Management of inguinal and femoral hernias in women: meta analysis of current practices and review of international guidelines.

Current management strategies for groin hernias in women are frequently based on data from male-dominated studies. This systematic review and meta-analysis evaluates clinical outcomes, complication rates, and recurrence risk specifically in female patients to provide evidence-based surgical recommendations. A systematic search of MEDLINE, Scopus, Cochrane Library, and Embase was performed according to PRISMA 2020 guidelines. Studies reporting operative or conservative management of inguinal (IH) or femoral hernias (FH) in adult women were included. A meta-analysis of proportions was conducted using a random-effects model to pool outcomes including recurrence, mortality, and the need for bowel resection. Thirty-four studies comprising 107,422 IH and 18,550 FH cases were analyzed. No studies evaluated a "watch-and-wait" strategy in women. Elective surgery was associated with a low mortality rate (0.2%), whereas emergency repair carried a 4% mortality risk. In emergency settings, bowel resection was required in 17.3% of cases. Recurrence rates for IH following minimally invasive surgery and anterior repair were 0.3% versus 4.4% respectively. Similarly, FH recurrence was 1.0% versus 3.3% respectively. A "watch-and-wait" strategy in women has not been evaluated; thus, the actual incarceration rate in non-operated women remains unclear. However, emergency surgery for incarcerated hernias is associated with significant mortality. Minimally invasive surgery should be the preferred technique for both elective and emergency repairs instead of an anterior approach.