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Niebuhr H, Malaibari Z, Dag H, Reinpold W, Köckerling F. Dynamic Inguinal Ultrasound (DIUS) in diagnosing groin hernias: Technique, examples and results. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2021. [DOI: 10.4103/ijawhs.ijawhs_13_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Imaging modalities for inguinal hernia diagnosis: a systematic review. Hernia 2020; 24:917-926. [PMID: 32328842 DOI: 10.1007/s10029-020-02189-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of the study was to determine which diagnostic modality [Computerized Tomography (CT), Magnetic Resonance Imaging (MRI), or ultrasound (US)] is more precise in terms of sensitivity and specificity in diagnosing inguinal hernia and sub-type of inguinal hernia (direct or indirect). METHODS This systematic review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and a search for relevant articles was undertaken in PubMed, Embase, and the Cochrane Library. Inclusion criteria were original studies that preoperatively diagnosed patients suspected of inguinal hernia by either CT, MRI, or US and compared diagnostic findings with operative findings or definitive follow-up. The main outcomes were the diagnostic certainty of inguinal hernia and type of hernia by sensitivity and specificity. All eligible studies were searched in the Retraction Watch database to ensure that all included studies were suitable for inclusion. RESULTS Bubble charts depicting the size of each patient cohort and percentual range for both sensitivity and specificity showed that US was better than CT and MRI in diagnosing inguinal hernia. Bubble charts for US and CT depicted high values within the studies that reported sensitivity and specificity in diagnosing type of hernia. CONCLUSIONS We found that US had the highest sensitivity and specificity. However, it must be taken into consideration that performance is highly dependent on the operator's level of expertise. Based on this systematic review, ultrasound may be the preferred imaging modality when physical examination is inconclusive, given that local expertise in performing US examination for hernia disease is adequate.
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Melloy A, Paine B, Wysocki AP. Pain resolution in non-operatively managed ultrasound-only groin hernias: 3-year follow-up. Hernia 2019; 23:1061-1064. [PMID: 30852717 DOI: 10.1007/s10029-019-01925-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 03/02/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND General surgeons frequently see patients with groin lumps and pain. However, in the absence of a lump, an ultrasound scan identified groin hernia is a diagnostic and management challenge. Some surgeons recommend inguinal hernia surgery while others do not. The outcome of non-operative management is uncertain. METHODS This study represents a minimum 3-year follow-up of all non-operatively managed patients seen in general surgical outpatient clinic over a 12-month period. To be included, patients needed to meet all four criteria: groin pain, no clinical hernia, groin hernia identified on ultrasound scan requested by the general practitioner and non-operative management. Patients were interviewed via a standardised telephone survey. Primary outcome measure was groin pain which was assessed with the Sheffield Pain score. RESULTS From July 2014 to June 2015, 67 patients met the inclusion criteria. 42 participated (37 men and 5 women). Two-thirds were pain free (68%). Only 2 patients underwent hernia surgery. Women were more likely to describe developing a lump (60% vs 14%; p = 0.013), to see a surgeon (40% vs 8%; p = 0.039) and undergo hernia surgery (20% vs 3% p = 0.088). CONCLUSION At least in the medium term, non-operative management of men who present with groin pain (with an ultrasound scan reporting a hernia but no lump) is reasonable.
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Affiliation(s)
- A Melloy
- Ipswich Hospital, Chelmsford Avenue, Ipswich, QLD, 4305, Australia.
