Skip to main content
SpringerLink
Log in

Recurrence after totally extraperitoneal (TEP) inguinal hernia repair: the role of physical examination and ultrasound

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Purpose

Physical examination (PE) combined with ultrasound (US) is recommended to confirm a recurrent hernia. However, the evidence is rather weak. The aim of this study was to evaluate PE and appraise the added value of US in alleged recurrent inguinal hernias after totally extraperitoneal (TEP) inguinal hernia repair.

Methods

All adult patients who were re-operated for suspicion of a recurrent hernia after a primary unilateral or bilateral TEP between 2006 and 2017 were identified and investigated retrospectively. Patient characteristics, PE, additional imaging and intra-operative findings were registered. PE outcomes were compared with intra-operative findings to calculate the positive predictive value (PPV) of PE. In case of clinical doubt, the added value of US was evaluated by comparing US findings with the intra-operative findings.

Results

A total of 130 patients were re-operated for suspicion of 137 recurrent hernias. In 75 patients, US was performed. PE was positive for an inguinal hernia in 101 groins (73.7%), negative in 30 (21.9%) and inconclusive in 6 (4.4%). PE matched the operative findings in 75.2%. The PPV of diagnosing a recurrent hernia (or lipoma) on PE was 97%. In case of clinical doubt (n = 36), positive US matched the operative findings in 20 cases (87.0%).

Conclusion

US does not necessarily need to be incorporated in the standard diagnostic workup of a recurrent inguinal hernia. After PE alone, a recurrent hernia (or lipoma) can be diagnosed with a PPV of 97%. Only in case of clinical doubt, US has additional value.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22(1):1–165. https://doi.org/10.1007/s10029-017-1668-x

    Article  Google Scholar 

  2. Kingsnorth A, Hernias LeBlanc K (2003) Hernias: Inguinal and incisional. Lancet 362:1561–1571. https://doi.org/10.1016/S0140-6736(03)14746-0

    Article  PubMed  Google Scholar 

  3. Shpitz B, Kuriansky J, Werener M, Osadchi A, Tiomkin V, Bugayev N, Klein E (2004) Early postoperative evaluation of groins after laparoscopic total extraperitoneal repair of inguinal hernias. J Laparoendosc Adv Surg Tech A 14(6):353–357. https://doi.org/10.1089/lap.2004.14.353

    Article  PubMed  Google Scholar 

  4. Young J, Gilbert AI, Graham MF (2007) The use of ultrasound in the diagnosis of abdominal wall hernias. Hernia 11(4):347–351. https://doi.org/10.1007/s10029-007-0227-2

    Article  PubMed  CAS  Google Scholar 

  5. Roos MM, van Hessen CV, Verleisdonk EJMM, Clevers GJ, Davids PHP, Voorbrood CEH, Simmermacher RKJ, Burgmans JPJ (2018) An 11-year analysis of reoperated groins after endoscopic totally extraperitoneal (TEP) inguinal hernia repair in a high volume hernia center. Hernia. https://doi.org/10.1007/s10029-018-1827-8

    Article  PubMed  Google Scholar 

  6. Burgmans JP, Voorbrood CE, Simmermacher RK, Schouten N, Smakman N, Clevers G, Davids PH, Verleisdonk EM, Hamaker ME, Lange JF, van Dalen T (2016) Long-term results of a randomized double-blinded prospective trial of a lightweight (Ultrapro) versus a heavyweight mesh (Prolene) in laparoscopic total extraperitoneal inguinal hernia repair (TULP-trial). Ann Surg 263(5):862–866. https://doi.org/10.1097/SLA.0000000000001579

    Article  PubMed  Google Scholar 

  7. Roos MM, Bakker WJ, Schouten N, Voorbrood CEH, Clevers GJ, Verleisdonk EJMM, Davids PHP, Burgmans JPJ (2018) Higher recurrence rate after endoscopic totally extraperitoneal (TEP) inguinal hernia repair with ultrapro lightweight mesh: 5-year results of a randomized controlled trial (TULP-trial). Ann Surg 268(2):241–246. https://doi.org/10.1097/SLA.0000000000002649

