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Page 4 of 7 Oyola et al. Mini-invasive Surg 2023;7:26 https://dx.doi.org/10.20517/2574-1225.2023.26

Table 1. Patient demographics
Hernia type Unilateral (n = 14,179) Bilateral (n = 4,426)
Age
≤ 30 years 770 5% 177 4%
31-65 years 7,605 54% 2,689 61%
> 65 years 5,804 41% 1,560 35%
Sex
Male 12,805 90% 4,137 93%
Female 1,374 10% 325 7%
Hernia incidence at time of repair
Primary 12,818 90% 3,947 89%
Recurrent 1,361 10% 515 12%

Table 2. ACHQC compliance with strong recommendations for surgical management of inguinal hernias
Surgical Treatment Recommendations of Inguinal Hernias: (STRONG) % Compliance
Prophylactic antibiotics in open herniorrhaphy only in high-risk environment N/A
Surgeons should offer anterior and posterior repair options N/A
Mesh for large direct hernias during TAP/TEPP to decrease recurrence 100
Surgeon choice on TEP vs. TAPP due to comparable outcomes 99
Nerve awareness and recognition during herniorrhaphy to avoid chronic pain 96
Same day elective surgery if timely follow up is organized 92
Mesh-based repair 89
Laparoscopic approach for bilateral herniorrhaphy 89
Femoral hernias to be repaired laparoscopically with mesh 78
Flat mesh over plug & patch or 3D bilayer 70
Women with groin hernias to undergo laparoscopic repair with mesh 57
Shouldice technique in non-mesh inguinal herniorrhaphy 52
Avoid mesh selection solely based on terms “lightweight” and “heavyweight”, as weight limits are not clearly defined 50
Local anesthesia for open repair of reducible inguinal hernias 25
Avoid prophylactic antibiotics in laparoscopic herniorrhaphy 5
ACHQC: Abdominal Core Health Quality Collaborative; TAP: total extraperitoneal; TAPP: transabdominal pre-peritoneal; TEP: total
extraperitoneal; TEPP: transabdominal preperitoneal.

Table 3. ACHQC compliance with weak recommendations for surgical management of inguinal hernias
Surgical Treatment Recommendations for Inguinal Hernias: (WEAK) % Compliance
Atraumatic (glue) mesh fixation in open herniorrhaphy to reduce pain N/A
Avoid routine bladder catheterization during herniorrhaphy N/A
Round ligament division optional during TAPP/TEP 96
Pre-peritoneal mesh (vs. Lichtenstein repair) limited to research settings 87
General or local over regional anesthesia in patients > 65 yo 84
Mesh use in clean emergent herniorrhaphy 82
Laparoscopic approach for unilateral herniorrhaphy in male patients due to lower incidence of postop and chronic pain 59
Avoid prophylactic partial or complete neurectomy 50

ACHQC: Abdominal Core Health Quality Collaborative; TAPP: transabdominal pre-peritoneal; TEP: total extraperitoneal.