| | - B Paine
- Logan Hospital, Corner Meadowbrook and Loganlea Roads, Meadowbrook, QLD, 4131, Australia
| | - A P Wysocki
- Griffith University Medical School, Griffith Health Centre-G40, Gold Coast Campus, Southport, QLD, 4222, Australia
- Department of Surgery, Logan Hospital, Corner Meadowbrook and Loganlea Roads, Meadowbrook, QLD, 4131, Australia
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Jayaram PR, Pereira FDA, Barrett JA. Evaluation of dynamic ultrasound scanning in the diagnosis of equivocal ventral hernias with surgical comparison. Br J Radiol 2018; 91:20180056. [PMID: 29745748 PMCID: PMC6209466 DOI: 10.1259/bjr.20180056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 04/24/2018] [Accepted: 05/02/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study aims to compare ultrasonography for ventral hernias with surgical findings and establish its accuracy in equivocal cases. Comparison is also made against groin hernia ultrasound scanning, which has a positive predictive value ranging from 71-100%. METHODS A retrospective review of all patients who underwent an ultrasound scan between June 2011 and June 2015 was performed. The word "hernia" in the referral information was the sole inclusioncriterion. Patients who were found to have a clinically evident ventral hernia, unrelated hernia in aseparate location or had a known hernia were excluded. Thus, only patients with a clinically suspected ventral hernia and equivocal clinical assessment were included. These patients were followed up for at least 12 months and subsequent operation notes, if any, were also analysed. RESULTS 348 scans were included (F = 198, M = 150, F:M ratio = 1.32:1). The mean age was 53.4 years (range = 16-97 years). 101 scans were positive for hernias (29.0%), 190 were negative (54.3%), and 57 had other findings (e.g. seroma, lipoma; 16.3%). 54 patients were taken to surgery (15.5%), including 5 who were found to be negative on ultrasound. Of these, 45 were truepositives, 4 true-negatives, 4 false-negatives, and 1 false-positive, giving a sensitivity of 91.8% and positive predictive value of 97.8%. CONCLUSION This study confirms that ultrasound scans are effective in the diagnosis of equivocal ventral hernias. Advances in knowledge: The accuracy of ultrasound scanning specifically for ventral hernias is quantified, and are comparable to that of groin hernias.
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Affiliation(s)
| | | | - James A Barrett
- Radiology Department, West Suffolk Hospital, Bury Saint Edmunds, UK
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Kwee RM, Kwee TC. Ultrasonography in diagnosing clinically occult groin hernia: systematic review and meta-analysis. Eur Radiol 2018; 28:4550-4560. [DOI: 10.1007/s00330-018-5489-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/09/2018] [Accepted: 04/16/2018] [Indexed: 11/30/2022]
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Abstract
INTRODUCTION Worldwide, more than 20 million patients undergo groin hernia repair annually. The many different approaches, treatment indications and a significant array of techniques for groin hernia repair warrant guidelines to standardize care, minimize complications, and improve results. The main goal of these guidelines is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain, the most frequent problems following groin hernia repair. They have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery. METHODS An expert group of international surgeons (the HerniaSurge Group) and one anesthesiologist pain expert was formed. The group consisted of members from all continents with specific experience in hernia-related research. Care was taken to include surgeons who perform different types of repair and had preferably performed research on groin hernia surgery. During the Group's first meeting, evidence-based medicine (EBM) training occurred and 166 key questions (KQ) were formulated. EBM rules were followed in complete literature searches (including a complete search by The Dutch Cochrane database) to January 1, 2015 and to July 1, 2015 for level 1 publications. The articles were scored by teams of two or three according to Oxford, SIGN and Grade methodologies. During five 2-day meetings, results were discussed with the working group members leading to 136 statements and 88 recommendations. Recommendations were graded as "strong" (recommendations) or "weak" (suggestions) and by consensus in some cases upgraded. In the Results and summary section below, the term "should" refers to a recommendation. The AGREE II instrument was used to validate the guidelines. An external review was performed by three international experts. They recommended the guidelines with high scores. The risk factors for inguinal hernia (IH) include: family history, previous