    Article  PubMed  Google Scholar 

  8. Tonolini M, Ippolito S (2016) Multidetector CT of expected findings and early postoperative complications after current techniques for ventral hernia repair. Insights Imaging 7:541–551. https://doi.org/10.1007/s13244-016-0501-x

    Article  PubMed  PubMed Central  Google Scholar 

  9. Vandersteegen T, Marneffe W, Cleemput I, Vandijck D, Vereeck L (2016) The determinants of defensive medicine practices in Belgium. Health Econ Policy Law 12:363–386. https://doi.org/10.1017/S174413311600030X

    Article  PubMed  Google Scholar 

  10. Assing Hvidt E, Lykkegaard J, Pedersen LB, Pedersen KM, Munck A, Andersen MK (2017) How is defensive medicine understood and experienced in a primary care setting? A qualitative focus group study among Danish general practitioners. BMJ Open 7(12):e019851. https://doi.org/10.1136/bmjopen-2017-019851

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ertem M, Ozben V, Gok H, Ozveri E (2013) Relaparoscopic treatment of recurrences after previous laparoscopic inguinal hernia repair. Minim Invasive Surg. https://doi.org/10.1155/2013/260131(Article ID 260131)

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sharma A, Sarwal A (2017) Surgical repair in recurrent inguinal hernia. Ann Laparosc Endosc Surg 2:97. https://doi.org/10.21037/ales.2017.05.03

    Article  Google Scholar 

  13. Lacour M, Ridereau Zins C, Casa C, Venara A, Cartier V, Yahya S, Barbieux J, Aubé C (2017) CT findings of complications after abdominal wall repair with prosthetic mesh. Diagn Interv Imaging 98:517–528. https://doi.org/10.1016/j.diii.2017.01.002

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hernia Clinic, Department of Surgery, Diakonessenhuis Utrecht/Zeist, Room: Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands

    C. V. van Hessen, E. J. M. M. Verleisdonk, G. J. Clevers, P. H. P. Davids & J. P. J. Burgmans

  2. Department of Radiology, Diakonessenhuis Utrecht/Zeist, Zeist, The Netherlands

    F. B. M. Sanders

  3. Department of General Practice, Universitair Medisch Centrum Utrecht (UMCU), Utrecht, The Netherlands

    M. M. Roos

Authors
  1. C. V. van Hessen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. M. Roos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. B. M. Sanders
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. J. M. M. Verleisdonk
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. J. Clevers
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. H. P. Davids
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. P. J. Burgmans
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CH: study conception and design, data collection, analysis and interpretation of data, drafting of manuscript. MR: study conception and design, interpretation of data, critical revision. FS: study conception and design, interpretation of data, critical revision EV: study conception and design, critical revision. GC: study conception and design, critical revision. PD: study conception and design, critical revision JB: study conception and design, interpretation of data, critical revision.

Corresponding author

Correspondence to C. V. van Hessen.

Ethics declarations

Conflict of interest

Coen van Hessen declares no conflict of interest. Marleen Roos declares no conflict of interest. Floris Sanders declares no conflict of interest. Egbert Jan Verleisdonk declares no conflict of interest. Geert Jan Clevers declares no conflict of interest. Paul Davids declares no conflict of interest. Josephina Burgmans declares no conflict of interest.

Ethical approval

This study did not need approval from an ethic committee.

Human and animal rights

This study does not contain any studies with participants or animals performed by any of the authors.

Informed consent

Informed consent was not required for this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

van Hessen, C.V., Roos, M.M., Sanders, F.B.M. et al. Recurrence after totally extraperitoneal (TEP) inguinal hernia repair: the role of physical examination and ultrasound. Hernia 24, 153–157 (2020). https://doi.org/10.1007/s10029-019-02029-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-019-02029-0

Keywords

Search

Navigation