Multicentre double-blind RCT — full text PDF opened; direction corroborated by Shrestha et al. SR/MA (*Int J Surg*, 2019: recurrence OR 0.22 for mesh; DOI 10.1016/j.ijsu.2018.12.015, abstract-level) and by guideline recommendations for mesh in defects >1 cm
Grade yourself — spaced repetition
Verification stamp: 🟢 Verified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it
ABD-HER-UMB-WW-01 · Emergency repair risk on watchful waiting, umbilical/epigastric
any later repair ; delayed elective repair had no excess 30-day readmission, reoperation or mortality
Kaplan–Meier probability of emergency repair after referral, patients managed without initial surgery
🟡 Qualified · Registry audit 2026-11-06 · Pending triple review
🔄 Flip the card — population, dispute & sources
ABD-HER-UMB-WW-01 · Emergency repair risk on watchful waiting, umbilical/epigastric
🟡 Qualified. Single source, or abstract-level verification — provisional
Applies to — the population, exactly as printed Danish nationwide cohort: 789 umbilical/epigastric referrals (WW 43.2%)
Evidence tier (the registry's wording) Nationwide cohort — abstract verified (full text paywalled)
Grade yourself — spaced repetition
Verification stamp: 🟡 Qualified · Registry audit 2026-11-06 · Pending triple review · Surgery Code registry — family file 12 (12-adult-hernias.md), coded unit; registry audit 2026-11-06. Permalink to this card
↩ Flip back to the number
🏷️ BookmarkClick the card — or focus it and press Enter — to flip it