contra-lateral hernia, male gender, age, abnormal collagen metabolism, prostatectomy, and low body mass index. Peri-operative risk factors for recurrence include poor surgical techniques, low surgical volumes, surgical inexperience and local anesthesia. These should be considered when treating IH patients. IH diagnosis can be confirmed by physical examination alone in the vast majority of patients with appropriate signs and symptoms. Rarely, ultrasound is necessary. Less commonly still, a dynamic MRI or CT scan or herniography may be needed. The EHS classification system is suggested to stratify IH patients for tailored treatment, research and audit. Symptomatic groin hernias should be treated surgically. Asymptomatic or minimally symptomatic male IH patients may be managed with "watchful waiting" since their risk of hernia-related emergencies is low. The majority of these individuals will eventually require surgery; therefore, surgical risks and the watchful waiting strategy should be discussed with patients. Surgical treatment should be tailored to the surgeon's expertise, patient- and hernia-related characteristics and local/national resources. Furthermore, patient health-related, life style and social factors should all influence the shared decision-making process leading up to hernia management. Mesh repair is recommended as first choice, either by an open procedure or a laparo-endoscopic repair technique. One standard repair technique for all groin hernias does not exist. It is recommended that surgeons/surgical services provide both anterior and posterior approach options. Lichtenstein and laparo-endoscopic repair are best evaluated. Many other techniques need further evaluation. Provided that resources and expertise are available, laparo-endoscopic techniques have faster recovery times, lower chronic pain risk and are cost effective. There is discussion concerning laparo-endoscopic management of potential bilateral hernias (occult hernia issue). After patient consent, during TAPP, the contra-lateral side should be inspected. This is not suggested during unilateral TEP repair. After appropriate discussions with patients concerning results tissue repair (first choice is the Shouldice technique) can be offered. Day surgery is recommended for the majority of groin hernia repair provided aftercare is organized. Surgeons should be aware of the intrinsic characteristics of the meshes they use. Use of so-called low-weight mesh may have slight short-term benefits like reduced postoperative pain and shorter convalescence, but are not associated with better longer-term outcomes like recurrence and chronic pain. Mesh selection on weight alone is not recommended. The incidence of erosion seems higher with plug versus flat mesh. It is suggested not to use plug repair techniques. The use of other implants to replace the standard flat mesh in the Lichtenstein technique is currently not recommended. In almost all cases, mesh fixation in TEP is unnecessary. In both TEP and TAPP it is recommended to fix mesh in M3 hernias (large medial) to reduce recurrence risk. Antibiotic prophylaxis in average-risk patients in low-risk environments is not recommended in open surgery. In laparo-endoscopic repair it is never recommended. Local anesthesia in open repair has many advantages, and its use is recommended provided the surgeon is experienced in this technique. General anesthesia is suggested over regional in patients aged 65 and older as it might be associated with fewer complications like myocardial infarction, pneumonia and thromboembolism. Perioperative field blocks and/or subfascial/subcutaneous infiltrations are recommended in all cases of open repair. Patients are recommended to resume normal activities without restrictions as soon as they feel comfortable. Provided expertise is available, it is suggested that women with groin hernias undergo laparo-endoscopic repair in order to decrease the risk of chronic pain and avoid missing a femoral hernia. Watchful waiting is suggested in pregnant women as groin swelling most often consists of self-limited round ligament varicosities. Timely mesh repair by a laparo-endoscopic approach is suggested for femoral hernias provided expertise is available. All complications of groin hernia management are discussed in an extensive chapter on the topic. Overall, the incidence of clinically significant chronic pain is in the 10-12% range, decreasing over time. Debilitating chronic pain affecting normal daily activities or work ranges from 0.5 to 6%. Chronic postoperative inguinal pain (CPIP) is defined as bothersome moderate pain impacting daily activities lasting at least 3 months postoperatively and decreasing over time. CPIP risk factors include: young age, female gender, high preoperative pain, early high