Danish XXXX Database recommendations for the management of @entity18659 in adults.

@entity1 @entity18659 @entity158 @entity547
The nationwide Danish @entity547 Database, recording more than 10,000 inguinal and 400 @entity18659 repairs annually, provides a unique opportunity to present valid recommendations in the management of Danish @entity1 with groin @entity547 . The cumulated data have been discussed at biannual meetings and guidelines have been approved by the Danish Surgical Society. Diagnosis of groin @entity547 is based on clinical examination. Ultrasonography, CT or MRI are rarely needed, while herniography is not recommended. In @entity1 with indicative symptoms of @entity547 , but no detectable @entity547 , diagnostic laparoscopy may be an option. Once diagnosed, @entity547 repair is recommended in the presence of symptoms affecting daily life. In male @entity1 with minimal or absent symptoms watchful waiting is recommended. In females, however, repair is recommended also in asymptomatic @entity1 . In male @entity1 with primary unilateral or bilateral groin @entity547 the preferred method is mesh repair, either at open surgery (Lichtenstein) or laparoscopically, irrespective of age. Conventional tension-producing methods like Bassini, McVay or Shouldice are no longer recommended in a routine elective setting. Whether repair should be done by open or laparoscopic technique, depends on local expertise, economical considerations and @entity1 preference. Compared to the Lichtenstein operation laparoscopic repair is associated with less acute @entity158 and faster recovery. Furthermore, available data suggest less chronic long-term @entity158 after laparoscopic repair. In female @entity1 laparoscopic repair is the recommended method. In @entity1 with recurrent @entity547 repair is preferred in @entity1 with a previous open repair, while @entity1 with recurrence after laparoscopic repair should undergo open mesh repair. In open repair it is recommended to use a mesh secured with a nonabsorbable monofilament suture. In laparoscopic repair a mesh without a slit and with a minimum size of 15 by 10 cm is used. For mesh fixation absorbable or nonabsorbable tacks or glue can be used. Elective surgery for groin @entity547 should be performed in an outpatient setting, using cost-effective local anaesthesia in open mesh repair and general anaesthesia for laparoscopic repair. Spinal anaesthesia is not recommended. Routine prophylactic antibiotics are not indicated. In the early convalescence period there are no physical restrictions. These guidelines will also be available at the website for the Danish @entity547 Database (www.herniedatabasen.dk). The guidelines will be updated when new substantial evidence becomes available.
