{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T15:47:33Z","timestamp":1770565653352,"version":"3.49.0"},"reference-count":26,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T00:00:00Z","timestamp":1737676800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The history of inguinal hernia repair has been marked by the description of several therapies over ages, each with its own approach to managing the hernial sac. An analysis of hernia sac transection (with or without high ligation) versus reduction (invagination) in adults who underwent Lichtenstein open tension\u2010free inguinal hernia repair and in adult and pediatric patients who underwent suture repair has been the primary aim of this systematic review and meta\u2010analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The authors conducted a comprehensive review and meta\u2010analysis. A comprehensive literature search yielded 15 publications, consisting of 12 randomized controlled trials (RCTs) including 1598 patients and 3 controlled clinical trials (CCTs) including 243 patients. In total, the included patients amounted to 1.841.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Analysis of the data revealed a lower rate of recurrence in patients who had sac reduction (0.35% in randomized controlled trials and 0 in clinical trials) compared to patients who had sac excision and ligation (0.86% in randomized controlled trials and 0.93% in clinical trials). However, this difference was not statistically significant (RCTs: relative risk 2.94 [0.30, 29.24]\u2014CCTs: relative risk 4.46 [0.18, 111.36]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The reduction of sacs does not result in a statistically significant decrease in recurrence compared to patients who underwent sac excision and subsequent ligation. This study has demonstrated that the various courses of treatment for the inguinal hernia sac have similar primary and secondary outcomes in both adult and pediatric patients.<\/jats:p><\/jats:sec>","DOI":"10.1002\/wjs.12474","type":"journal-article","created":{"date-parts":[[2025,1,25]],"date-time":"2025-01-25T03:14:12Z","timestamp":1737774852000},"page":"590-604","source":"Crossref","is-referenced-by-count":2,"title":["Comparison of Hernia Sac Transection and Full Sac Reduction for the Treatment of Inguinal Hernias: A Systematic Review and Meta\u2010Analysis of Clinical Trials"],"prefix":"10.1002","volume":"49","author":[{"given":"Roberto","family":"Cirocchi","sequence":"first","affiliation":[{"name":"Department of Medicine and General Surgery University of Perugia  Perugia Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgi I.","family":"Popivanov","sequence":"additional","affiliation":[{"name":"Department of Surgery Medical Military Academy of Sofia  Sofia Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Chiara","family":"Cianci","sequence":"additional","affiliation":[{"name":"University of Florence Meyer Children's Hospital  Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonino","family":"Morabito","sequence":"additional","affiliation":[{"name":"University of Florence Meyer Children's Hospital  Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8724-2859","authenticated-orcid":false,"given":"Matteo","family":"Matteucci","sequence":"additional","affiliation":[{"name":"Department of Medicine and General Surgery University of Milan  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Lauricella","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Division Department of Surgery Fondazione IRCCS Istituto Nazionale dei Tumori  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diletta","family":"Cassini","sequence":"additional","affiliation":[{"name":"General and Emergency Surgery Sesto San Giovanni Hospital  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"Boselli","sequence":"additional","affiliation":[{"name":"Department of Medicine and General Surgery University of Perugia  Perugia Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivan","family":"Szergyuk","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Jagiellonian University Medical College  Krakow Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni Domenico","family":"Tebala","sequence":"additional","affiliation":[{"name":"Department of Digestive and Emergency Surgery Hospital of Santa Maria of Terni  Terni Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonia","family":"Rizzuto","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences Magna Gr\u00e6cia University  Catanzaro Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Bruzzone","sequence":"additional","affiliation":[{"name":"Dipartimento di Chirurgia Generale e Specialistica Sapienza University of Rome  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,1,24]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1159\/000487278"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10029\u2010017\u20101668\u2010x"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.9868"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.6890"},{"issue":"2","key":"e_1_2_14_6_1","first-page":"152","article-title":"Ligation of Hernial Sac. 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