Four classes of acutely incarcerated/strangulated groin hernia

Q: What are the four classes of acutely incarcerated/strangulated groin hernia?

Answer: Acutely incarcerated or strangulated groin hernia are divided into four classes to determine whether to use mesh and which kind of mesh should be used while repairing an acutely incarcerated or strangulated groin hernia. This classification is per the Centers for Disease Control and Prevention (CDC).

Class 1 (clean) – Bowel incarceration but not strangulation, and there is no need for bowel resection. Synthetic mesh should be used to repair the hernia. 

Class 2 (clean-contaminated) – For patients with bowel strangulation and/or a concomitant bowel resection, the wound should be classified as clean-contaminated, and a synthetic, monofilament, large-pore mesh should be used to repair the hernia.

Class 3 (contaminated) and class 4 (dirty-infected) – For patients with bowel perforation and/or abscess formation, the wound should be classified as contaminated or dirty-infected, in which case no mesh should be used to repair the hernia. Once source control has been achieved, the hernia can be repaired with or without mesh, depending on the patient's clinical condition. 

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References:

1. HerniaSurge Group. International guidelines for groin hernia management. Hernia 2018; 22:1.

2. Elsebae MM, Nasr M, Said M. Tension-free repair versus Bassini technique for strangulated inguinal hernia: A controlled randomized study. Int J Surg 2008; 6:302.

3. Hentati H, Dougaz W, Dziri C. Mesh repair versus non-mesh repair for strangulated inguinal hernia: systematic review with meta-analysis. World J Surg 2014; 38:2784.