Advertisement

Diagnosis and classification of inguinal hernias

  • B. M. KraftEmail author
  • H. Kolb
  • B. Kuckuk
  • S. Haaga
  • B. J. Leibl
  • K. Kraft
  • R. Bittner
Original article

Abstract

Background: The aim of this prospective clinical study was to determine whether the presence of a hernia, its size, and its type can be established preoperatively by clinical and ultrasound, examination. Methods: The study population comprised 220 consecutive patients referred to our department for the surgical management of an inguinal hernia. On admission, both inguinal regions were examined clinically and by ultrasound. All patients were operated on laparoscopically. Results: In regard to the intraoperative findings for both inguinal regions, clinical and ultrasound examination for the diagnosis of inguinal hernia yielded a high total rate of accuracy of 93% respective 94%. However, when the same methods were used to differentiate between lateral and medial hernia, the total rate of accuracy fell to only 54% respective 62%. In the determination of inguinal hernia size, it was even lower: 50% respective 53%. Conclusions: Although a diagnosis of inguinal hernia can be established reliably by clinical and ultrasound examination, only an approximate classification is possible by these methods.

Keywords

Diagnosis Classification Ultrasound Inguinal hernia Transabdominal preperitoneal (TAPP) hernioplasty 

References

  1. 1.
    Amid, PK, Shulman, AG, Lichtenstein, IL 1996Open “tension free” repair of inguinal hernias: the Lichtenstein technique.Eur J Surg162447453PubMedGoogle Scholar
  2. 2.
    Babkova, IV, Bozhko, VV 1999Ultrasound assessment in diagnosis of uncomplicated inguinal hernia.Khirurgiia (Mosk)24650Google Scholar
  3. 3.
    Bau, A, Atri, M 2000Acute female pelvic pain: ultrasound evaluation.Semin Ultrasound CT MR217893PubMedGoogle Scholar
  4. 4.
    Bittner, R 1995Standardtechnik.Bittner, R eds. Laparoskopische HernioplastikHippokrates VerlagStuttgart8197Google Scholar
  5. 5.
    Bittner, R, Kraft, K, Schmedt, C-G, Schwarz, J, Leibl, B 1998Risiko und Nutzen der laparoskopischen Hernioplastik (TAPP): 5 Jahre Erfahrung bei 3000 Hernienoperationen [in German].Chirurg69854858CrossRefPubMedGoogle Scholar
  6. 6.
    Chen, KC, Chu, CC, Chou, TY, Wu, CJ 1998Ultrasonography for inguinal hernias in boys.J Pediatr Surg3317841787PubMedGoogle Scholar
  7. 7.
    Chou, TY, Chu, CC, Diau, GY, Wu, CJ, Gueng, MK 1996Inguinal hernia in children: US versus exploratory surgery and intraoperative contralateral laparoscopy.Radiology201385388PubMedGoogle Scholar
  8. 8.
    Deitch, EA, Soncrant, MC 1981Ultrasonic diagnosis of surgical disease of the inguinal–femoral region.Surg Gynecol Obstet152319322Google Scholar
  9. 9.
    Horgan, LF, Shelton, JC, O’Riordan, DC, Moore, DP 1996Strengths and weaknesses of laparoscopic and open mesh inguinal hernia repair: a randomized controlled experimental study.Br J Surg8314631467PubMedGoogle Scholar
  10. 10.
    Korenkov, M, Paul, A, Troidl, H 1999Color duplex sonography: diagnostic tool in the differentiation of inguinal hernias.J Ultrasound Med18565568PubMedGoogle Scholar
  11. 11.
    Leibl, B, Däubler, P, Schwarz, J, Ulrich, M, Bittner, R 1995Standardisierte laparoskopische Hernioplastik vs Shouldice-Reparation. Ergebnisse einer randomisierten Studie [in German].Chirurg66895898PubMedGoogle Scholar
  12. 12.
    Leibl, BJ, Schmedt, CG, Schwarz, J, Däubler, P, Kraft, K, Schlossnickel, B, Bittner, R 1998A single-institution experience with transperitoneal laparoscopic hernia repair.Am J Surg175446452CrossRefPubMedGoogle Scholar
  13. 13.