postoperative pain, recurrent hernia and open repair. For CPIP the focus should be on nerve recognition in open surgery and, in selected cases, prophylactic pragmatic nerve resection (planned resection is not suggested). It is suggested that CPIP management be performed by multi-disciplinary teams. It is also suggested that CPIP be managed by a combination of pharmacological and interventional measures and, if this is unsuccessful, followed by, in selected cases (triple) neurectomy and (in selected cases) mesh removal. For recurrent hernia after anterior repair, posterior repair is recommended. If recurrence occurs after a posterior repair, an anterior repair is recommended. After a failed anterior and posterior approach, management by a specialist hernia surgeon is recommended. Risk factors for hernia incarceration/strangulation include: female gender, femoral hernia and a history of hospitalization related to groin hernia. It is suggested that treatment of emergencies be tailored according to patient- and hernia-related factors, local expertise and resources. Learning curves vary between different techniques. Probably about 100 supervised laparo-endoscopic repairs are needed to achieve the same results as open mesh surgery like Lichtenstein. It is suggested that case load per surgeon is more important than center volume. It is recommended that minimum requirements be developed to certify individuals as expert hernia surgeon. The same is true for the designation "Hernia Center". From a cost-effectiveness perspective, day-case laparoscopic IH repair with minimal use of disposables is recommended. The development and implementation of national groin hernia registries in every country (or region, in the case of small country populations) is suggested. They should include patient follow-up data and account for local healthcare structures. A dissemination and implementation plan of the guidelines will be developed by global (HerniaSurge), regional (international societies) and local (national chapters) initiatives through internet websites, social media and smartphone apps. An overarching plan to improve access to safe IH surgery in low-resource settings (LRSs) is needed. It is suggested that this plan contains simple guidelines and a sustainability strategy, independent of international aid. It is suggested that in LRSs the focus be on performing high-volume Lichtenstein repair under local anesthesia using low-cost mesh. Three chapters discuss future research, guidelines for general practitioners and guidelines for patients. CONCLUSIONS The HerniaSurge Group has developed these extensive and inclusive guidelines for the management of adult groin hernia patients. It is hoped that they will lead to better outcomes for groin hernia patients wherever they live. More knowledge, better training, national audit and specialization in groin hernia management will standardize care for these patients, lead to more effective and efficient healthcare and provide direction for future research.
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Niebuhr H, König A, Pawlak M, Sailer M, Köckerling F, Reinpold W. Groin hernia diagnostics: dynamic inguinal ultrasound (DIUS). Langenbecks Arch Surg 2017; 402:1039-1045. [PMID: 28812139 DOI: 10.1007/s00423-017-1604-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 07/10/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Although clinical examination is the gold standard for the diagnosis of groin hernia, imaging procedures can improve the detection of femoral hernias, incipient hernias, and less-common types of hernias (e.g., an obturator hernia). The aim of this study is to evaluate the sensitivity and specificity of dynamic inguinal ultrasound (DIUS). MATERIALS AND METHODS Between July 2010 and June 2015, 4951 clinical and ultrasound examinations of the groin area were conducted at the Hanse-Hernienzentrum in Hamburg, Germany. The ultrasonographic findings were prospectively evaluated to determine the number of inguinal and femoral hernia diagnoses that were ultrasonically confirmed and also to consider cases in which clinical examination overlooked these diagnoses. The results were compared with the intraoperative findings. RESULTS The results show that standardized ultrasound examination of the groin area with high-frequency, small-part linear transducers also serves to accurately display femoral and small or occult groin hernias. The high-level specificity (0.9980) and sensitivity (0.9758) are proof of the procedure's quality. CONCLUSIONS To ensure high-quality hernia treatment, regular use of standardized ultrasound examinations is recommended.
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Affiliation(s)
- Henning Niebuhr
- Hanse-Hernienzentrum Hamburg, Alte Holstenstrasse 16, 21031, Hamburg, Germany.
