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level of evidence was generally low and a wide variety of
techniques were described, lacking good-quality RCTs with
uniformity of reporting baseline characteristics and peri-
and postoperative outcome. In spite of the studies’
methodological limitations, minimally invasive techniques
showed promising results with regard to complications and
recovery, and could be considered for use. For open surgery,
the smallest possible [18_TD$DIFF]Gibson incision appeared to yield the
most favorable results. Consensus on outcome definitions
and operative techniques is needed for obtaining higher-
quality evidence in future studies.
Author contributions: SvenWagenaar had full access to all the data in the
study and takes responsibility for the integrity of the data and the
accuracy of the data analysis.
Study concept and design: Wagenaar, van Ramshorst.
Acquisition of data: Wagenaar, van Ramshorst.
Analysis and interpretation of data: Wagenaar, van Ramshorst.
Drafting of the manuscript: Wagenaar, van Ramshorst.
Critical revision of the manuscript for important intellectual content:
Wagenaar, van Ramshorst, Nederhoed, Hoksbergen, Bonjer, Wisselink.
Statistical analysis: Wagenaar, van Ramshorst.
Obtaining funding: None.
Administrative, technical, or material support: Wagenaar, van Ramshorst.
Supervision: Bonjer, Wisselink, van Ramshorst.
Other: None.
Financial disclosures: Sven Wagenaar certifies that all conflicts of
interest, including specific financial interests and relationships and
affiliations relevant to the subject matter or materials discussed in the
manuscript (eg, employment/affiliation, grants or funding, consultan-
cies, honoraria, stock ownership or options, expert testimony, royalties,
or patents filed, received, or pending), are the following: Gabrielle van
Ramshorst received travel and accommodation reimbursements for
participation in the World Guidelines for the Treatment of Inguinal
Hernia (Bard, Johnson and Johnson) and advises Johnson and Johnson on
SSI prevention.
Funding/Support and role of the sponsor: None.
Appendix A. Supplementary data
Supplementary data associated with this article can be
found, in the online version, at
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