    Leibl, BJ, Schmedt, CG, Ulrich, M, Kraft, K, Bittner, R 1999Laparoscopic hernia repair—the facts, but no fashion.Langenbeck’s Arch Surg384302311CrossRefGoogle Scholar
  14. 14.
    Leibl, BJ, Däubler, P, Schmedt, CG, Kraft, K, Bittner, R 2000Long-term results of a randomized clinical trial between laparoscopic hernioplasty and Shouldice repair.Br J Surg87780783PubMedGoogle Scholar
  15. 15.
    Leibl, BJ, Schmedt, DG, Kraft, K, Bittner, R 2000Laparoskopische transperitoneale Hernioplastik (TAPP) — Effektivität und Gefahren [in German].Chir Gastroenterol16106109CrossRefGoogle Scholar
  16. 16.
    Leibl, BJ, Schmedt, CG, Kraft, K, Ulrich, M, Bittner, R 2000Scrotal hernias—a contraindication for an endoscopic procedure? Results of a single institution experience in transabdominal preperitoneal repair (TAPP).Surg Endosc14289292PubMedGoogle Scholar
  17. 17.
    Leibl, BJ, Schmedt, CG, Kraft, K, Ulrich, M, Bittner, R 2000Recurrence after endoscopic transperitoneal hernia repair (TAPP): causes, reparative techniques and results of the reoperation.Am Coll Surg(in press)PubMedGoogle Scholar
  18. 18.
    Leung, WY, Poon, M, Fan, TW, Siu, KW, Chung, KW, Kwok, WK, Kwok, CH 1999Testicular volume of boys after inguinal herniotomy: combined clinical and radiological follow-up.Pediatr Surg Int154041CrossRefPubMedGoogle Scholar
  19. 19.
    Moreno-Egea, A, Girela, E, Canteras, M, Martinez, D, Aguayo, JL 2000Accuracy of clinical diagnosis of inguinal and femoral hernia and its usefulness for indicating laparoscopic surgery.Hernia42327Google Scholar
  20. 20.
    Neuhauser, D 1977Elective inguinal herniorrhaphy versus truss in the elderly.Bunker, JPBarnes, BAMosteller, F eds. Costs, risks and benefits of surgery.Oxford University PressNew York223239Google Scholar
  21. 21.
    Renzulli, P, Frei, E, Schafer, M, Werlen, S, Wegmuller, H, Krahenbuhl, L 1997Preoperative Nyhus classification of inguinal hernias and type-related individual hernia repair: a case for diagnostic laparoscopy.Surg Laparosc Endopsc7373377CrossRefGoogle Scholar
  22. 22.
    Rutkow, IM, Robbins, AW 1993Demographic, classification and socioeconomic aspects of hernia repair in the United States.Surg Clin North Am73413426Google Scholar
  23. 23.
    Rutkow, IM, Robbins, AW 1997Hernioplastik mit der Netzplombe [in German].Chirurg68970976CrossRefPubMedGoogle Scholar
  24. 24.
    Schumpelick, V, Arlt, G 1996Transinguinale präperitoneale Netzplastik (TIPP) beim Leistenbruch in Lokalanästhesie [in German].Chirurg67419424CrossRefPubMedGoogle Scholar
  25. 25.
    Schumpelick, V, Treutner, KH, Arlt, G 1994Inguinal hernia repair in adults.Lancet344375379PubMedGoogle Scholar
  26. 26.
    Stoppa, R, Rives, JL, Warlamount, C, Palot, JP, Verhaege, PJ, Delattre, JF 1984The use of Dacron in the repair of hernias of the groin.Surg Clin North Am64269285PubMedGoogle Scholar
  27. 27.
    Van den Berg, JC, de Valois, JC, Go, PM, Rosenbusch, G 1999Detection of groin hernia with physical examination, ultrasound, and MRI compared with laparoscopic findings.Invest Radiol34739743CrossRefPubMedGoogle Scholar
  28. 28.
    Van den Berg, JC, de Valois, JC, Go, PM, Rosenbusch, G 2000Radiological anatomy of the groin region.Eur Radiol10661670CrossRefPubMedGoogle Scholar
  29. 29.
    Zollinger Jr, RM 1999A unified classification for inguinal hernias.Hernia3195200Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • B. M. Kraft
    • 1
    Email author
  • H. Kolb
    • 1
  • B. Kuckuk
    • 1
  • S. Haaga
    • 1
  • B. J. Leibl
    • 1
  • K. Kraft
    • 1
  • R. Bittner
    • 1
  1. 1.Department of General and Visceral SurgeryMarienhospital Stuttgart, Böheimstrasse 37, D-70199 StuttgartGermany

Personalised recommendations