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

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.

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Author information

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.

Correspondence to C. V. van Hessen.

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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.

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Informed consent was not required for this study.

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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

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Keywords

  • Inguinal hernia
  • TEP repair
  • Recurrence
  • Physical examination
  • Ultrasound
  • Positive predictive value