| | - Anita König
- Abteilung für Anästhesiologie und Operative Intensivmedizin, Bethesda Krankenhaus Bergedorf, Glindersweg 80, 21029, Hamburg, Germany
| | - Maciej Pawlak
- Department of Vascular Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Marco Sailer
- Klinik für Chirurgie, Bethesda Krankenhaus Bergedorf, Glindersweg 80, 21029, Hamburg, Germany
| | - Ferdinand Köckerling
- Vivantes Klinikum Spandau, Klinik für Chirurgie-Visceral- und Gefäßchirurgie, Neue Bergstraße 6, 13585, Berlin, Germany
| | - Wolfgang Reinpold
- Chirurgische Abteilung, Wilhelmsburger Krankenhaus Groß-Sand, Groß-Sand 3, 21107, Hamburg, Germany
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Gupta H, Subedi N, Robinson P. Effectiveness of Sonography in Detecting Clinically Occult Femoral Hernias. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1675-1679. [PMID: 27335438 DOI: 10.7863/ultra.15.09045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/13/2015] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the accuracy of sonography for femoral hernia diagnosis in patients with suspected hernias that were not evident on clinical examination. METHODS A retrospective analysis was performed for 39 consecutive patients with 40 clinically suspected but occult femoral hernias and subsequent positive sonographic findings for femoral hernias. Clinical records for all patients were reviewed for surgical outcomes and clinical follow-up. Surgical findings of a femoral hernia sac or widened femoral canal requiring repair, with symptomatic relief after the procedure, were considered positive for a femoral hernia. RESULTS Among the 40 femoral hernias examined by sonography, 33 of 40 groins underwent surgical exploration, with 32 true-positive findings and 1 false-positive finding on sonography. The false-positive case was an inguinal hernia at surgery. The accuracy of sonography was 96.9% for those with surgical correlations. The remaining 7 patients did not undergo surgery but had clinical follow-up. CONCLUSIONS This study confirms high diagnostic accuracy of sonography for nonpalpable femoral hernias in symptomatic groins compared to surgical findings.
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Affiliation(s)
- Harun Gupta
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, England
| | - Nawaraj Subedi
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, England
| | - Philip Robinson
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, England. Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, England
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Brandel DW, Girish G, Brandon CJ, Dong Q, Yablon C, Jamadar DA. Role of Sonography in Clinically Occult Femoral Hernias. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:121-128. [PMID: 26657750 DOI: 10.7863/ultra.15.02061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/06/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this article is to evaluate the diagnostic accuracy of sonography in clinically occult femoral hernias and to describe our sonographic technique. METHODS The clinical and imaging data for 93 outpatients referred by general surgeons, all of whom underwent sonographic evaluation and surgery, were reviewed retrospectively. Of these, 55 patients who underwent surgical exploration for groin hernias within 3 months of sonography and met all inclusion criteria were included in the study. The sonographic technique involves using the pubic tubercle as an osseous landmark to identify and appropriately visualize the femoral canal. The Valsalva maneuver is then used to differentiate the movement of normal fat (a potential pitfall) from true herniation in the femoral canal. Surgical findings were used as the reference standard by which sonographic results were judged. Two-by-two contingency tables were used to calculate the sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS In these 55 patients, surgery revealed 15 femoral hernias. Eight femoral hernias occurred in women, and 7 occurred in men. For diagnosing femoral hernias, sonography demonstrated sensitivity of 80%, specificity of 88%, a positive predictive value of 71%, and a negative predictive value of 92%. True-positive cases of femoral hernias have a sonographic appearance of a hypoechoic sac with speckled internal echoes. When examining during the Valsalva maneuver, a femoral hernia passes deep to the inguinal ligament, expands the femoral canal, displacing the normal canal fat, and effaces the femoral vein. CONCLUSIONS Sonography can exclude femoral hernias with high confidence in light of its exceptional negative predictive value. With attention to technique and imaging criteria, the diagnostic accuracy of sonography can be enhanced.
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Affiliation(s)
- David W Brandel
- From the University of Michigan Health System, Ann Arbor, Michigan USA
| | - Gandikota Girish
- From the University of Michigan Health System, Ann Arbor, Michigan USA.
