腹腔鏡疝氣修補術之圍手術期併發症預測：
新型臨床分級系統與歐洲疝氣學會分類之比較

陳品鍵、蔡秉軒、曾聖修、陳仲均、蔡曜州¹

佛教慈濟醫療財團法人台北慈濟醫院 外科部 泌尿科

Predicting Perioperative Complications in Endoscopic Hernia Repair:
Novel Clinical Grading System vs. European Hernia Society Classification

Nicholas Pin Jian Tan, Pin-Hsuan Tsai, Shen-Shiou Tseng, Chung-Chun Chen, Yao-Chou Tsai¹

Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei, Taiwan

Purpose: This study aimed to compare the predictive validity of this novel system against the standard EHS classification regarding peri-operative complications.

Materials and Methods: We conducted a retrospective analysis of a hernia registry at our institution from 2011 to 2020, enrolling patients scheduled for elective laparoscopic inguinal hernia repair with synthetic mesh. Hernias were classified using both the EHS anatomical system and the novel clinical grading system (Yang's Classification). To identify independent predictors for complications, multivariable logistic regression models were constructed to calculate Odds Ratios (OR). To evaluate and compare the overall predictive accuracy of the two systems, the Area Under the Receiver Operating Characteristic Curve (AUC) was utilized for each clinical outcome.

Results: A total of 502 patients were included, with the majority undergoing LESS TEP repair (67.92%). The cohort was predominantly male (92.8%) with a mean age of 57.07 years. Multivariable analysis revealed that Yang’s Grade 6 was a powerful predictor for intraoperative peritoneal tear repair (OR 9.58, P = 0.007), while EHS Size 3 failed to reach statistical significance (P = 0.08). For postoperative seroma, Yang’s Grade 4 (OR 9.03, P = 0.036) and Grade 6 (OR 9.05, P = 0.007) both showed significant associations. An inverse association was found between hernia size and chronic pain impairing job performance, with Yang Grade 3 (OR 0.05; P=0.046) and EHS Size 3 (OR 0.04; P=0.029) exhibiting a protective effect. Right direct and indirect inguinal hernia (DIIH) predicted long-term recurrence (OR 4.27; P=0.003). Overall, Yang's system demonstrated superior predictive discrimination (AUC) across all evaluated outcomes, including peritoneal tear repair (0.7217 vs. 0.6615), chronic pain impairing job (0.9153 vs. 0.9020) and seroma formation (0.6894 vs. 0.6832).

Conclusions: The novel Clinical Grading System provides higher discriminative accuracy for perioperative complications than the anatomical EHS classification. Incorporating functional clinical parameters enables more precise preoperative risk stratification and surgical planning for endoscopic hernia repair.