Management of inguinoscrotal hernia in Spain: Results of a national survey.

Introduction: Inguinoscrotal hernia (ISH) represents an advanced form of inguinal hernia, with greater technical complexity and higher risk of complications. Despite its significant prevalence, its management remains heterogeneous in Spain. This study evaluates clinical practice and adherence to the recommendations of the European Hernia Society (EHS).

Methods: A cross-sectional observational study was conducted through an online survey distributed among members of the Spanish Association of Surgery (AEC). Demographic variables and specific data on the diagnostic and therapeutic management of ISH were collected. Subgroup analyses were performed based on age and specialization in abdominal wall surgery.

Results: Out of 3014 surveys distributed, 392 complete responses were obtained (13%). While 60.2% had an Abdominal Wall Unit, only 11.7% centralized all inguinal hernia cases. Open surgery remains the most frequent approach (96.4%). In ISH cases, the use of minimally invasive surgery (MIS) is lower (38.6%), with TAPP being the predominant technique. Surgeons specialized in abdominal wall procedures used more posterior and endoscopic techniques. Adherence to EHS guidelines was partial (58.8%).

Conclusions: The treatment of ISH in Spain lacks proper centralization in specialized units, which limits the adoption of advanced techniques and adherence to international guidelines. Promoting specific training, European certification, and the creation of specialized units could improve clinical outcomes and the quality of life for these patients.