| | | | - Qian Dong
- From the University of Michigan Health System, Ann Arbor, Michigan USA
| | - Corrie Yablon
- From the University of Michigan Health System, Ann Arbor, Michigan USA
| | - David A Jamadar
- From the University of Michigan Health System, Ann Arbor, Michigan USA
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Kim B, Robinson P, Modi H, Gupta H, Horgan K, Achuthan R. Evaluation of the usage and influence of groin ultrasound in primary and secondary healthcare settings. Hernia 2014; 19:367-71. [DOI: 10.1007/s10029-014-1212-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 01/03/2014] [Indexed: 11/24/2022]
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Diao X, Chen Y, Qiu Z, Pang Y, Zhan J, Chen L. Diagnostic value of an automated breast volume scanner for abdominal hernias. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:39-46. [PMID: 24371097 DOI: 10.7863/ultra.33.1.39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES This study explored the diagnostic values of an automated breast volume scanner (ABVS) for abdominal external hernias. METHODS Conventional sonograms and ABVS images from 128 abdominal external hernias in 104 patients (98 male and 6 female; age range, 41-79 years; mean age ± SD, 68.0 ± 14.6 years) were analyzed. The results were identified by surgical outcomes. The hernia type, hernial ring position, hernial sac size, hernia content, and hernia structure were evaluated by both sonographic modalities. RESULTS The sensitivity and accuracy differences between the ABVS and conventional sonography for diagnosis of abdominal hernias and hernia size measurements were compared. The hernia types, as confirmed by surgery, included 45 indirect inguinal hernias (30 reducible and 15 irreducible), 12 reducible direct inguinal hernias, 5 femoral hernias, 62 incisional hernias (42 isolated and 20 multiple), and 4 umbilical hernias. The sensitivity of the ABVS was higher than that of conventional sonography for incisional hernias (P < .01), whereas there were no statistical differences in sensitivity for other types of hernias. The ABVS hernial sac number detection rate for both isolated and multiple incisional hernias was significantly higher compared with that of conventional sonography (both P < .01). The ABVS measurements correlated well with surgical results (length, P = .47; width, P = .31). CONCLUSIONS Automated breast volume scanner images have the outstanding advantage of displaying the entire scope of the internal structure and the relationship with adjacent tissues of abdominal hernias. Therefore, an ABVS has good application prospects for diagnosis of abdominal external hernias and merits further research.
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Affiliation(s)
- Xuehong Diao
- Department of Ultrasound in Medicine, Huadong Hospital, Fudan University, 221 Yanan Xi Rd, 200040 Shanghai, China.
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Light D, Chattopadhyay D, Bawa S. Radiological and clinical examination in the diagnosis of Spigelian hernias. Ann R Coll Surg Engl 2013; 95:98-100. [PMID: 23484989 PMCID: PMC4098597 DOI: 10.1308/003588413x13511609957092] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Spigelian hernia are rarely reported lateral abdominal wall hernias. Clinical diagnosis of a suspected hernia can be challenging owing to vague presenting symptoms and signs. This study aimed to investigate the accuracy of preoperative imaging and clinical examination in the diagnosis of Spigelian hernias. METHODS A retrospective analysis was performed of patients who presented to North Tyneside and Wansbeck General Hospitals between 1998 and 2010. All patients were assessed by a consultant general surgeon in the outpatient clinic or on the surgical admissions ward. Patients were included who presented with a history suggestive of a Spigelian hernia and a palpable lump or equivocal clinical examination. All patients proceeded to surgery, which was used as the reference standard. RESULTS Overall, correlation with operative findings showed computed tomography (CT) to have a sensitivity of 100% and a positive predictive value (PPV) of 100%. Ultrasonography had a sensitivity of 90% and a PPV of 100%. Clinical assessment alone had a sensitivity of 100% and a PPV of 36%. CONCLUSIONS This study shows that ultrasonography and CT have a high sensitivity and PPV in relation to occult Spigelian hernias. When no obvious Spigelian hernia is present, patients should be evaluated with radiological investigation to establish a diagnosis. Owing to diagnostic uncertainty, a laparoscopic approach should be favoured.
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Affiliation(s)
- D Light
- Northumbria Healthcare NHS Foundation Trust, UK.
