The Outcomes of Siriraj’s Classification for Giant Inguinal Hernia: A Literature Review and Meta-analysis

Objective: Giant inguinal hernia is a rare condition associated with high perioperative morbidity. Siriraj's classification was developed to guide surgical management according to hernia extent; however, clinical outcome data remain limited. This study aimed to evaluate postoperative complications associated with giant inguinal hernia repair according to Siriraj's classification. Materials and Methods: A literature review and proportion meta-analysis were conducted to assess the surgical outcomes of giant inguinal hernia repair. PubMed and Google Scholar were systematically searched for studies reporting surgical management and complications of giant inguinal hernia. Studies were included if the hernia type could be classified according to Siriraj's classification or sufficient clinical information was available. The primary outcome was postoperative complications. Pooled complication rates with 95% confidence intervals (CI) were calculated using fixed- or random-effects models based on heterogeneity. Results: Ten studies involving 101 giant inguinal hernias were included in the meta-analysis. The overall postoperative complication rate was 35% (95% CI: 0.17–0.59). Type I giant inguinal hernia showed a complication rate of 43%, while non-Type I hernias demonstrated a complication rate of 37%. Although overall complication rates were comparable, major complications were predominantly observed in cases not adhering to Siriraj's classification. Protocol adherence was significantly associated with reduced risk of major complications (odds ratio 0.007, 95% CI: 0.0003–0.142; p=0.0013). Conclusion: Siriraj's classification provides a practical framework for guiding surgical management of giant inguinal hernia and may reduce major postoperative complications. Further large-scale studies are required to validate these findings.