ArticleHernia : the journal of hernias and abdominal wall surgery2026
Adherence to international guidelines for groin hernia management in a tertiary government hospital: a 1-year retrospective audit.
Article in Hernia : the journal of hernias and abdominal wall surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThis study aimed to assess the degree of adherence to key recommendations of the 2023 HerniaSurge International Guidelines for Groin Hernia Management among surgeons performing adult groin hernia repair at a high-volume tertiary government training hospital in the Philippines.
backgroundInternational guidelines for groin hernia management provide evidence-based recommendations to standardize the care of groin hernia cases. Despite dissemination, adherence varies across institutions. Evaluating real-world compliance is essential to identify gaps in implementation.
methodsA retrospective audit of adult patients who underwent groin hernia repair at the Philippine General Hospital over one year was performed. The primary outcome was guideline adherence rate which was defined as the proportion of cases fulfilling predefined, audit-appropriate operational definitions based solely on ten selected guideline recommendations assessable through routine institutional documentation.
resultsA total of 355 patients underwent groin hernia repair during the study period, accounting for 373 hernia units after separating bilateral cases. Use of clinical examination alone for diagnosis of primary inguinal hernias was documented in 203 cases (60.4%), while EHS classification was recorded in 251 cases (70.7%). Appropriate anesthesia was administered in 84.5% of patients, while antibiotic prophylaxis was given in 93.0%. All patients (100%) received recommended postoperative oral analgesics. In contrast, documentation-dependent technical steps such as nerve identification and intraoperative anesthesia infiltration were not recorded in any case, resulting in 0% documented compliance by audit criteria. Among female patients (n = 4), round ligament preservation was documented in one case (25.0%). Compliance patterns varied across training levels and surgical divisions, with higher adherence observed in mesh utilization and prophylaxis than in technical documentation elements.
conclusionsAdherence to guidelines was high for broadly established practices such as mesh-based repair, antibiotic prophylaxis, and post-operative analgesia, but inconsistent for documentation-sensitive technical recommendations. Findings for intraoperative parameters with 0% documented compliance should be interpreted with caution, as these most likely reflect documentation gaps rather than confirmed non-performance. Gaps in adherence may reflect documentation practices as much as technical deviations. This establishes a baseline for institutional quality improvement and future outcome-linked evaluations.
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