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Laparoscopic diagnosis and management of a novel inguino-pelvic hernia. Hernia 2012; 17:419-22. [PMID: 22527928 DOI: 10.1007/s10029-012-0910-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 03/24/2012] [Indexed: 10/28/2022]
Abstract
Inguinal hernias can typically be diagnosed with a proper history and thorough physical exam. However, patients with chronic groin pain, normal physical exam and no radiologic findings present a diagnostic/therapeutic dilemma [1]. We present a case of a female patient with obscure chronic groin pain. Upon laparoscopic exploration, she was found to have a hernia in a previously non-described location. Reduction of a chronically incarcerated preperitoneal fat and subsequent repair using traditional transabdominal preperitoneal repair resulted in a complete resolution of her pain.
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Valent A, Frizziero A, Bressan S, Zanella E, Giannotti E, Masiero S. Insertional tendinopathy of the adductors and rectus abdominis in athletes: a review. Muscles Ligaments Tendons J 2012; 2:142-8. [PMID: 23738289 PMCID: PMC3666502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Insertional tendinopathy of the adductors and rectus abdominis is common in male athletes, especially in soccer players. It may be worsened by physical activity and it usually limits sport performance. The management goal in the acute phase consists of analgesic and anti-inflammatory drugs and physical rehabilitation. In the early stages of rehabilitation, strengthening exercises of adductors and abdominal muscles, such as postural exercises, have been suggested. In the sub-acute phase, muscular strength is targeted by overload training in the gym or aquatherapy; core stability exercises seem to be useful in this phase. Finally, specific sport actions are introduced by increasingly complex exercises along with a preventive program to limit pain recurrences.
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Affiliation(s)
| | | | - Stefano Bressan
- Department of Rehabilitation Medicine, University of Padova, Italy
| | - Elena Zanella
- Department of Rehabilitation Medicine, University of Padova, Italy
| | - Erika Giannotti
- Department of Rehabilitation Medicine, University of Padova, Italy
| | - Stefano Masiero
- Department of Rehabilitation Medicine, University of Padova, Italy
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Zendejas B, Farley DR. Re: Contralateral metachronous inguinal hernias and role for prophylaxis during TEP repair. Hernia 2011. [DOI: 10.1007/s10029-011-0852-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Laurence I, Ngan-Soo E, Gandhi S. The role of multi-detector computed tomography in imaging hernias. Br J Hosp Med (Lond) 2011; 72:72-7. [PMID: 21378612 DOI: 10.12968/hmed.2011.72.2.72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clinical presentation of a hernia is often non-specific or atypical and in these circumstances diagnosis and management decisions can be aided by imaging. This review contains diagrammatic illustrations, explanations and computed tomography examples of the different types of external, internal and diaphragmatic hernias.
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Light D, Ratnasingham K, Banerjee A, Cadwallader R, Uzzaman M, Gopinath B. The role of ultrasound scan in the diagnosis of occult inguinal hernias. Int J Surg 2011; 9:169-72. [DOI: 10.1016/j.ijsu.2010.10.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Revised: 09/23/2010] [Accepted: 10/30/2010] [Indexed: 10/18/2022]
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Körner M, Linsenmaier U, Reiser M. [Mechanical obstruction as a cause of acute abdomen. Radiological differential diagnosis]. Radiologe 2010; 50:226, 228-36. [PMID: 20165939 DOI: 10.1007/s00117-009-1902-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Mechanical obstruction is a common cause of acute abdomen. Besides the diagnosis of the obstruction itself it is crucial to recognize the cause of the obstruction for planning of conservative or operative treatment.This article gives a general overview of the methods available for imaging obstructions in the setting of an acute abdomen. In the second part the differential diagnoses of the most common causes of obstruction will be discussed.
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Affiliation(s)
- M Körner
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Innenstadt, München, Deutschland.
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Depasquale R, Landes C, Doyle G. Audit of ultrasound and decision to operate in groin pain of unknown aetiology with ultrasound technique explained. Clin Radiol 2009; 64:608-14. [DOI: 10.1016/j.crad.2008.11.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Revised: 11/08/2008] [Accepted: 11/23/2008] [Indexed: 11/29/2022]
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